外伤性鼓膜穿孔和单纯慢性化脓性中耳炎鼓膜成形术的疗效比较

A Myringoplasty Healing Rate and Hearing Outcomes Comparison between Traumatic Tympanic Membrane Perforation and Perforation following Simple Chronic Suppurative Otitis Media

目的回顾性分析外伤性鼓膜穿孔与单纯型慢性化脓性中耳炎的鼓膜成形术后愈合率及手术前后的听力变化.方法2008年7月~2011年7月于我科接受首次手术治疗的住院患者,外伤性鼓膜穿孔组19例（20耳）,单纯型慢性化脓性中耳炎54例（55耳）.术前及术后三个月随访使用电子耳镜检查鼓膜像,听力评估以500 Hz、1000 Hz、2000 Hz和4000 Hz的气骨导差（Air Bone Gap, ABG）平均数x-±s表示.结果外伤性鼓膜穿孔的手术愈合率是70.00%（14/20）.单纯型慢性化脓性中耳炎手术愈合率为92.73%（51/55）,连续校正的X2=4.74,P〈0.05;鼓膜愈合率与年龄、手术方式（外置或内置）以及穿孔大小未见明显相关性.外伤性鼓膜穿孔患者术前平均ABG为17.25±5.81 dB HL,单纯型慢性化脓性中耳炎患者术前平均ABG为23.34±9.53 dB,两组术前平均听力比较t=2.68,p=0.003.外伤性鼓膜愈合的14例术前平均ABG为17.85±6.15 dB,术后为10.58±5.99 dB,p=0.005;单纯型慢性化脓性中耳炎组51例鼓膜愈合术前ABG为23.35±9.76 dB,术后为14.28±10.53 dB,p=0.001,两组术后听力较术前均有明显提高.结论外伤性鼓膜穿孔手术修补成功率较慢性化脓性中耳炎为低.多数外伤性鼓膜穿孔的听力损失较单纯型慢性化脓性中耳炎要轻,而手术成功率更低,需要耳科医生在术前谈话中注意交代手术风险与收益.

Objective To retrospectively analyze the healing rate and hearing improvement after myringoplasty for traumatic tympanic membrane perforation or perforation from simple chronic suppurative otitis media. Methods Data from 73 patients who received the first myringoplasty in our department between July 2008 and July 2011 were reviewed, including 19 patients （20 ears） with traumatic tympanic membrane perforation and 54 patients （55 ears） with simple chronic suppurative otitis media. The tympanic membrane was examined using an electric endoscope and pure tone audiometry performed before and 3 months after the surgery. The mean air-bone gap （ABG） at 500, 1000, 2000 and 4000 Hz was calculated. Results Tympanic membrane healing rate was 70.00% （14/20） in traumatic tympanic membrane perforation, and 92.73%（51/55） in simple chronic otitis media （P=0.03）. Age, size of perforation or surgical technique （underlay or overlay） did not affect the healing rate. Mean ABG in 14 ears with healed traumatic tympanic membrane perforation was 17.85±6.15 dB preoperative and 10.58±5.99 dB postoperative. Mean ABG in 51 ears with healed perforation in simple chronic otitis media was 23.35±9.76 dB preoperative and 14.28±10.53 dB postoperative. Postoperative hearing was improved significantly in both groups （ p〈0.05）. Conclusion The myringoplasty success rate is lower in traumatic tympanic membrane perforation than in simple chronic suppurative otitis media. Potential risks and benefits should be carefully explained to the patient before surgery as hearing loss is often mild in traumatic tympanic membrane perforation.