In this retrospective study,we evaluated the preoperative and intraoperative findings and functional results of revision surgery after canal wall down mastoidectomy.We reviewed 34 patients(14 men,20 women;age,17–68 y...In this retrospective study,we evaluated the preoperative and intraoperative findings and functional results of revision surgery after canal wall down mastoidectomy.We reviewed 34 patients(14 men,20 women;age,17–68 years)who underwent revision canal wall down mastoidectomy from March 2006 to March 2017 in the Department of Otology of the First Affiliated Hospital,Wenzhou Medical University,China.This study was approved by the Ethics Committee of the First Affiliated Hospital,Wenzhou Medical University,China(approval No.2008-05-02A11)on May 2,2008.The possible reasons for previous surgical failures were confirmed by the operative findings and included a narrow auditory meatus orifice(100%),recurrent or residual cholesteatoma(82%),high facial ridge(94%),residual air cells(47%),and labyrinthine fistula(12%).The mean time until achievement of dry ear after surgery was 5.8±2.4 weeks.After a mean 6-month follow-up,the mean postoperative air–bone gap decreased from 33.8±4.8 to 17.1±5.1dB in 30 patients who underwent mastoidectomy with simultaneous tympanoplasty.However,no significant postoperative hearing change had occurred in the other 4 patients with eustachian tube occlusion.All patients were followed up for>24 months with a disease-free dry ear and stable hearing results.The main reasons for lack of dry ears after mastoidectomy were a narrow auditory meatus orifice,recurrent or residual cholesteatoma,high facial ridge,and residual air cells.Early dry ear and hearing promotion are obtainable in most patients using revision canal wall down mastoidectomy.展开更多
目的探讨顽固性分泌性中耳炎(otitis media with effusion,OME)及相关后遗症的手术治疗策略及疗效。方法回顾分析复旦大学附属眼耳鼻喉科医院2014年7月-2017年12月期间收治的顽固性OME患者29例(31耳),31耳均接受了完壁式乳突切除,其中1...目的探讨顽固性分泌性中耳炎(otitis media with effusion,OME)及相关后遗症的手术治疗策略及疗效。方法回顾分析复旦大学附属眼耳鼻喉科医院2014年7月-2017年12月期间收治的顽固性OME患者29例(31耳),31耳均接受了完壁式乳突切除,其中15耳同期行鼓膜置管术;6耳应用人工听骨行听骨链重建;5耳对鼓膜进行了修复。结果28耳获痊愈;3耳在术后6-12月时出现复发,改为开放式乳突切除+鼓膜置管术,均治愈。术后(包括再次手术)6个月复查纯音测听,语言频率(0.5-2KHz)气导平均值12-50dB[(33.06±10.82)dB],气骨导差在5-21 dB[(11.00±4.13)dB]之间。鼓室导抗图恢复为A型曲线者29耳,C型曲线2耳,但负压均在150 mm H20(1mm H20=0.0098 kPa)内。术后随访8个月-4年,31耳均无复发。结论经过各种方法治疗无效的慢性OME应考虑到有长期OME导致的不可逆并发症的可能性,积极采取中耳乳突手术治疗。展开更多
基金supported by Zhejiang Provincial Natural Science Foundation of China,No.LY19H130003(to YH),LY19H130004(to HL)Wenzhou Basic Scientific Research Project of China,No.Y20180091(to YH).
文摘In this retrospective study,we evaluated the preoperative and intraoperative findings and functional results of revision surgery after canal wall down mastoidectomy.We reviewed 34 patients(14 men,20 women;age,17–68 years)who underwent revision canal wall down mastoidectomy from March 2006 to March 2017 in the Department of Otology of the First Affiliated Hospital,Wenzhou Medical University,China.This study was approved by the Ethics Committee of the First Affiliated Hospital,Wenzhou Medical University,China(approval No.2008-05-02A11)on May 2,2008.The possible reasons for previous surgical failures were confirmed by the operative findings and included a narrow auditory meatus orifice(100%),recurrent or residual cholesteatoma(82%),high facial ridge(94%),residual air cells(47%),and labyrinthine fistula(12%).The mean time until achievement of dry ear after surgery was 5.8±2.4 weeks.After a mean 6-month follow-up,the mean postoperative air–bone gap decreased from 33.8±4.8 to 17.1±5.1dB in 30 patients who underwent mastoidectomy with simultaneous tympanoplasty.However,no significant postoperative hearing change had occurred in the other 4 patients with eustachian tube occlusion.All patients were followed up for>24 months with a disease-free dry ear and stable hearing results.The main reasons for lack of dry ears after mastoidectomy were a narrow auditory meatus orifice,recurrent or residual cholesteatoma,high facial ridge,and residual air cells.Early dry ear and hearing promotion are obtainable in most patients using revision canal wall down mastoidectomy.
文摘目的探讨顽固性分泌性中耳炎(otitis media with effusion,OME)及相关后遗症的手术治疗策略及疗效。方法回顾分析复旦大学附属眼耳鼻喉科医院2014年7月-2017年12月期间收治的顽固性OME患者29例(31耳),31耳均接受了完壁式乳突切除,其中15耳同期行鼓膜置管术;6耳应用人工听骨行听骨链重建;5耳对鼓膜进行了修复。结果28耳获痊愈;3耳在术后6-12月时出现复发,改为开放式乳突切除+鼓膜置管术,均治愈。术后(包括再次手术)6个月复查纯音测听,语言频率(0.5-2KHz)气导平均值12-50dB[(33.06±10.82)dB],气骨导差在5-21 dB[(11.00±4.13)dB]之间。鼓室导抗图恢复为A型曲线者29耳,C型曲线2耳,但负压均在150 mm H20(1mm H20=0.0098 kPa)内。术后随访8个月-4年,31耳均无复发。结论经过各种方法治疗无效的慢性OME应考虑到有长期OME导致的不可逆并发症的可能性,积极采取中耳乳突手术治疗。
文摘目的:比较完壁式(canal wall up,CWU)与开放式(canal wall down,CWD)乳突根治鼓室成形术治疗慢性化脓性中耳炎与中耳胆脂瘤的疗效。方法:通过计算机检索中国知网期刊数据库(CNKI)、万方数据库、维普数据库(VIP)、PubMed、Cochrane Library、Web of Science及Elsevier Clinicalkey数据库从2000年1月至2019年12月的文献,纳入比较CWU与CWD乳突根治鼓室成形术治疗慢性化脓性中耳炎与中耳胆脂瘤疗效的随机对照研究与病例对照研究。采用RevMan5.3软件包对纳入文献进行Meta分析,分析两种术式的术后气导听阈(pure tone average,PTA)、术后气骨导差气骨导差(air bone gap,ABG)、并发症、干耳时间与复发率。结果:共9篇符合纳入标准的文献,其中5篇为随机对照研究,4篇为病例对照研究。总患病耳数为778耳,348耳行CWU乳突根治鼓室成形术,430耳行CWD乳突根治鼓室成形术。两种手术方式的平均PTA差异有统计学意义(MD=−6.99,95%CI:−12.40~−1.58,P=0.01),CWU较CWD好;两种手术方式的术后ABG差异无统计学意义(MD=−2.88,95%CI:−7.11~1.35,P=0.18);CWU及CWD的复发率分别为20.6%(20/97)和4%(4/98),差异具有统计学意义(OR=5.42,95%CI:1.92~15.31,P=0.001);与CWD相比,CWU手术并发症少(OR=0.37,95%CI:0.14~0.96,P=0.04),干耳时间短(MD=–15.19,95%CI:–19.12~–11.27,P<0.001),差异具有统计学意义。结论:CWU乳突根治鼓室成形术干耳时间短,手术并发症少,但具有较高的复发率;与开放术式相比,CWU提高患者术后听力的效果并不显著。手术方案需结合患者的病变性质、病变程度、术前听力状况、随访条件及医师的技术能力等方面来制定。
