Effect of myringoplasty under otoendoscope on poor air-bone conductivity and prognosis of patients with traumatic tympanic membrane perforation
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摘要:
目的 观察耳内镜下鼓膜修补术治疗外伤性鼓膜穿孔患者的效果及其对患者气骨导差的影响。 方法 纳入2019年1月~2021年2月本院收治的40例外伤性鼓膜穿孔患者，在充分告知本研究设计思路后，均开展耳内镜下鼓膜修补术，观察患者治疗效果、听力情况(对比患者术前、术后1月及术后3月气导听阈和气骨导差情况)及疼痛程度[术前、术后1 d、出院时，采用视觉模拟评分法(VAS)]。 结果 40例外伤性鼓膜大穿孔患者经耳内镜下鼓膜修补术治疗后，显效28例，有效10例，无效2例，治疗总有效率95.00%。40例患者经耳内镜鼓膜修补术治疗后，与术前相比，术后1月及术后3月气导听阈、气骨导差均较低，差异有统计学意义(P < 0.001)；与术前相比，术后1 d、出院时，患者VAS评分均下降，术前、术后1 d及住院时3个时间段患者VAS评分的差异有统计学意义(P < 0.001)；术前与术后1 d患者VAS评分的差异无统计学意义(P > 0.05)，与术前相比，出院时患者VAS评分较低，差异有统计学意义(P < 0.05)。 结论 外伤性鼓膜穿孔患者采取耳内镜下鼓膜修补术，手术治疗效果显著，利于术后听力恢复，缓解疼痛程度，建议在临床外伤性鼓膜穿孔患者中大范围开展。 Abstract:Objective To observe the effect of myringoplasty under otoendoscope in the treatment of traumatic tympanic membrane perforation and its effect on the poor air- bone conductivity of patients. Methods A total of 40 patients with traumatic tympanic membrane perforation were included from January 2019 to February 2021. After fully informing the design ideas of this study, all included patients underwent otoscopic myringoplasty. The treatment effect, hearing condition (comparison of patients' air conduction hearing threshold and air- bone conduction difference before operation, one month after operation, and three months after operation) and pain severity were observed [visual analogue scale (VAS) was used before operation, 1d after operation, and at discharge]. Results Among the 40 patients with traumatic large perforation of tympanic membrane treated by endoscopic myringoplasty, 28 cases were markedly improved, 10 cases were effective, and 2 cases were ineffective, the total effective rate was 95.00%. After treatment with otoscopic myringoplasty, the air conduction hearing threshold and air-bone conduction difference were lower one month after operation and three months after operation compared with those before operation, and the difference was statistically significant (P < 0.001). After treatment with endoscopic myringoplasty, their VAS scores were decreased 1 d after operation and at the time of discharge compared with those before operation, the VAS score of the patients before operation, 1 d after operation and during hospitalization showed statistical significance (P < 0.001); There was no significant difference in VAS score between pre-surgery and 1 d post-surgery (P > 0.05); Compared with pre-surgery, VAS score of patients at discharge was lower and the difference was statistically significant (P < 0.05). Conclusion Endoscopic myringoplasty is effective for patients with traumatic tympanic membrane perforation, which is beneficial to postoperative hearing recovery and pain relief. It is recommended to widely carry out used in clinical patients with traumatic tympanic membrane perforation. -
图 1 外伤性鼓膜大穿孔患者内镜所示及耳内镜鼓膜修补术修补前(左侧)与修补后(右侧)
Figure 1. Endoscopy of patients with traumatic large perforation of the tympanic membrane, as well as before (left) and after (right) ear endoscopic repair of the tympanic membrane.
表 1 不同时段听力恢复情况对比
Table 1. Comparison of hearing recovery of patients (n=40, Mean±SD)
Time Air conduction auditory threshold(kHz) Air bone gap(dB) Preoperative 42.02±4.56 26.56±4.25 1 month after surgery 31.22±5.68a 18.05±4.21a 3 months after surgery 22.56±4.25ab 9.22±1.89ab F 160.388 229.207 P < 0.001 < 0.001 aP < 0.05 vs preoperative; bP < 0.05 vs 1 month after surgery. 
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[1] Eldaebes MMAS, Landry TG, Bance ML. Effects of cartilage overlay on the tympanic membrane: lessons from a temporal bone study for cartilage tympanoplasty[J]. Otol Neurotol, 2018, 39(8): 995-1004. doi: 10.1097/MAO.0000000000001888 [2] 侯晓燕, 孙敬武, 孙家强. 耳内镜下软骨膜-软骨岛在鼓膜修补术中应用的效果分析[J]. 中国耳鼻咽喉头颈外科, 2020, 27(7): 386-9. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT202007006.htm [3] 杨礼宏, 陈登胜, 刘忠意, 等. 耳内镜下嵌入蝶形软骨鼓膜成形术治疗鼓膜前缘穿孔效果及对患者听力恢复的影响[J]. 临床和实验医学杂志, 2021, 20(1): 107-10. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLC202101031.htm [4] Dursun E, Demir E, Terzi S, et al. Endoscopic type 1 cartilage tympanoplasty in children[J]. Int J Pediatr Otorhinolaryngol, 2020, 131(25): 215-8. [5] 钟晓声, 范绍翀, 杨海弟. 耳内镜下鼓室探查和鼓室成形术可行性及疗效分析[J]. 中国耳鼻咽喉头颈外科, 2019, 26(7): 354-7. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT201907005.htm [6] 朱跃新, 胡春波, 陈恺铮, 等. 显微镜和耳内镜下鼓膜修补术对麻醉管理和患者早期恢复的影响[J]. 中国眼耳鼻喉科杂志, 2019, 19(5): 342-4, 348. https://www.cnki.com.cn/Article/CJFDTOTAL-YRBH201905014.htm [7] 周庆, 刘雄光, 吴昌林, 等. 耳内镜下耳屏软骨环-软骨膜修补术治疗鼓膜穿孔40例[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 226. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYU201806016.htm [8] 付莲英, 段淑云, 万水珍. 视觉模拟评分法在病人满意度调查中的应用[J]. 中国护理管理, 2008, 8(9): 66-9. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL200809029.htm [9] Hanege FM, Karaca S, Kalcioglu MT, et al. Comparing spontaneous closure and paper patching in traumatic tympanic membrane perforations[J]. J Craniofacial Surg, 2018, 29(7): 1922-4. doi: 10.1097/SCS.0000000000005047 [10] Schwam ZG, Cosetti MK. Endoscopic myringoplasty and type I tympanoplasty[J]. Otolaryngol Clin N Am, 2021, 54(1): 75-88. doi: 10.1016/j.otc.2020.09.010 [11] 刘红, 付宝花, 温立婷, 等. 耳内镜下鼓膜修补术与显微镜下鼓膜修补术的对比观察[J]. 中国医药导报, 2018, 15(24): 117-20. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201824030.htm [12] Lee YC, Chao WC. Transcanal endoscopic type I tympanoplasty using nasal septal perichondrium with concomitant septoturbinoplasty: our experience in eighteen patients[J]. Clin Otolaryngol, 2020, 45(3): 419-23. doi: 10.1111/coa.13512 [13] 姜妍, 李江平, 王鹏举. 耳内镜下鼓室成形术鼓膜穿孔修复材料的比较[J]. 听力学及言语疾病杂志, 2019, 27(6): 623-5. https://www.cnki.com.cn/Article/CJFDTOTAL-TLXJ201906010.htm [14] Hassannia F, Lee J, Rutka JA. Delayed failure in tympanoplasty: a 20-year study of the incidence and reasons for re-perforation in 359 patients[J]. Clin Otolaryngol, 2020, 45(3): 429-31. [15] Torre Carlos DL, Carolina V, Perla V. Middle ear risk index (MERI) as a prognostic factor for tympanoplasty success in children[J]. Int J Pediatr Otorhinolaryngol, 2021, 144: 110695. [16] 冀庆军, 柴伟, 黄辉, 等. 耳内镜与显微镜下夹层法修补鼓膜大穿孔的疗效比较[J]. 听力学及言语疾病杂志, 2020, 28(1): 92-4. https://www.cnki.com.cn/Article/CJFDTOTAL-TLXJ202001026.htm [17] List MA, Dirain CO, Haberman RS, et al. Efficacy of topical epinephrine in tympanoplasty[J]. Laryngoscope, 2021, 131(10): 2319-22. [18] Simon F, Thierry B, Rabeony T, et al. Long-term outcomes of cartilage tympanoplasty in 139 ears in children[[J]. Clin Otolaryngol, 2021, 46(6): 1395-9. [19] Tachibana T, Kariya S, Orita Y, et al. Spontaneous closure of traumatic tympanic membrane perforation following long-term observation[J]. Acta Oto Laryngol, 2019, 139(6): 487-91. [20] 吴照红. 耳内窥镜与耳科显微镜下耳屏软骨-软骨膜鼓膜修补术治疗鼓膜穿孔[J]. 中国现代手术学杂志, 2018, 22(3): 217-21. https://www.cnki.com.cn/Article/CJFDTOTAL-XDSS201803016.htm -
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