儿童慢性化脓性中耳炎鼓室成形术的临床分析

The clinical analysis of tympanoplasty in treating children′s chronic otitis media

目的:探讨鼓室成形术治疗儿童慢性化脓性中耳炎(包括中耳胆脂瘤)的手术策略,分析其临床特点及疗效。方法:回顾性分析23例慢性化脓性中耳炎行鼓室成形术患者的临床资料及随访情况,其中有完整资料的15例,观察其干耳时间、听力改善程度及术腔、鼓膜和有无复发情况。结果:15例患儿主要表现为耳流脓和(或)听力下降;鼓膜松弛部内陷及穿孔或紧张部穿孔;15例患儿均有不同程度的听力损失;颞骨CT主要表现为乳突发育不良、病变位于鼓室、岩部及乳突部。术后干耳时间平均为(6.0±1.5)周,听力提高12例,无改变2例,下降1例,总有效率80%;术后1例胆脂瘤患儿复发。结论:儿童慢性化脓性中耳炎(包括中耳胆脂瘤)有侵蚀性强、进展快等特点;鼓室成形术能有效治疗该病,并减少患儿认知感下降的发生,改善患儿的生活质量。

Objective： To study the effectiveness of tympanoplasty for treatment of chronic otitis media and eholesteatoma in children. Method：Twenty-three cases with chronic otitis media and cholesteatoma treated by tym- panoplasty were retrospectively studied, among which 15 eases had complete clinical data . The condition of surgi- cal cavities, the duration of getting dry ears, the hearing improvements, the growth of new ear drums and whether the reeurrenee of cholesteatomas occurred or not were observed. Result ： In all patients, the chief complains were ear discharging and hearing loss. The tympana membranes（pars flaccid or pars tensa） became retracted or perforated and CT scan showed mastoid processes were poor developed in some cases with lesions mainly located at attic, middle tympan cavity and/or petrous parts. The duration of getting dry ear was（6.0 ±1.5） weeks after surgery. The effective rate was 80%. The hearing of 12 cases has been improved, that of 2 cases has no changed,that of 1 case has been descended, and 1 case exhibited recurrent cholesteatoma after surgery. Conclusion：This study dem- onstrated that children＇s chronic otitis media and cholesteatoma have their own clinic fectures of wide erosiveness and strong aggressiveness, and tympanoplasty has been proved to treat this disease effectively, also been proved to improve these patientsr hearing cognitions and eventually improve their life qualities.