慢性化脓性中耳炎的二次手术和初次手术的听力疗效配对比较

Paired Analysis between Revision and First Time Surgery in Chronic Suppurative Otitis Media

目的比较慢性化脓性中耳炎(包括胆脂瘤型和非胆脂瘤型)的二次手术和初次手术的听力变化,分析二次鼓室成形术提高听力的可能。方法回顾2006～2011年因慢性化脓性中耳炎在我院由通讯作者完成的二次鼓室成形修复手术(非分期手术)且有完整听力随访资料的患者共16例,选择作者同期完成的初次手术患者按照相似病史和年龄、相同性别和术式(单纯鼓室成形术或鼓室成形并开放式乳突根治术)的16例进行配对病例对照研究。用术后平均气骨导差ABG≤20 dB和手术前后气导差值ACG≥10 dB为标准,比较两组手术前后听力变化和听力提高成功率,同时观察手术并发症如感染和面瘫情况。结果 7对病例行单纯鼓室成形术,9对病例行鼓室成形并开放式乳突根治术,二次手术组术后平均ABG≤20 dB比例为43.8%,初次手术组比例为68.8%,卡方检验P=0.289,无统计学差异。二次手术组手术前后ACG≥10 dB比例为62.5%,初次手术组比例为50%,卡方检验P=0.754,无统计学差异。二次手术组中术后ABG≤20 dB且ACG≥10 dB比例为31.3%,初次手术组比例为43.8%,卡方检验P=0.687,无统计学差异。两组均无面瘫和感染记录。结论慢性化脓性中耳炎术后复发或听力差可行二次鼓室成形术,二次手术的听力提高比例虽比初次手术低,但无统计学差异。所以,中耳炎二次手术在清除病灶的同时也可以积极争取保存或提高听力。

Objective To review treatment outcomes of revision surgery in chronic suppurative otitis media by compar- ing postoperative assessment findings between revision and first surgery. Methods Data from 16 patients （16 ears） who under- went revision surgery operated by the corresponding author were reviewed. Sixteen separate cases with matched age, history of disease, gender and surgical method were chosen for a paired analysis. The 32 patients were followed up to assess postopera- tive complications for at least 3 months and their pre- and postoperative pure tone threshold results were documented. Postop- erative mean air-bone gap （ABG） ~〈20dB and air conduction gain （ACG） 〉I 10dB were set as evaluation standards. Results 7 pairs underwent simple tympanoplasty, 9 pairs underwent tympanoplasty and canal-wall-down mastoidectomy. The percent- age of postoperative mean ABG ~〈20dB was 43.8% after revision surgery compared with 68.8% after first time surgery （P-- 0289）. The percentage of ACG~〉 10dB after revision surgery was 62.5% compared with 50.0% after,first time surgery （P= 0.754）. The percentage of ABG ~〈20dB and ACG~〉 10dB was 31.3% after revision surgery compared with 43.8% after first time surgery （P=0.687）. No postoperative complication was found in either group. Conclusion Postoperative recrudescence or failed hearing improvement can be operative indications for tympanoplasty. Revision surgery is an effective treatment to clear lesions and improve hearing outcomes.