耳内镜下夹层法鼓膜成形术治疗鼓膜大穿孔的效果及对鼓膜愈合、听力恢复的影响

Effect of otoendoscopic myringoplasty with interlayer method in the treatment of large tympanic membrane perforation and its influences on tympanic membrane healing and hearing recovery

目的研究耳内镜下夹层法鼓膜成形术治疗鼓膜大穿孔的效果及对鼓膜愈合、听力恢复的影响。方法选取2021年1月至2022年1月我院收治的120例鼓膜大穿孔患者,根据治疗方法不同将其分为对照组和观察组,各60例。对照组采用显微镜下夹层法鼓膜成形术,观察组采用耳内镜下夹层法鼓膜成形术。比较两组的治疗效果。结果观察组的鼓膜愈合总有效率为96.67%,略高于对照组的93.33%,但差异无统计学意义(P>0.05)。观察组的手术时间、术腔干耳时间及术腔上皮化时间短于对照组,术中出血量少于对照组,差异具有统计学意义(P<0.05)。治疗后,两组的气导听阈(AC)、骨导听阈(BC)及气骨导差(ABG)低于治疗前,差异具有统计学意义(P<0.05);治疗前、后,两组的AC、BC及ABG无明显差异(P>0.05)。观察组的并发症总发生率低于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组的躯体表现、医学资源利用、情感异常、日常活动受限评分及总分高于对照组,差异具有统计学意义(P<0.05)。结论耳内镜与显微镜下夹层法鼓膜成形术对鼓膜大穿孔患者疗效相当,但耳内镜下夹层法鼓膜成形术可减少术中出血量,缩短手术时间、术腔干耳时间与上皮化时间,降低术后并发症发生率,改善患者生活质量。

Objective To study the effect of otoendoscopic myringoplasty with interlayer method in the treatment of large tympanic membrane perforation and its influences on tympanic membrane healing and hearing recovery.Methods A total of 120 patients with large tympanic membrane perforation admitted in our hospital from January 2021 to January 2022 were selected and divided into control group and observation group according to different treatment methods,with 60 cases in each group.The control group was treated with microscopic myringoplasty with interlayer method,and the observation group was treated with otoendoscopic myringoplasty with interlayer method.The therapeutic effects of the two groups were compared.Results The total effective rate of tympanic membrane healing in the observation group was 96.67%,which was slightly higher than 93.33%in the control group,but the difference was not statistically significant(P>0.05).The operation time,operation cavity dry ear time and operation cavity epithelialization time of the observation group were shorter than those of the control group,and the intraoperative blood loss was less than that of the control group,the differences were statistically significant(P<0.05).After treatment,the air conduction(AC),bone conduction(BC)and air-bone gap(ABG)of the two groups were lower than those before treatment,and the differences were statistically significant(P<0.05);before and after treatment,there were no significant differences in AC,BC and ABG between the two groups(P>0.05).The total incidence of complications in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).After treatment,the scores of physical performance,medical resource utilization,emotional abnormality,daily activity limitation and total score in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).Conclusion The otoendoscopic myringoplasty and microscopic myringoplasty with interlayer method have the same effect in the treatment of patients with large tympanic membrane perforation,but otoendoscopic myringoplasty with interlayer method can reduce the intraoperative blood loss,shorten the operation time,operation cavity dry ear time and epithelization time,decrease the incidence of postoperative complications,and improve the quality of life of patients.