开放式鼓室成形术中听骨链重建效果及其影响因素

Auditory outcomes and prognostic factors in canal wall-down tympanoplasty with single-stage ossiculoplasty

目的探讨胆脂瘤中耳炎患者行开放式鼓室成形伴听骨链重建的效果和影响因素。方法分析142例胆脂瘤患者,行开放式鼓室成形术伴一期听骨链重建,随访24月,记录术后并发症、纯音平均听阈、平均气骨导差和听力重建成功率。结果随访期间未发现鼓膜内陷袋形成及胆脂瘤复发,术后干耳率达96.5%,听骨赝复物脱出4例(2.8%),气导平均听阈降低11.6dB,气骨导差较术前缩小7.4dB,70例患者气骨导差<20dB,听力重建总成功率达49.3%。听力重建成功的关键主要取决于术腔感染控制、咽鼓管功能、病变范围、听骨赝复物材料和手术技术。结论虽然影响因素较多,开放式鼓室成形伴一期听骨链重建仍是胆脂瘤中耳炎患者安全有效的术式,术后并发症少,复发率低,听力重建效果令人满意。

Objective To explore the auditory outcomes and prognostic factors in canal wall-down tympanoplasty with ossiculoplasty. Methods A retrospective review was performed in 142 patients with cholesteatoma, who underwent canal wall-down tympanoplasty （CWDT） with ossiculoplasty in a single stage. The postoperative complication and hearing thresholds were analyzed in the 24 months follow-up. Results We had not found any postoperative retraction pocket or recurrence of cholestatoma during the follow-up. The rate of dry ear was 96.5%. But the extrusion of prosthesis occurred in 4 patients （2.8%）. Auditory outcomes showed air threshold improved by 11.6 dB while the air-bone gaps were 7.4 dB. The successful auditory reconstruction rate was 49.3% on the whole. And we deemed the control of infection, function of eustachian tube, extent of cholesteatoma, material of prosthesis and surgical technique as the prognostic factors in CWDT with single stage of ossiculoplasty. Conclusion Influenced by several factors, CWDT with single stage of ossiculoplasty are safe and effective for cholesteatoma with low complication, low recurrence, and satisfactory outcome of auditory reconstruction.