Eviatar A
Laryngoscope. 1978 Aug;88(8 Pt 2 Suppl 11):Suppl 11: 1-23. doi: 10.1288/00005537-197808001-00001.
Two hundred and fifty-five ear operations using tragal perichondrium and cartilage for reconstruction are presented. Of these, 108 were myringoplasties, 137 were tympanoplasties with ossicular reconstruction performed by nine different methods, and 10 were tympanoplasties with reconstruction of posterior canal wall defects left by radical mastoid surgery. The method presented in this study of using the tragal perichondrial graft is well suited for myringoplasty and can be used where the drum remnant is very small or the anulus is missing. The natural angle of the tragal perichondrium can take the place of the missing anulus anteriorly, inferiorly or posteriorly. Myringoplasty graft survival at one year follow-up was 92%, and 76% had hearing within 10 db of bone conduction. In tympanoplasty, the tragal perichondrium was used en bloc with its cartilage for reconstruction of the ossicular chain where suited. The malleus was used to reconstruct the ossicular chain in different variations. Other methods used are fully described. At one year follow-up the rate of grafting success for tympanoplasties was 91%, and 78% had hearing within 10 db of bone conduction. A method for reconstruction of the posterior canal wall and tympanoplasty after radical mastoidectomy is presented. It uses tragal cartilage and perichondrium en bloc. At one year follow-up, eight of ten cases operated on by this method had an intact drum and posterior canal wall, one had an intact drum but the posterior canal collapsed into the mastoid, and one had an intact canal wall but the eardrum re-perforated. Nine had postoperative hearing within 10 db of bone conduction. A randomly selected group of 100 tympanoplasties was examined for postoperative gain in hearing according to the speech reception threshold, a more practical criterion of surgical success than 10 db air-bone gap. Although the total number showing improvement was similar to the number gaining hearing within 10 db of pure tone bone conduction (76% vs. 78%), when changes of 5 db were discounted, only 56% were improved (and 33% had a significant gain in hearing).
本文介绍了255例采用耳屏软骨膜和软骨进行重建的耳部手术。其中，108例为鼓膜成形术，137例为采用9种不同方法进行听骨链重建的鼓室成形术，10例为乳突根治术后遗留外耳道后壁缺损的鼓室成形术。本研究中所介绍的使用耳屏软骨膜移植物的方法非常适合鼓膜成形术，可用于鼓膜残端非常小或鼓环缺失的情况。耳屏软骨膜的自然角度可在前方、下方或后方替代缺失的鼓环。鼓膜成形术移植物在1年随访时的成活率为92%，76%的患者听力在骨导10分贝以内。在鼓室成形术中，耳屏软骨膜与其软骨一起整块用于听骨链重建（适当时）。锤骨用于以不同方式重建听骨链。其他使用的方法有详细描述。鼓室成形术在1年随访时的移植成功率为91%，78%的患者听力在骨导10分贝以内。本文介绍了一种乳突根治术后外耳道后壁重建及鼓室成形术的方法。它使用耳屏软骨和软骨膜整块。在1年随访时，采用该方法手术的10例患者中，8例鼓膜和外耳道后壁完整，1例鼓膜完整但外耳道后壁塌陷至乳突内，1例外耳道壁完整但鼓膜再次穿孔。9例患者术后听力在骨导10分贝以内。根据言语接受阈对随机选择的100例鼓室成形术患者的术后听力增益进行了检查，这是一个比10分贝气骨差更实用的手术成功标准。尽管显示改善的总数与纯音骨导10分贝以内听力提高的数量相似（76%对78%），但当不考虑5分贝的变化时，只有56%的患者有所改善（33%听力有显著提高）。
