不同状态的慢性化脓性中耳炎施行鼓膜成形术的回顾性分析

发布时间：2018-05-09 05:00

本文选题：中耳炎 + 鼓膜成形术　；参考：《临床耳鼻咽喉头颈外科杂志》2017年19期

【摘要】：目的:分析慢性化脓性中耳炎行鼓膜成形术后的鼓膜穿孔率及听力改善率,观察术前中耳病变、咽鼓管功能及感染等不同状态对术后疗效的影响。方法:回顾性分析203例(203耳)行鼓膜成形术患者的临床资料:根据术中探查鼓室内有无脓性分泌物积聚,分为感染活动期组和感染静止期组;根据术前声导抗结果,分为咽鼓管功能不良组和咽鼓管功能良好组;根据术前颞骨HRCT提示中耳(乳突、鼓窦、鼓室)有无软组织密度影,分为中耳无明显病变组和中耳有局限病变组。术后3~6个月复查耳内镜和纯音测听,采用SPSS 19.0统计软件比较不同组别术后鼓膜穿孔率和听力改善率的差异。结果:单因素分析:(1)感染静止期组术后鼓膜穿孔率为11.93%(13/109),高于感染活动期组[8.51%(8/94)];感染静止期组术后听力改善率为75.23%(82/109),低于感染活动期组[79.79%(75/94)],差异均无统计学意义(P0.05)。(2)咽鼓管功能不良组术后鼓膜穿孔率为14.06%(9/64),高于咽鼓管功能良好组[4.04%(4/99)],差异有统计学意义(P0.05);咽鼓管功能不良组术后听力改善率为76.56%(49/64),低于咽鼓管功能良好组[81.82%(81/99)],差异无统计学意义(P0.05)。(3)中耳无明显病变组术后鼓膜穿孔率为9.09%(10/110),低于中耳有局限病变组[11.83%(11/93)];中耳无明显病变组的术后听力改善率为78.18%(86/110),高于中耳有局限病变组[76.34%(71/93)],差异均无统计学意义(P0.05)。多因素分析:(1)术前咽鼓管功能与术后鼓膜的穿孔率有明显的相关性(P0.05),术前感染状态及颞骨HRCT影像提示的中耳病变情况与术后鼓膜的穿孔率均不存在明显的相关性(P0.05)。(2)术前感染状态、咽鼓管功能及颞骨HRCT影像提示的中耳病变情况与术后的听力改善率均不存在明显的相关性(P0.05)。结论:术前咽鼓管功能不良及中耳局限性病变多见于感染活动期;鼓室黏膜表面脓性分泌物积聚及中耳局限性病变不影响术后的鼓膜愈合率及听力改善率;咽鼓管功能是影响术后鼓膜愈合率的一个重要因素,咽鼓管功能障碍者其术后鼓膜穿孔的可能性更大,但不影响术后的听力改善率。
[Abstract]:Objective: to analyze the rate of tympanic membrane perforation and hearing improvement after tympanoplasty in patients with chronic suppurative otitis media. Methods: the clinical data of 203 patients with tympanoplasty were retrospectively analyzed. According to the intraoperative examination of purulent secretion accumulation in tympanic chamber, the patients were divided into two groups: active infection group and static infection group, according to the results of acoustic conductance before operation. According to HRCT of temporal bone before operation, soft tissue density of middle ear (mastoid process, tympanic sinus and tympanic chamber) was indicated, and divided into middle ear group without obvious lesion and middle ear with limited lesion group. Endoscope and pure tone audiometry were reexamined 3 ~ 6 months after operation. The differences of tympanic membrane perforation rate and hearing improvement rate in different groups were compared with SPSS 19.0 software. Results: univariate analysis showed that the rate of tympanic membrane perforation was 11.93% / 109 in the still stage group, which was higher than that in the active stage group [8.51% 8 / 94], and the hearing improvement rate in the still stage group was 75.23% 82109%, lower than that in the active stage group [79.79 75% 94], and there was no significant difference in the eustachian tube. The rate of tympanic membrane perforation in the dysfunctional group was 14.06 / 64, which was higher than that in the eustachian tube functional group [4.04 / 4 / 99], the difference was statistically significant (P 0.05), and the improvement rate of postoperative hearing in the dysfunctional eustachian tube group was 76.56 / 4964 / 64, which was lower than that in the eustachian tube functional group [81.82 / 89 / 99], with no statistical significance. The rate of tympanic membrane perforation was 9.09% (10 / 110) in the group with no obvious middle ear lesion, which was lower than that in the group with limited middle ear lesion [11.833%], and the improvement rate of hearing was 78.18% / 110 in the group without obvious lesion of middle ear, which was higher than that in the group with limited lesion of middle ear [76.3434% 71 / 93], and there was no significant difference (P 0.05%). Multivariate analysis: there was a significant correlation between the function of eustachian tube before operation and the perforation rate of tympanic membrane after operation (P 0.05). There was no significant correlation between the infection status before operation and the lesion of middle ear revealed by HRCT images of temporal bone and the perforation rate of tympanic membrane after operation. Infection status before operation, There was no significant correlation between the function of eustachian tube and HRCT images of temporal bone and the improvement rate of hearing after operation (P 0.05). Conclusion: preoperative dysfunctions of eustachian tube and localized lesions of middle ear are more common in the active stage of infection, the accumulation of purulent secretion on the surface of tympanic mucosa and localized lesions of middle ear do not affect the rate of tympanic membrane healing and hearing improvement after operation. The function of eustachian tube is an important factor affecting the healing rate of tympanic membrane after operation. The patients with dysfunctional eustachian tube are more likely to have perforation of tympanic membrane after operation, but have no effect on the improvement rate of hearing after operation.
【作者单位】：新疆喀什地区第二人民医院耳鼻咽喉头颈外科;复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科;
【分类号】：R764.9

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