先天性外中耳畸形的听力重建与同步耳廓再造

Auditory rehabilitation and auricle reconstruction by MEDPOR procedures for cases with congenital middle and external ear malformation

目的总结同步进行外耳道、鼓室成形术与应用多孔高密度聚乙烯(MEDPOR)再造耳廓技术治疗先天性外、中耳畸形的手术经验。方法25例(25耳)外、中耳畸形患者,采用Ⅰ期外耳道、鼓室成形术联合耳后皮下皮肤扩张器埋置术,Ⅱ期应用MEDPOR作支架进行耳廓再造。术后随访1～5年,观察疗效并总结临床经验。结果术后1个月语频气导听力提高15dB HL以上者21耳(84%),其中听力提高30dB HL以上、气骨导间距少于15dB HL者10耳(40%),仍能保持听力稳定者17耳(68%);MEDPOR耳廓再造18耳一期愈合,外形良好,7耳支架外露,需要再次手术修复。结论听力重建与MEDPOR耳廓再造同步进行可获得较满意的听力提高水平和耳廓外形。

Objective To sum up the clinical experience with the treatment for cases with congenital middle and external ear malformation by means of simultaneous reconstruction for external auditory cannal and tympanoplasty based on the procedures of MEDPOR. Methods Included in this study were 25 cases （25 ears） with congenital middle and external ear malformation treated by a surgical procedure composed of two stages of surgery, with stage Ⅰ operation to reconstruct simultaneously the external auditory meatus and tympanic cavity with post-auricular skin dilator embedded subcutaneously and stage Ⅱ operation to reconstruct the auricle with MEDPOR as the frmne of it. Then, all the cases were followed up for 1 to 5 years to observe the therapeutic effect on and to sum up the clinical experience with such a lesion. Results One month after the operation,21 ears （84%） were shown with their hearing elevated more than 15 dB HL at an average,with 10 ears （40%） out of them with their hearing elevated more than 30 dB HL and the gap between the AC and BC less than 15 dB HL in language frequencies,and 17 ears （68%） with their hearing maintained at the stable level as determined by the end of following up period lasted for 1 to 5 ears. Moreover, 18 ears, out of the 25 cases received auricle reconstruction by MEDPOR, were undergoing a stage Ⅰ healing from the operation and the other 7 ears were suffered an exposure of the reconstructed frame of auricle needing to be repaired at another reconstructing surgery. Conclusions Simultaneously carried out hearing and auricle reconstruction operation on congenital middle and external ear malformation can be reached by the hearing elevating level and reconstructed auricle shape.