耳内镜下应用岛状软骨-软骨膜复合体对干湿耳行Ⅰ型鼓室成形术的疗效分析

Effect of endoscopic type Ⅰ tympanoplasty with island cartilage-perichondrium complex on dry and wet ears

目的探讨耳内镜下岛状软骨-软骨膜复合体对干湿耳状态下的疗效差异。方法回顾性分析中国科学院大学宁波华美医院耳鼻咽喉科收治的慢性化脓性中耳炎静止期患者,分为干耳组和湿耳组,均在耳内镜下用岛状软骨-软骨膜复合体以内置法行鼓室成形术,观察比较两组患者术后并发症、鼓膜愈合率及术后6个月听力。结果干耳组鼓膜愈合28例,湿耳组鼓膜愈合26例,愈合率没有统计学意义(χ^(2)=0.185,P=0.667)。术后6个月干耳组平均气导由术前(39.19±5.04)dB HL提高至(27.86±4.18)dB HL(P<0.05),平均气骨导差由术前(18.76±3.05)dB HL下降至(11.06±2.68)dB HL(P<0.05),湿耳组平均气导由术前(38.24±3.77)dB HL提高至(29.17±4.76)dB HL(P<0.05),平均气骨导差由术前(19.81±3.27)dB HL下降至(12.01±4.04)dB HL(P<0.05),而两组听力提高程度并无明显差异(P=0.287)。结论耳内镜下应用岛状软骨-软骨膜复合体在干耳或湿耳状态下行Ⅰ型鼓室成形术均能改善听力和修复鼓膜。

OBJECTIVE To investigate the difference of curative effect between dry and wet ears in the application of endoscopic tympanoplasty with island cartilage-perichondrium complex.METHODS Patients with chronic suppurative otitis media in the quiescent stage were retrospectively divided into dry ear group and wet ear group.All patients underwent inlay myringoplasty with island cartilage-perichondrium complex under otoendoscope.The complications,tympanic membrane healing rate and the improvement of hearing at 6 months after operation were observed and compared.RESULTS 28 cases dry ears and 26 cases of wet ears healed.There was no significant difference in the healing rate between the two groups(χ^(2)=0.185,P=0.667).Pure tone audiometry at 6 months after operation showed that the average air conduction threshhold decreased from(39.19±5.04)dB HL to(27.86±4.18)dB HL(P<0.05),the average air-bone gap decreased from(18.76±3.05)dB HL to(11.06±2.68)dB HL(P<0.05)in the dry ear group.The average air conduction threshhold decreased from(38.24±3.77)dB HL to(29.17±4.76)dB HL(P<0.05)and the average air-bone gap decreased from(19.81±3.27)dB HL to(12.01±4.04)dB HL(P<0.05)in the wet ear group.There was no significant difference in the degree of hearing improvement between the two groups(P=0.287).CONCLUSⅠON Endoscopic type Ⅰ tympanoplasty with island cartilage-perichondrium complex can repair tympanic membrane and improve hearing in both dry and wet ears.