耳内镜下I型鼓室成形干湿耳手术疗效分析

Endoscopic type 1 tympanoplasty in dry and wet ears: A perspective cohort study

摘要:

摘要：目的探究耳内镜下I型鼓室成形术在干湿耳状态下手术的疗效差异。方法前瞻性纳入2017年7月~2017年9月于上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科收治的慢性化脓性中耳炎静止期患者，术前由2名耳内镜医师和1名临床医师独立判断鼓膜及鼓室黏膜情况，将45例患者分为干耳组和湿耳组。其中干耳患者29例，湿耳患者16例。I型鼓室成形术后3个月时的鼓膜愈合率和听力改善率。结果术后3个月时干耳患者中26例（89.6%）的患者鼓膜完全愈合，湿耳患者中14例（87.5%）鼓膜完全愈合，两组气骨导差均明显下降，干耳组气骨导差由术前（23.5±7.3）dB HL下降至（8.6±6.2）dB HL，湿耳组气骨导差由术前（25.1±7.6）dB HL下降至（10.5±8.0）dB HL。两组在鼓膜愈合率和听力改善率上差异均无统计学意义（P>0.05）。结论对于不伴有听骨链病变的静止期慢性化脓性中耳炎，术前湿耳状态并非手术禁忌证，其术后鼓膜愈合率以及听力改善率与干耳手术一致，且可以降低患者术前等待时间，减少抗生素使用和并发症发生，但这一结论仍需多中心、前瞻性队列研究进一步证实。

Abstract:

Abstract:ObjectiveTo evaluate the effect of endoscopic type I tympanoplasty in dry and wet ears.MethodsA total of 45 patients underwent endoscopic type I tympanoplasty from July 2017 to Sept 2017 in our institution were prospectively enrolled. According to the independent preoperative evaluation of eardrum and mucosa of tympanic cavity by two endoscope doctors and one surgeon, all the patients were divided into two groups: the group with wet ear(n=16) and that with dry ear(n=29). All the patients were followed up postoperatively. The graft uptake and average airbone gap of pure tone audiometry at the 3rd month after surgery between the two groups were compared.ResultsAt the postoperative 3rd month, the graft take rates of the dry ear group and wet ear group were 89.6% and 87.5% respectively. The average airbone gap in the dry ear group decreased from (23.5±7.3)dB HL to (8.6±6.2)dB HL, and from (25.1±7.6)dB HL to (10.5±8.0)dB HL in the wet ear group. The differences of graft take rate and hearing improvement between the two groups were both statistically insignificant (both P>0.05).ConclusionFor the chronic suppurative otitis media at static stage and without lesion of ossicular chain, wet ear is not surgical contraindication. With advantages of reduction of preoperative waiting time, decreased use of antibiotics and avoidance of complications, the success of endoscopic type I tympanoplasty is not adversely affected by the presence of mucoid discharge at the time of surgery, and outcomes are comparable to those with dry ear. This conclusion needs to be further clarified by multicenter prospective cohort study.