耳甲腔软骨在保留骨桥的鼓室乳突切除术中应用

Clinical application of auricular cartilage in intact bridge tympanomastoidectomy

目的探讨并评价耳甲腔软骨在保留骨桥的鼓室乳突切除术(intact-bridge tympanomastoidectomy,IBM)中治疗慢性中耳乳突炎的临床效果。方法本文总结分析2013年7月~2016年5月86例慢性化脓性中耳乳突炎,IBM采用耳甲腔软骨封闭上鼓室和鼓窦入口重建上鼓室,对术后效果进行评估。结果所有病例随访不少于6个月,干耳时间4~6周。移植鼓膜一期愈合79例,重建上鼓室未塌陷。术后纯音测听气骨导间距≤20 dB者45.35%(39/86),21~30 dB者39.53%(34/86),≥31 dB者15.12%(13/86);术后语频区平均气导听阈15~55 dB HL,平均(25.4±6.3)dB HL,语频区平均骨导听阈10~35 dB HL,平均(15.3±9.2)dB HL。结论 IBM采用耳甲腔软骨封闭上鼓室和鼓窦入口,重建相对完整的上鼓室,保证听骨链的活动空间,在根除病灶基础上保存或提高听力,是较佳的优化治疗选择。

OBJECTIVE To investigate and evaluate the effects of intact-bridge tympanoplasty using auricular cartilage in treating chronic otitis media. METHODS A retrospective review of 86 cases undergoing an intact-bridge tympanomastoidectomywas performed from July,2013 to May,2016. The auricular cartilage was placed on the attic and tympanic antrum entrance to reconstruct the attic. RESULTS The outcome of dry ear and well-epithelialized mastoid cavities was achieved after 4-6 weeks. After 6-month follow-up no recurrence occurred. The pure-tone average threshold improved by （25.4±6.3） dB HL after operation, and the mean air bone gap was elevated. CONCLUSION On the basis of combination of closed and open techniques, the IBM technique is a optimal cure strategy for chronic otitis media, which can not only remove the pathological changes thoroughly to prevent disease recurrence but also maximally improve the hearing of the diseased ear. The closure of attic with auricular cartilage can ensure the space of the ossicular chain.