Cartilage tympanoplasty: Indications, techniques, and outcomes in a 1,000 patient series
Cartilage tympanoplasty: Indications, techniques, and outcomes in a 1,000 patient series
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DOI：
10.1097/00005537-200311000-00002
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发表时间：
2003-11-01
期刊：
影响因子：
2.6
通讯作者：
Dornhoffer, J
中科院分区：
文献类型：
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作者：
Dornhoffer, J
目的/假设：本研究的目的是分析1000多例软骨鼓室成形术的解剖学和听力学结果，这些软骨鼓室成形术合理地应用了几种技术来处理困难的耳朵(胆脂瘤、复发性穿孔、肺不张)。我们的假设是，听骨链的病理和状态应该决定用于获得最佳结果的技术。研究设计：对1994年7月至2001年7月间接受软骨鼓室成形术的患者进行回顾性临床研究。使用计算机化的耳科数据库和病历获得必要的数据。方法：采用改良软骨膜/软骨岛状瓣重建鼓膜，在听骨链完整的情况下进行高危穿孔的鼓膜重建术，在踝关节缺失的情况下进行听小骨成形术。改良的栅栏技术用于胆脂瘤患者的TM重建，并与踝关节存在时的听小骨成形术相结合。使用四个频率(500、1000、2000、3000赫兹)纯音平均气骨间隙(PTA-ABG)报告听力结果。统计学比较采用t检验。记录术后并发症。结果：在研究期间，1,000多名患者使用软骨重建TM，其中712名患者有足够的数据可供纳入。在这些研究中，有636个可用于结果分析。220例胆脂瘤患者术前平均PTA-ABG为26.5±12.6分贝，术后平均为14.6+/-8.8分贝(P<；0.05)。复发8耳(3.6%)，传导性耳聋需翻修4耳(1.8%)，穿孔3耳(1.4%)，术后置管11耳(5.0%)，术中置管18耳(8.2%)。215例高危穿孔患者术前平均PTA-ABG为21.7+/-13.5分贝，术后平均为11.9+/-9.3分贝(P<0.05)。并发症包括复发穿孔9耳(4.2%)，传导性HL翻修4耳(1.9%)，术后置管4耳(1.9%)，术中置管6耳(2.8%)。98例肺不张患者术前、术后平均PTA-ABG分别为20.2+/-10.9分贝和14.2+/-10.2分贝(P<0.05)。并发症包括穿孔1耳(1.0%)，电导丢失2耳(2.0%)，术后插管7耳(7.1%)，术中插管12耳(12%)。听力改善组103例，术前平均PTA-ABG为33.6+/-9.6分贝，术后平均为14.6+/-10.1分贝(P<0.05)。并发症包括穿孔1例(1.0%)，电导丢失11例(11%)，术后插管6例(5.8%)，术中插管2例(1.9%)。结论：软骨鼓室成形术具有良好的解剖学和听力学效果，听骨链的病理和状态决定了所采用的技术。各病理组大鼠听力均有明显改善。在不电性耳中，软骨使我们能够重建TM，与传统重建相比具有良好的解剖结果，传统重建显示出较高的回缩和失败率。在胆脂瘤中，使用栅栏技术的软骨鼓室成形术可以精确地重建TM，并有助于减少复发。在高危穿孔的情况下，软骨重建术产生的解剖和功能结果优于使用传统技术的直接鼓室成形术。我们认为这些结果证实了软骨鼓室成形术(耳不张、胆脂瘤、高危穿孔)的适应证。关键词：软骨鼓室成形术，胆脂瘤，高危穿孔，耳不张，听力结果。
Objectives/Hypothesis: The purpose of this study was to analyze the anatomical and audiologic results in more than 1,000 cartilage tympanoplasties that utilized a logical application of several techniques for the management of the difficult ear (cholesteatoma, recurrent perforation, atelectasis). Our hypothesis was that pathology and status of the ossicular chain should dictate the technique used to achieve optimal outcome. Study Design: Retrospective clinical study of patients undergoing cartilage tympanoplasty between July 1994 and July 2001. A computerized otologic database and patient charts were used to obtain the necessary data. Methods: A modification of the perichondrium/cartilage island flap was utilized for tympanic membrane reconstruction in cases of the atelectatic ear, for high-risk perforation in the presence of an intact ossicular chain, and in association with ossiculoplasty when the malleus was absent. A modification of the palisade technique was utilized for TM reconstruction in cases of cholesteatoma and in association with ossiculoplasty when the malleus was present. Hearing results were reported using a four-frequency (500, 1,000, 2,000, 3,000 Hz) pure-tone average air-bone gap (PTA-ABG). The Student t test was used for statistical comparison. Postoperative complications were recorded. Results: During the study period, cartilage was used for TM reconstruction in more than 1,000 patients, of which 712 had sufficient data available for inclusion. Of these, 636 were available for outcomes analysis. In 220 cholesteatoma cases, the average pre- and postoperative PTA-ABGs were 26.5 +/- 12.6 dB and 14.6 +/- 8.8 dB, respectively (P < .05). Recurrence was seen in 8 cases (3.6%), conductive HL requiring revision in 4 (1.8%), perforation in 3 (1.4%), and post-and intraoperative tube insertion in 11 (5.0%) and 18 ears (8.2%), respectively. In 215 cases of high-risk perforation, the average pre- and postoperative PTA-ABGs were 21.7 +/- 13.5 dB and 11.9 +/- 9.3 dB, respectively (P < .05). Complications included recurrent perforation in 9 ears (4.2%), conductive HL requiring revision in 4 (1.9%), postoperative and intraoperative tube insertion in 4 (1.9%) and 6 ears (2.8%), respectively. In 98 cases of atelectasis, the average pre- and postoperative PTA-ABGs were 20.2 +/- 10.9 dB and 14.2 +/- 10.2 dB, respectively (P < .05). Complications included 1 perforation (1.0%), conductive loss requiring revision in 2 cases (2.0%), and post- and intraoperative tube insertion in 7 (7.1%) and 12 ears (12%), respectively. In 103 cases to improve hearing (audiologic), the average pre- and postoperative PTA-ABGs were 33.6 +/- 9.6 dB and 14.6 +/- 10.1 dB, respectively (P < .05). Complications included 1 perforation (1.0%), conductive loss requiring revision in 11 (11%), and post- and intraoperative tube insertion in 6 (5.8%) and 2 (1.9%), respectively. Conclusions: Cartilage tympanoplasty achieves good anatomical and audiologic results when pathology and status of the ossicular chain dictate the technique utilized. Significant hearing improvement was realized in each pathological group. In the atelectatic ear, cartilage allowed us to reconstruct the TM with good anatomic results compared to traditional reconstructions, which have shown high rates of retraction and failure. In cholesteatoma, cartilage tympanoplasty using the palisade technique resulted in precise reconstruction of the TM and helped reduce recurrence.In cases of high-risk perforation, reconstruction with cartilage yielded anatomical and functional results that compared favorably to primary tympanoplasty using traditional techniques. We believe the indications for cartilage tympanoplasty (atelectatic ear, cholesteatoma, high-risk perforation) were validated by these results. Key Words: Cartilage tympanoplasty, cholesteatoma, high-risk perforation, atelectatic ear, hearing outcomes.