感染中耳状态行保留乳突的鼓室成形术临床评价

Tympanoplasty without mastoidectomy for active otitis media

目的:回顾性分析中耳炎不同感染状态行保留乳突的鼓室成形术的临床疗效,评估保留乳突对鼓室成形术疗效的影响。方法:将113例(113耳)慢性化脓性中耳炎行保留乳突的鼓室成形术患者分为感染耳组(72耳)和非感染耳组(41耳),所有患者术前颞骨CT显示乳突及鼓窦区有炎性增生性病变,且术后随访超过1年。应用SPSS统计软件进行疗效分析。结果:92耳术后0.5~1个月干耳,术后3~6个月鼓室负压逐渐消失。感染耳组术后干耳69耳(95.8%),术中见鼓室大量脓性分泌物4耳,术后均干耳;复发3耳,出现干性鼓膜小穿孔;气骨导差≤20dB的有效耳为51.4%。非感染耳组术后干耳40耳(97.6%);复发1耳,2耳出现干性鼓膜小穿孔;气骨导差≤20dB的有效耳为48.8%。随访中未见面瘫、眩晕、鼓膜内陷袋及胆脂瘤形成。结论:CT显示乳突、鼓窦内有炎性增生性病灶的慢性化脓性中耳炎患者,临床观察中耳处于不干耳的感染状态,可以选择保留乳突的鼓室成形术,术后复发率及听力增益没有差异。

Objective：The study aims to assess the effect of tympanoplasty without mastoidectomy for the middle ear under different infected states.Method：One hundred and thirteen cases（113 ears）with chronic otitis media（COM）received tympanoplasty without mastoidectomy.All the patients were found inflammatory proliferative lesions in the mastoid and tympanic antrum via CT scan before surgery and were followed up over 1 year.The patients were placed into the infected ear group（72 ears）and uninfected ear group（41 ears）according to the infective condition.We used SPSS statistical software to analyze the efficacy.Result：Of 113 cases,92ears had dry ear canals in 1/2 to 1 month after surgery,and the negative air pressure in the tympanum gradually disappeared in 3-6 months after surgery.Of the 72 ears in the infected ear group,69 ears had postoperative dry ears,and a large amount of intraoperative purulent secretion was seen in the tympanum in 4cases,which all had dry ear canals.Three cases had relapse,for a dry ear canal rate of 95.8%.Three ears showed dry tympanic membrane perforations,and effective ears with air-bone conduction differences smaller than or equal to 20 dB accounted for 51.4%of cases.Of the 41 ears in the uninfected group,40 ears had postoperative dry ears,1 case had relapse,for a dry ear canal rate of 97.6%.Two ears showed dry tympanic membrane perforations.Effective ears with air-bone conduction differences smaller than or equal to 20 dB accounted for 48.8% of cases.No case of facial paralysis,dizziness,formation of invaginations of the tympanic membrane and cholesteatoma were seen in the patients included in this study during the follow-up visits.Conclusion：Whether there are inflammatory proliferative lesions in the mastoidor not,tympanoplasty without mastoidectomy is feasible for chronic active otitis media.Moreover,different infection statuses of the middle ear do not cause difference in the postoperative relapse rate and hearing improvement.