中耳风险指数对耳内镜下鼓室成形术预后的影响

Effect of middle ear risk index on prognosis of endoscopic tympanoplasty

摘要:

目的 探讨中耳风险指数（MERI）对耳内镜下鼓室成形术预后的影响。方法 选择2019年7月－2022年4月于该院耳鼻喉科行耳内镜下鼓室成形术的慢性中耳炎患者112例作为研究对象，回顾性分析患者的临床资料。术后6个月行纯音测听检测气骨导间距（A-B gap），将患者分为预后较好组（A-B gap > 20 dB HL，n = 77）和预后不佳组（A-B gap ≤ 20 dB HL，n = 35）。通过电子病历系统，获取相关临床资料，并计算MERI得分情况。采用汉化版苏黎世慢性中耳炎量表（ZCMEI-21Chn）进行生活质量随访，并统计患者并发症发生情况。结果 预后较好组与预后不佳组性别、年龄、病程、手术时间、病变部位、术前气导听阈和术前骨导听阈比较，差异均无统计学意义（P > 0.05）；两组患者咽鼓管情况、鼓室黏膜情况和MERI评分比较，差异均有统计学意义（P < 0.05）；多因素Logistic回归分析结果显示，咽鼓管不通、鼓室黏膜病变和MERI评分较高，是慢性中耳炎患者耳内镜下鼓室成形术后6个月预后不佳的独立危险因素（P < 0.05）；受试者操作特征曲线（ROC curve）结果显示，MERI预测慢性中耳炎患者耳内镜下鼓室成形术后6个月预后的曲线下面积（AUC）为0.863，约登指数为0.561，最佳截断值为7分，灵敏度为73.17%，特异度为82.93%。MERI ≤ 7分组和MERI > 7分组术前ZCMEI-21Chn总分比较，差异无统计学意义（P > 0.05）；MERI ≤ 7分组，术后6个月ZCMEI-21Chn总分和并发症总发生率低于MERI > 7分组，差异均有统计学意义（P < 0.05）。结论 MERI评分较低的慢性中耳炎患者，耳内镜下鼓室成形术后6个月预后较好，且生活质量较高，并发症发生率较低，值得临床推广应用。

Abstract:

Objective To investigate the effect of middle ear risk index (MERI) on the prognosis of endoscopic tympanoplasty.Methods 112 patients with chronic otitis media who underwent endoscopic tympanoplasty from July 2019 to April 2022 were selected as the study subjects. The patients were divided into good prognosis group (A-B gap > 20 dB HL, n = 77) and poor prognosis group (A-B gap ≤ 20 dB HL, n = 35) according to the A-B gap detected by pure tone audiometry at 6 months after operation. Relevant clinical data were obtained through the electronic medical record system and MERI scores were calculated. The quality of life was followed up by the Chinese version of the Zurich chronic middle ear inventory (ZCMEI-21Chn) and the complications of the patients were counted.Results There was no significant difference in gender, age, course of disease, operation time, lesion location, preoperative air conduction hearing threshold and preoperative bone conduction hearing threshold between the good prognosis group and the poor prognosis group (P > 0.05). There were significant differences in pharyngotympanic tube condition, tympanic cavity mucosa and MERI scores between the two groups (P < 0.05). Multivariate Logistic regression analysis showed that pharyngotympanic tube obstruction, tympanic cavity mucosal lesion and high MERI score were independent influencing factors for poor prognosis at 6 months after endoscopic tympanoplasty in patients with chronic otitis media (P < 0.05). Receiver operator characteristic curve (ROC curve) analysis showed that the area under the curve (AUC) of MERI predicting the prognosis of patients with chronic otitis media at 6 months after endoscopic tympanoplasty was 0.863, and the Youden index was 0.561, the best cut-off value was 7, the sensitivity was 73.17% and the specificity was 82.93%. There was no significant difference in preoperative ZCMEI-21Chn total score between MERI ≤ 7 group and MERI > 7 group (P > 0.05). The total score of ZCMEI-21Chn and the total incidence of complications in patients with MERI ≤ 7 group were lower than those in patients with MERI > 7 group 6 mouths after operation (P < 0.05).Conclusion The prognosis of patients with chronic otitis media with low MERI score after 6 months of endoscopic tympanoplasty is better, and the quality of life is higher, and the incidence of complications is lower. It is worth to promotion and application.