耳内镜下中耳炎修正手术疗效分析

The curative effect of revision operation for otitis media under endoscopic ear surgery

目的:探讨耳内镜下行中耳炎修正手术的安全性和疗效。方法:回顾分析2016年2月至2019年2月单用耳内镜行中耳炎术后修正手术患者24例。对患者手术时间、术前和术后6个月的听力、鼓膜愈合情况、鼓索神经损伤进行分析。结果:24例患者术前的气导听力500、1 000、2 000、4 000 Hz为(53.54±7.20)d B nHL,气骨导差500、1 000、2 000、4 000 Hz为(32.08±6.41)dB nHL,术后6个月气导听力500、1 000、2 000、4 000 Hz为(34.04±7.58)dB nHL,气骨导差500、1 000、2 000、4 000 Hz为(12.29±7.27)dB nHL,术前术后听力比较,差异有统计学意义(P<0.05)。术后6个月所有患者移植鼓膜色泽好,移植鼓膜完整;术中探查鼓索神经8例未见,6例由于粘连分离时鼓索神经离断,10例鼓索神经完整。结论:耳内镜下中耳炎修正术是可行的,但与首次手术相比,易引起鼓索神经损伤。

Objective:To investigate the safety and efficacy of revision operation for otitis media under endoscopic ear surgery.Methods:A retrospective analysis of 24 patients who underwent otitis media re-correction surgery under otoscope from February 2016 to February 2019.We analyzed the time of surgery,results of hearing test 6 months before and 6 months after surgery,tympanic membrane healing and tympanic nerve injury.Results:The operation time was(138.4±27.6)min,the preoperative air-guided hearing 500,1000,2000,4000 Hz was(53.54±7.20)dB nHL,and the air-bone conductance difference 500,1000,2000,4000 Hz was(32.08±6.41)dB nHL.The hearing guide 500,1000,2000,4000 Hz was(34.04±7.58)dB nHL,and the air-bone conduction difference 500,1000,2000,4000 Hz was(12.29±7.27)dB nHL.There was significant difference in hearing before and after surgery.All patients had good tympanic membrane transplantation and complete tympanic membrane transplantation 6 months after the surgery.Intra-operative exploration of the tympanic nerve was not observed in 8 cases.The tympanic nerve was disconnected in 6 cases due to adhesion separation,and it was intact in 10 cases.Conclusion:With wide angle and clear field of vision under otoscope,corrective surgery after otitis media is feasible.However,compared with the first operation,due to local scars and adhesions,the corrective surgery is more complicated than the initial surgery,and the tympanic nerve is prone to damage.Surgeons need to keep improving their surgical skills to achieve better practical hearing after surgery.