耳内镜下鼓膜修补术对外伤性鼓膜穿孔患者气骨导差及预后的影响

Effect of myringoplasty under otoendoscope on poor air-bone conductivity and prognosis of patients with traumatic tympanic membrane perforation

目的观察耳内镜下鼓膜修补术治疗外伤性鼓膜穿孔患者的效果及其对患者气骨导差的影响。方法纳入2019年1月~2021年2月本院收治的40例外伤性鼓膜穿孔患者,在充分告知本研究设计思路后,均开展耳内镜下鼓膜修补术,观察患者治疗效果、听力情况(对比患者术前、术后1月及术后3月气导听阈和气骨导差情况)及疼痛程度[术前、术后1 d、出院时,采用视觉模拟评分法(VAS)]。结果40例外伤性鼓膜大穿孔患者经耳内镜下鼓膜修补术治疗后,显效28例,有效10例,无效2例,治疗总有效率95.00%。40例患者经耳内镜鼓膜修补术治疗后,与术前相比,术后1月及术后3月气导听阈、气骨导差均较低,差异有统计学意义(P<0.001);与术前相比,术后1 d、出院时,患者VAS评分均下降,术前、术后1 d及住院时3个时间段患者VAS评分的差异有统计学意义(P<0.001);术前与术后1 d患者VAS评分的差异无统计学意义(P>0.05),与术前相比,出院时患者VAS评分较低,差异有统计学意义(P<0.05)。结论外伤性鼓膜穿孔患者采取耳内镜下鼓膜修补术,手术治疗效果显著,利于术后听力恢复,缓解疼痛程度,建议在临床外伤性鼓膜穿孔患者中大范围开展。

Objective To observe the effect of myringoplasty under otoendoscope in the treatment of traumatic tympanic membrane perforation and its effect on the poor air-bone conductivity of patients.Methods A total of 40 patients with traumatic tympanic membrane perforation were included from January 2019 to February 2021.After fully informing the design ideas of this study,all included patients underwent otoscopic myringoplasty.The treatment effect,hearing condition(comparison of patients'air conduction hearing threshold and air-bone conduction difference before operation,one month after operation,and three months after operation)and pain severity were observed[visual analogue scale(VAS)was used before operation,1d after operation,and at discharge].Results Among the 40 patients with traumatic large perforation of tympanic membrane treated by endoscopic myringoplasty,28 cases were markedly improved,10 cases were effective,and 2 cases were ineffective,the total effective rate was 95.00%.After treatment with otoscopic myringoplasty,the air conduction hearing threshold and air-bone conduction difference were lower one month after operation and three months after operation compared with those before operation,and the difference was statistically significant(P<0.001).After treatment with endoscopic myringoplasty,their VAS scores were decreased 1 d after operation and at the time of discharge compared with those before operation,the VAS score of the patients before operation,1 d after operation and during hospitalization showed statistical significance(P<0.001);There was no significant difference in VAS score between pre-surgery and 1 d post-surgery(P>0.05);Compared with pre-surgery,VAS score of patients at discharge was lower and the difference was statistically significant(P<0.05).Conclusion Endoscopic myringoplasty is effective for patients with traumatic tympanic membrane perforation,which is beneficial to postoperative hearing recovery and pain relief.It is recommended to widely carry out used in clinical patients with traumatic tympanic membrane perforation.