鼓膜成形术患者术后听力改善及穿孔率的回顾性分析

Retrospective study on the hearing improvement and postoperative perforation rates in 121 myringoplasty cases

目的 回顾性分析术前咽鼓管功能及鼓室黏膜状态对慢性化脓性中耳炎鼓膜成形术患者术后听力改善和穿孔率的影响.方法 回顾性分析121例慢性化脓性中耳炎鼓膜成形术患者的临床资料,根据术前穿孔耳声导抗正负压平衡试验结果分为咽鼓管功能良好组和功能不良组,根据术中所见鼓室黏膜情况分为干耳组和湿耳组.术后2～3个月复查耳内镜和纯音测听,利用SPSS19.0统计软件比较不同组别术后听力改善成功率和穿孔率的差异.结果 咽鼓管功能良好组72例（58例干耳和14例湿耳）,咽鼓管功能不良组46例（19例干耳和27例湿耳）;咽鼓管功能良好组的术后听力改善率为85.5％（59/69）,略高于功能不良组[72.1％ （31/43）],但二者差异无统计学意义（x^2 =2.230,P=0.093）;功能良好组术后穿孔率为16.7％（12/72）,功能不良组术后穿孔率为2.2％（1/46）,差异具有统计学意义（x^2=4.626,P=O.015）.干耳组78例（58例咽鼓管功能正常,19例咽鼓管功能不良,1例未查）,湿耳组43例（14例咽鼓管功能正常,27例咽鼓管功能不良,2例未查）.干耳组术后听力改善率为85.3％ （64/75）,湿耳组听力改善率71.8％（28/39）,二者差异无统计学意义（x^2=2.213,P=0.085）;干耳组术后发生穿孔率为12.8％（10/78）,湿耳组术后穿孔率为7.0％（3/43）,二者差异无统计学意义（x^2 =0.472,P=0.377）.结论 术前咽鼓管功能不良者多数存在鼓室黏膜水肿等湿耳状态,其术后听力改善成功率略低于咽鼓管功能良好者,但其术后鼓膜穿孔率明显低于功能良好组.鼓膜成形术的适应证和预后因素值得进一步大样本研究.

Objective Retrospectively analyzed the influences of preoperative acoustic immittance pressure balance tests and intraoperative wet ear findings in myringoplasty surgery results.Methods One hundred and twenty-one chronic suppurative otitis media patients underwent myringoplasty surgeries were included and divided into functional group and non-functional group according to preoperative acoustic immittance pressure balance tests.Meanwhile,cases were divided into dry ear group and wet ear group according to intraoperative findings.Postoperative hearing improvement and perforation rate were compared between the two groups.Results Functional group had 72 cases,including 58 dry ears and 14 wet ears.Non-functional group had 46 cases,including 19 dry ears and 27 wet ears.Postoperative hearing improvement rate in functional group was 85.5% （59/69）,and 72.1% （31/43） in non-functional group （x^2 =2.230,P =0.093）.Perforation rate in functional group was 16.7 % （12/72）,significant higher when compared with 2.2% （1/46） in non-functional group （x^2 =4.626,P =0.015）.Postoperative hearing improvement rate in dry ear group was 85.3% （64/75）,and 71.8% （28/39） in wet ear group（x^2 =2.213,P =0.085）.Perforation rate in dry ear group was 12.8% （10/78）,and 7.0% （3/43） in wet ear group （x^2 =0.472,P =0.377）.Conclusions Non-functional result of preoperative acoustic immittance pressure balance test had significant relationship with the intraoperative wet ear findings.It may result in lower postoperative hearing level,and lower perforation rate.Large sample studies should be carried out in future.