耳内镜下软骨-软骨膜复合体用于慢性化脓性中耳炎合并耳真菌病鼓室成形术的疗效分析

Analysis of the efficacy of the cartilage-perichondrium complex in the treatment of chronic suppurative otitis media with myringoplasty in the presence of otomycosis

摘要:

目的 探讨慢性化脓性中耳炎合并耳真菌病患者行耳内镜下软骨-软骨膜复合体鼓室成形术的临床疗效。方法 选取2021年1月－2023年12月该院收治的，于耳内镜下采用耳屏软骨-软骨膜复合体行鼓室成形术的慢性化脓性中耳炎患者68例，根据是否合并过耳真菌病，将患者分为真菌组和对照组，各34例。真菌组术前合并耳真菌病，均行抗真菌治疗后好转，其中18例合并湿耳；对照组未曾合并过耳真菌病，术前均为干耳。所有患者均接受了耳内镜下鼓室成形术，采用软骨-软骨膜复合体修复穿孔。术后随访至少3个月。于术前和术后3个月，检查纯音听力。观察两组患者鼓膜修补成功率、听力改善情况和干耳时间。结果 真菌组和对照组的鼓膜修补成功率分别为88.24%（30/34）和91.18%（31/34），差异无统计学意义（P > 0.05）；两组患者术后3个月气骨导间距明显小于术前，差异有统计学意义（P < 0.05）；但两组间比较，差异无统计学意义（P > 0.05）；真菌组干耳时间长于对照组，差异有统计学意义（P < 0.05）。结论 慢性化脓性中耳炎合并耳真菌病有时伴有湿耳，患者需要更长的时间来达到完全健康的状态，使用软骨-软骨膜复合体的耳内镜下鼓室成形术，是治疗慢性化脓性中耳炎合并耳真菌病患者的有效方法。值得应用于临床。

Abstract:

Objective To explore the clinical efficacy of otoendoscopic cartilaginous and perichondrial complex tympanoplasty in patients with chronic suppurative otitis media complicated with otomycosis.Methods A total of 68 patients with chronic suppurative otitis media who underwent tympanoplasty using the tragus cartilaginous and perichondrial complex under otoscopy from January 2021 to December 2023 were selected, according to whether they were complicated with otomycosis. The patients were divided into the fungal group and the control group, with 34 cases in each group. In the fungal group, there were preoperative fungal diseases of the ear. All of them improved after antifungal treatment, among which 18 cases were complicated with wet ear. The control group had never been complicated with otofungal disease and all had dry ears before the operation. All patients underwent tympanoplasty under otoscopy, and the perforation was repaired using the cartilaginous perichondrium complex. Postoperative follow-up should be conducted for at least 3 months. Pure tone hearing should be examined before the operation and 3 months after the operation. Observe the success rates of tympanic membrane repair, hearing improvement and dry ear time of the two groups of patients.Results The success rates of tympanic membrane repair of the fungal group and the control group were 88.24% (30/34) and 91.18% (31/34) respectively, and the difference was not statistically significant (P > 0.05). The preoperative hearing of both groups of patients was improved compared with the postoperative hearing, and the difference was statistically significant (P < 0.05). The degree of improvement in hearing before and after the operation was similar between the two groups, and the difference was not statistically significant (P > 0.05). The dry ear time in the fungal group was longer than that in the control group, and the difference was statistically significant (P < 0.05).Conclusion Chronic suppurative otitis media complicated with otomycosis is sometimes accompanied by wet ears. Patients need a longer time to reach a completely healthy state. Otoendoscopic tympanoplasty using cartilaginous and perichondrial complex is an effective method for treating patients with chronic suppurative otitis media complicated with otomycosis. It is worth applying in clinical practice.