耳内镜下耳屏软骨-软骨膜复合体Ⅰ型鼓室成形术改善慢性化脓性中耳炎患者听力的疗效分析

Analysis of the efficacy of type I tympanoplasty of the tragus cartilaginous perichondrium complex under otoendoscopy in improving hearing in patients with chronic suppurative otitis media

摘要:

目的 分析耳内镜下耳屏软骨-软骨膜复合体Ⅰ型鼓室成形术改善慢性化脓性中耳炎（CSOM）患者听力的临床效果。方法 选择2021年6月－2023年6月该院收治的行Ⅰ型鼓室成形术治疗的CSOM患者98例，按掷硬币法分为A组和B组，各49例。A组采用耳屏软骨-软骨膜复合体修补术，B组采用颞肌筋膜修补术，两组患者术后随访6个月。比较两组患者围手术期指标（手术时间、术中出血量和移植物提取处愈合时间），术前、术后3个月和术后6个月骨导听阈、气导听阈和气骨导间距（A-B gap），术前、术后1个月、术后3个月和术后6个月耳鸣致残量表（THI）评分，术后6个月鼓膜愈合情况（完全愈合、愈合不全和鼓膜回缩/位移），以及随访期间干耳率、干耳时间和并发症的发生情况。结果 两组患者手术时间、术中出血量和移植物提取处愈合时间比较，差异均无统计学意义（P > 0.05）；术后3和6个月，两组患者骨导听阈、气导听阈和A-B gap较术前呈逐步下降趋势，且A组明显低于B组，组间、时间和交互效应比较，差异均有统计学意义（P < 0.05）；术后1、3和6个月，两组患者THI评分较术前呈逐步下降趋势，且A组明显低于B组，组间、时间和交互效应比较，差异均有统计学意义（P < 0.05）；术后6个月，A组愈合率明显高于B组，差异有统计学意义（P < 0.05）。随访期间，A组干耳率为95.92%（47/49），明显高于B组的83.67%（41/49），干耳时间为（10.94±1.31）周，明显短于B组的（12.56±1.28）周，两组患者比较，差异均有统计学意义（P < 0.05）；两组患者并发症总发生率比较，差异无统计学意义（P > 0.05）。结论 对于耳内镜下Ⅰ型鼓室成形术，与颞肌筋膜修补术比较，耳屏软骨-软骨膜复合体修补术治疗CSOM，可明显提高患者的听力水平和干耳率，改善耳鸣，缩短干耳时间，且安全性高。值得临床推广应用。

Abstract:

Objective To analyze the clinical effect of type I tympanoplasty of the tragus cartilaginous perichondrium complex under otoendoscopy in improving the hearing of patients with chronic suppurative otitis media (CSOM).Method 98 patients with CSOM who underwent type I tympanoplasty from June 2021 to June 2023 were selected. They were divided into group A and group B by the coin-toss method, with 49 cases in each group. Group A underwent tragus cartilaginous-perichondrium complex repair, and group B underwent temporal muscle fascia repair. Both groups of patients were followed up for 6 months after the operation. The perioperative indicators (operation time, intraoperative blood loss and healing time at the graft extraction site), bone conduction hearing threshold, air conduction hearing threshold and air-bone gap (A-B gap) before the operation, 3 months after the operation and 6 months after the operation were compared between the two groups. The tinnitus handicap inventory (THI) score before the operation, 1, 3 and 6 months after the operation, the tympanic membrane healing status (complete healing, incomplete healing and tympanic membrane retraction/displacement) at 6 months after the operation, as well as the dry ear rate, dry ear duration and the occurrence of complications during the follow-up period were compared between the two groups.Results There were no statistically significant differences in the operation time, intraoperative blood loss and healing time of the graft extraction site between the two groups (P > 0.05); The bone conduction hearing threshold, air conduction hearing threshold and A-B gap of the two groups at 3 and 6 months after the operation showed a gradually decreasing trend compared with those before the operation, and group A was significantly lower than group B, the comparisons of intergroup, time and interaction effects all showed statistically significant differences (P < 0.05); At 1, 3 and 6 months after the operation, the THI scores of the two groups of patients showed a gradually decreasing trend compared with those before the operation, and the THI score of group A was significantly lower than that of group B, the comparisons of intergroup, time and interaction effects all showed statistically significant differences (P < 0.05); Six months after surgery, group A exhibited a significantly higher healing rate compared with group B (P < 0.05). During the follow-up period, the dry ear rate in group A was 95.92% (47/49), significantly higher than 83.67% (41/49) in group B, the dry ear time was (10.94 ± 1.31) weeks in group A, significantly shorter than (12.56 ± 1.28) weeks in group B, the differences were statistically significant (P < 0.05); There was no statistically significant difference in the total incidence of complications between the two groups (P > 0.05).Conclusion Compared with temporal muscle fascia repair, tragus cartilaginous-perichondrium complex repair for CSOM can significantly improve the hearing level and dry ear rate of patients, alleviate tinnitus, shorten the dry ear time, and has high safety. It is worthy of clinical promotion and application.