Correlation between middle-ear pressure-regulation functions and outcome of type-I tympanoplasty
Correlation between middle-ear pressure-regulation functions and outcome of type-I tympanoplasty
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DOI：
10.1016/j.anl.2006.09.007
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发表时间：
2007-06-01
影响因子：
1.7
通讯作者：
Umeki, Hiroshi
中科院分区：
文献类型：
--
作者：
Takahashi, Haruo;Sato, Hiroaki;Umeki, Hiroshi
目的：探讨中耳压力调节功能（包括主动咽鼓管（ET）功能和跨粘膜气体交换功能）与鼓室成形术结果的相关性。 患者和方法：75 例（78 耳）患有鼓膜穿孔但无听小骨损伤或中耳异常的非胆脂瘤性慢性中耳炎患者参加了本研究。术前通过鼓膜穿孔对中耳施加正压检查ET的通畅性，然后通过充气放气试验检查ET的压力调节功能。此外，还通过术前 CT 或术中显微镜检查乳突是否存在通气来评估其跨粘膜气体交换功能。均接受I型鼓室成形术，并对术后听力等情况进行6个多月的随访。有下列情况之一者，手术结果判定为不良；平均气骨间隙超过 20 dB、6 个月内自发穿孔或持续潮湿状态，包括复发性耳漏。 结果：首先，所有 4 个被认为机械性阻塞的 ET 耳朵的结果都很差。接下来，在剩下的74只耳朵中，正、负中耳压力平衡功能和乳突通气这三个单独参数均未与手术结果呈现显着正相关，但只有当这三个参数均较差时，不良结果的发生率才会显着升高。结论：这些结果表明，所有中耳压力调节功能的损害很可能导致鼓室成形术的不良结果，也使我们再次确认了机械阻塞的ET的耳朵是鼓室成形术的禁忌症。因此，鼓室成形术前乳突状况以及 ET 功能的评估很重要。 (c) 2006 Elsevier Ireland Ltd. 保留所有权利。
Objectives: To examine the correlation between the middle-ear pressure-regulation functions including active eustachian tube (ET) functions and transmucosal gas exchange function, and outcome of tympanoplasty.Patients and methods: Seventy five patients (78 ears) with non-cholesteatomatous chronic otitis media with eardrum perforation but without ossicular damage or middle-ear anomaly participated in this study. Before surgery, patency of the ET was examined by applying positive pressure to the middle ear through the eardrum perforation, and then the ET pressure-regulation functions were examined using the inflation-deflation test. Also their transmucosal gas exchange function was evaluated by examining the presence or absence of aeration in the mastoid on the CT before surgery or through the microscope during the surgery. All of them underwent type-I tympanoplasty, and their postoperative conditions including the hearing were followed for more than 6 months. The outcome of the surgery was judged as poor outcome when they had any of the following conditions; more than 20 dB of mean air-bone gap, spontaneous perforation within 6 months, or persistent wet condition including recurrent otorrhea.Results: First, the outcome of all the four ears of which ETs were considered mechanically obstructed was poor. Next, among the remaining 74 ears, none of the three individual parameters, including positive and negative middle-ear pressure-equalizing functions and mastoid aeration, showed significantly positive correlation with the outcome of the surgery, but significantly higher incidence of poor outcome was seen only when all the three parameters were poor.Conclusions: These results indicated that impairment of all the middle-ear pressure-regulation functions was likely to cause poor outcome of tympanoplasty, and also allowed us reconfirm that ears with mechanically obstructed ETs were contraindicated for tympanoplasty. Therefore, assessment of mastoid condition is important as well as the ET function before tympanoplasty. (c) 2006 Elsevier Ireland Ltd. All rights reserved.