33例耳廓化脓性软骨膜炎诊治经验

目的总结分析33例不同病因引起的耳廓化脓性软骨膜炎的治疗体会。方法回顾性分析南昌大学第一附属医院耳鼻咽喉头颈外科2015年1月~2020年6月收治的不同病因的耳廓化脓性软骨膜炎患者33例,分析总结病因及诊治经验。结果33例患者中行药物保守治疗者9例,治疗后9例均痊愈,未出现耳廓畸形等并发症;行局麻下脓肿切开引流治疗者4例,治疗后4例均痊愈,未出现耳廓畸形等并发症;行全麻下耳廓软骨清创缝合术者20例,术后痊愈20例,出现耳廓“菜花样”畸形1例。33例患者,取得脓液样本细菌培养及药敏者24例,微生物检出者20例,4例培养后未见微生物生长,检出金黄色葡萄球菌9例,检出率45%,检出铜绿假单胞菌12例,检出率60%,真菌均未检出。检出微生物舒普深均敏感。结论耳廓化脓性软骨膜炎病因较多,诊断相对简单,治疗上首选针对铜绿假单胞菌及金黄色葡萄球菌敏感的抗生素,病情较轻的可行药物保守治疗,病变严重时则应切开引流及清除病变的软骨,同时超短波辅助治疗也是十分有效的治疗手段。

A Novel Surgery Classification for Endoscopic Approaches to Middle Ear Cholesteatoma

This study aimed to develop a novel surgery classification for an endoscopic approach to middle ear cholesteatoma.We retrospectively analyzed the surgical approaches and outcomes of patients with middle ear cholesteatoma.Middle ear cholesteatoma surgeries were divided into four types and two special types as follows:type I,attic retraction pocket,which only requires tympanostomy tube placement or retraction pocket resection and cartilage reconstruction;typeⅡ,cholesteatoma which is limited to the attic or in which endoscopy can confirm complete removal of mastoid cholesteatoma lesions,including type Ⅱa,requiring only use of a curette,and type Ⅱ b,requiring use of an electric drill or chisel;type Ⅲ,cholesteatoma not limited to the attic,in which endoscopy cannot confirm complete removal of mastoid cholesteatoma lesions,requiring the combined use of endoscope and microscope to perform endoscopic tympanoplasty and"Canal Wall Up"mastoidectomy;type Ⅳ,extensive involvement of mastoid cavity cholesteatoma lesions and/or cases with a potential risk of complications,removal of which can only be performed under a microscope for"Canal Wall Down"mastoidectomy.In addition,there were two special types:"difficult external auditory canal"and congenital cholesteatoma in children.In our system,type I and type U middle ear cholesteatoma surgery was completely performed under an endoscope alone.However,estimating the extent of the lesions,determining the choice of mastoid opening and reestablishing ventilation are the key points for an endoscopic approach to middle ear cholesteatoma.The classification of endoscopic middle ear cholesteatoma surgery may benefit the selection of surgical indications.

耳前组织扩大切除术在感染期及复杂性耳前瘘管治疗中的应用

目的探讨耳前组织扩大切除术在感染期及复杂性耳前瘘管治疗中的应用。方法收集2013年5月~2018年2月我科99例(105耳)感染期及复杂性耳前瘘管患者,分析手术方法及疗效。结果 99例(105耳)中创口愈合不佳1耳,复发3耳,其余均一期愈合。复发3耳经再手术后观察6~12个月,未再见复发。治疗总有效率97.14%。结论耳前组织扩大切除术是治疗处于感染期及复杂性耳前瘘管疾病的良好方法。

Systematic review of animal models of middle ear surgery

Animal models of middle ear surgery help us to explore disease processes and intervention outcomes in a manner not possible in patients. This review begins with an overview of animal models of middle ear surgery which outlines the advantages and limitations of such models. Procedures of interest include myringoplasty/tympanoplasty, mastoidectomy, ossiculoplasty, stapedectomy, and active middle ear implants. The most important issue is how well the model reflects the human response to surgery. Primates are most similar to humans with respect to anatomy; however, such studies are uncommon now due to expense and ethical issues. Conversely, small animals are easily obtained and housed, but experimental findings may not accurately represent what happens in humans. We then present a systematic review of animal models of middle ear surgery. Particular attention is paid to any distinctive anatomical features of the middle ear, the method of accessing the middle ear and the chosen outcomes. These outcomes are classified as either physiological in live animals,(e.g., behavioural or electrophysiological responses), or anatomical in cadaveric animals,(e.g., light or electron microscopy). Evoked physiological measures are limited by the disruption of the evoking air-conducted sound across the manipulated middle ear. The eleven identified species suitable as animal models are mouse, rat, gerbil, chinchilla, guinea pig, rabbit, cat, dog, sheep, pig and primate. Advantages and disadvantages of each species as a middle ear surgical model are outlined, and a suggested framework to aid in choosing a particular model is presented.

Endoscopic revision tympanoplasties:our experience

Objective:The aim of this study was to analyze the outcomes and complications of endoscopic tympanoplasties and review the strategies for endoscopic revision surgeries.Methods:Revision endoscopic surgeries are performed on patients with unsatisfactory outcomes after endoscopic tympanoplasties.This study was approved by the Ethics Committee of Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,China(approval No.2020-0045-1).Results:Residual or recurrent tympanic membrane marginal perforation is treated by autogenous fat and cartilage grafting;graft collapse is treated using tissue from the tragus;and graft displacement is treated by endoscopic fixation of the cartilage-perichondrium complex.Lateral healing of the tympanic membrane,prosthesis fracture,prosthesis extrusion,middle ear adhesions,and recurrent perforation also required revision surgeries.Conclusion:Residual or recurrent tympanic membrane marginal perforation is the most common cause of unsatisfactory outcomes after endoscopic tympanoplasty;fat grafting is effective only for small perforations.Small cartilage grafts are an effective means of dealing with residual marginal perforation;the cartilage and perichondrium complex should be fixed securely.Patients with prosthesis implants require regular examination.

Rib Cartilage Assessment Relative to the Healthy Ear in Young Children with Microtia Guiding Operative Timing

Background：The optimal age at which to initiate for auricular reconstruction is controversial.Rib cartilage growth is closely related to age and determines the feasibility and outcomes of auricular reconstruction.We developed a method to guide the timing of auricular reconstruction in children with microtia ranging in age from 5 to 10 years.Methods：Rib cartilage and the healthy ear were assessed using low-dose multi-slice computed tomography.The lengths of the eighth rib cartilage and the helix of the healthy ear （from the helical crus to the joint of the helix and the earlobe） were measured.Surgery was performed when the two lengths were approximately equal.Results：The preoperative eighth rib measurements significantly correlated with the intraoperative measurements （P 〈 0.05）.From 5 to 10 years of age,eighth rib growth was not linear.In 76 （62.8%） of 121 patients,the eighth rib length was approximately equal to the helix length in the healthy ear;satisfactory outcomes were achieved in these patients.In 18 （14.9%） patients,the eighth rib was slightly shorter than the helix,helix fabrication was accomplished by adjusting the length of the helical crus of stent,and satisfactory outcomes were also achieved.Acceptable outcomes were achieved in 17 （14.0%） patients in whom helix fabrication was accomplished by cartilage splicing.In 9 （7.4%） patients with insufficient rib cartilage length,the operation was delayed.In one （0.8%） patient with insufficient rib cartilage length,which left no cartilage for helix splicing,the result was unsatisfactory.Conclusions：Eighth rib cartilage growth is variable.Rib cartilage assessment relative to the healthy ear can guide auricular reconstruction and personalize treatment in young patients with microtia.