Takahashi H, Honjo I, Naito Y, Miura M, Tanabe M, Hasebe S
Department of Hearing and Speech Science, Graduate School of Medicine, Kyoto University, Japan.
Am J Otol. 1998 Mar;19(2):131-5.
To determine the relationship between preservation of the mastoid mucosa during ear surgery and retraction of the attic or posterior wall of the external auditory canal (EAC) and mastoid aeration after surgery.
Retraction of the posterior EAC wall and mastoid aeration were evaluated after surgery in 48 individuals (50 ears) with cholesteatoma, adhesive otitis media, or chronic suppurative otitis media, in whom the posterior bony EAC walls were removed with or without preservation of mucosa and reconstructed with soft tissues alone (EAC skin and temporal fascia) during surgery.
Postoperative computed tomography showed that in ears with notable retraction of the posterior EAC wall appearing like an open mastoid cavity, there was no air in the mastoid, whereas in ears with no or only slight retraction there was computed tomographic evidence of mastoid aeration. Second, notable retraction of the posterior EAC wall occurred in a significantly smaller percentage of ears in which at least the epitympanic mucosa had been able to be preserved during surgery than in those that had undergone removal of all mucosa (mastoidectomy).
These results indicate that 1) preservation of epitympanic mucosa during surgery is an important factor for prevention of retraction of the posterior EAC wall and for reaeration of the mastoid after surgery, and 2) the intact canal wall technique seems to be indicated whenever at least the epitympanic mucosa can be preserved, and when no mucosa can be preserved the canal wall down procedure seems to be indicated.
确定耳部手术期间乳突黏膜的保留与上鼓室或外耳道（EAC）后壁回缩以及术后乳突气腔形成之间的关系。
对48例（50耳）患有胆脂瘤、粘连性中耳炎或慢性化脓性中耳炎的患者术后评估EAC后壁回缩及乳突气腔形成情况，这些患者在手术中去除或未去除骨质EAC后壁，同时保留或未保留黏膜，仅用软组织（EAC皮肤和颞肌筋膜）进行重建。
术后计算机断层扫描显示，EAC后壁明显回缩、类似开放乳突腔的耳内，乳突内无气体；而无回缩或仅有轻微回缩的耳内，计算机断层扫描有乳突气腔形成的证据。其次，与所有黏膜均被切除（乳突根治术）的耳相比，术中至少保留了上鼓室黏膜的耳中，EAC后壁明显回缩的比例显著更小。
这些结果表明，1）手术期间保留上鼓室黏膜是预防EAC后壁回缩及术后乳突再通气的重要因素；2）只要至少能保留上鼓室黏膜，似乎就应采用完整外耳道壁技术；而当无法保留黏膜时，则似乎应采用开放式乳突根治术。
