耳内镜下外耳道入路与耳后入路治疗粘连性中耳炎Ⅴ期特殊亚型的疗效评估OA

Objective To evaluate the selection of a transcanal endoscopic approach versus a postauricular approach for a special subtype of stage V adhesive otitis media(AdOM)and their impact on surgical outcomes.Methods A retrospective analysis was performed on 30 patients(32 ears)with stage V AdOM treated at Shandong Provincial Hospital Affiliated to Shandong First Medical University between December 2021 and June 2023.Based on their mastoid pneumatization,extent of lesion involvement and degree of ossicular destruction,patients underwent modified radical mastoidectomy via either transcanal endoscopic(25 patients,27 ears)or postauricular(5 patients,5 ears)approach.Preoperative clinical manifestations,audiological characteristics,and imaging findings were reviewed.Hearing improvement,anatomical reconstruction integrity and incidence of complications were compared between the two approaches.Results Postoperative follow-up showed significant hearing improvement overall.In the transcanal endoscopic group,the mean air-bone gap(ABG)decreased significantly after surgery(P<0.05),whereas no significant change in mean ABG was observed in the postauricular group(P>0.05).The tympanic membrane repair success rate was 96.9%(31/32),with 1 case of reperforation occurring at 2 years postoperatively.One patient developed delayed facial nerve palsy 10 days after surgery which fully recovered following 4 weeks of methylprednisolone pulse therapy.Conclusions Both surgical approaches have shown excellent efficacy in treating the special subtype of stage V adhesive otitis media.Individualized endoscopic ear surgery based on anatomical features can significantly improve the air-bone gap.An"anatomical subtype classification-functional assessment-approach selection"framework is recommended to optimize surgical decision-making and prognosis.