耳内镜下Ⅰ型鼓室成型术治疗慢性化脓性中耳炎伴外耳道真菌感染疗效分析OA
Endoscopic type Ⅰ tympanoplasty for chronic suppurative otitis media complicated by external auditory canal otomycosis
目的 探究慢性化脓性中耳炎伴外耳道真菌感染行耳内镜下Ⅰ型鼓室成型术的疗效.方法 回顾性选取2022年1月至2024年6月苏州大学附属第二医院耳鼻咽喉科收治的慢性化脓性中耳炎患者159例,依据术前检查及耳道病原菌培养结果将所有患者分为不伴真菌感染组(99例)、真菌感染干耳组(39例)和真菌感染湿耳组(21例).术后定期随访患者的鼓膜愈合、听力改善及外耳道等情况.结果 不伴真菌感染组患者术后3个月时97(97.9%)例患者鼓膜完全愈合,气导听力由术前(37.77±11.92)dB HL提高至(28.38±11.68)dB HL(P＜0.001);真菌感染干耳组患者术后3个月时37例(94.9%)患者鼓膜完全愈合,气导听力由术前(39.84±12.43)dB HL提高至(30.99±11.50)dB HL(P=0.002);真菌感染湿耳组患者术后3个月时20例(95.2%)患者鼓膜完全愈合,气导听力由术前(40.42±13.23)dB HL提高至(31.85±12.59)dB HL(P=0.038).3组患者的鼓膜愈合率差异无统计学意义(P=0.408).3组患者术后听力分别提高(8.94±4.09)dB HL、(8.56±3.40)dB HL、(9.35±3.27)dB HL,相比较差异无统计学意义(P=0.739).术后2周3组患者的干耳率分别为69.7%、66.7%、33.3%,不伴真菌感染组及真菌感染干耳组显著高于真菌感染湿耳组,差异有统计学意义(P=0.008),术后1个月干耳率分别为94.9%、92.3%、90.5%,差异无统计学意义(P=0.643).术后3个月干耳率为99.0%、97.4%、90.5%,差异无统计学意义(P=0.056).结论 对于不伴有听骨链病变的慢性化脓性中耳炎患者,合并外耳道真菌感染并非手术禁忌证,耳内窥镜下行Ⅰ型鼓室成型术可获得良好的鼓膜愈合率及听力改善,但术后干耳时间可能会延长.
Objective To report outcomes of endoscopic type Ⅰ tympanoplasty under for chronic suppurative otitis media(CSOM)complicated by fungal infection in the external auditory canal.Methods Cases of CSOM with complete medical records that underwent endoscopic type Ⅰ tympanoplasty at the Department of Otorhinolaryngology,the Second Affiliated Hospital of Soochow University,from January 2022 to June 2024(n=159)were retrospective analyzed.All patients were divided into groups based on presence/absence of fungal infection and ear discharge,i.e.no fungal infection(n=99),with fungal infection but dry ear(n=39),and with fungal infection and wet ear(n=21).All patients were followed up regularly after surgery.The rate of graft uptake,hearing improvement and conditions of external auditory canal were compared.Results The rate of tympanic membrane healing at 3rd months was 97.9%(97/99)in patients without fungal infection with the mean air conduction(AC)threshold improved from 37.77±11.92 dB HL preoperatively to 28.38±11.68 dB HL postoperatively(P＜0.001),94.9%(37/39)in patients with fungal infection but dry ear with the AC thresholds improved from 39.84±12.43 dB HL to 30.99±11.50 dB HL(P=0.002),and 95.2%(20/21)in patients with fungal infection and wet ear with the AC threshold improved from 40.42±13.23 dB HL to 31.85±12.59 dB HL(P=0.038),showing no significant difference among the three groups(P=0.408).Postoperative hearing improvement in the three groups was 8.94±4.09 dB HL,8.56±3.40 dB HL and 9.35±3.27 dB HL,respectively(P=0.739).The rate of dry ear at 2nd week after surgery for the three groups was higher in patients without fungal infection(69.7%)and those with fungal infection dry ear(66.7%)than in patients with fungal infection and wet ear(33.3%).The rate,however,was 94.9%,92.3%and 90.5%at 1st month after surgery,and 99.0%,97.4%and 90.5%at 3rd month after surgery for the three groups,respectively(P=0.056).Conclusions For patients without ossicular chain lesions,CSOM complicated by external auditory canal otomycosis is not a surgical contraindication.Endoscopic type Ⅰ tympanoplasty can achieve satisfactory graft uptake rates and hearing improvement.However,it should be noted that the dry ear time may be delayed in patients with wet ear preoperatively.
莫江伟;曹忠胜;罗颜
苏州大学附属第四医院(苏州市独墅湖医院)耳鼻咽喉头颈外科,江苏 苏州 215000苏州大学附属第二医院耳鼻咽喉头颈外科,江苏 苏州 215000苏州大学附属第二医院耳鼻咽喉头颈外科,江苏 苏州 215000
鼓室成型慢性化脓性中耳炎外耳道真菌耳内镜
tympanoplastychronic suppurative otitis mediaotomycosisoto-endoscope
《中华耳科学杂志》 2026 (8)
773-778,6
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