手术显微镜的推广与应用开创了现代耳显微外科的新纪元。近30年来，耳内镜技术经历了飞速发展，并广泛应用于从外耳道到内听道及侧颅底手术中，使得部分手术更加具有微创性，促使耳显微外科逐步向微创外科发展。目前，全耳内镜手术主要应用于外、中耳局限性非血管性病变。对于侧颅底病变，显微镜手术仍占主导，但耳内镜作为辅助工具，有助于减少手术创伤。手术工具的选择应基于疾病治疗理念和原则，结合各自的优势取长补短，从而做出适合于患者的最佳选择。.

BACKGROUND: The microscopic middle ear surgery involves a limited operating space and numerous important anatomical structures in which good visualization is crucial, as even a small amount of bleeding can greatly affect the clarity of surgical field. This study aims to investigate whether intravenous 1 g of tranexamic acid can improve surgical visualization and further shorten the operation time in microscopic middle ear surgery.
METHODS: This study is a prospective, randomized, double-blind, controlled trial conducted from December 2021 to December 2022, enrolling patients who were scheduled for microscopic modified radical mastoidectomy due to chronic otitis media. In addition to standard techniques to optimize the surgical field, participants were randomized into the TXA (tranexamic acid) group (1 g diluted to 20 ml normal saline) and the control group (20 ml normal saline). The primary outcome was assessed based on the clarity of the surgical field using the Modena Bleeding Score. Secondary outcomes included operation time, the surgeon satisfaction with the visual clarity, postoperative 24 h coagulation parameters, and the incidence of adverse events. Student\'s t -test, χ2 test, and ANOVA of repeated measures were used for statistical analyses.
RESULTS: A total of 28 patients were enrolled in each group using a 1:1 randomized allocation with similar demographic characteristics, including 24 male and 32 female individuals, and the mean age is 45.6±11.9 years. The surgical visualization in the TXA group was significantly better than that of the control group (2.29±0.46 vs. 2.89±0.31, P <0.001) as assessed by the Modena Bleeding Score. Furthermore, the TXA group demonstrated a shorter operation time compared to the control group (88.61±10.9 vs. 105.2±15.9, P <0.001) and higher surgeon satisfaction with surgical field (7.82±0.55 vs. 6.50±0.64, P <0.001). No statistically significant differences were found in postoperative coagulation parameters in the two groups. No TXA-related adverse events or complications occurred during the 12-month follow-up.
CONCLUSIONS: Intravenous 1 g of TXA can further significantly improve the visual clarity in the microscopic middle ear surgery and shorten the operation time based on other standard measures implemented.

UNASSIGNED: This study aimed to explore the ability of fusion images of non-echo planar diffusion-weighted magnetic resonance imaging (non-EPI-DWI MRI) and computed tomography (CT) to accurately locate cholesteatoma and plan the surgical approach.
UNASSIGNED: In the first part, 41 patients were included. Their CT images and non-EPI DWMRI images were fused. The scope of cholesteatoma in the fusion image was compared with that in the surgical video to evaluate the capability to locate cholesteatoma. A total of 229 patients were included in the second part, and they were divided into 2 groups. We chose the surgical approach for the CT group and the fusion group, and compared the accuracy of surgical approaches in the CT group and the fusion group using the surgical records.
UNASSIGNED: The location of cholesteatoma shown in the fusion images was almost identical to that observed during the operation (kappa = .862). The overall specificity and sensitivity of the fusion images in locating cholesteatoma were 94.12% and 93.06%, respectively. The accuracy of surgical approach selection based on the fusion images (99.02%) was higher than that of surgical approach selection based on the CT images (85.83%).
UNASSIGNED: It is recommended that the fusion images be used to locate the range of the cholesteatoma before operation.

The application of microscope is a milestone in the history of otosurgery, which makes otologists deal with middle ear lesions more clearly and finely, and helps otologists expand the scope of treatment to the lateral skull base area, which greatly promotes the development of otosurgery. In the past 20 years, with the continuous improvement of endoscopic equipment research and development and the gradual improvement of endoscopic technology, the application of endoscopic technology in China has shown an explosive development, and Chinese otolaryngologists have experienced from the initial attempts of endoscopic technology, to the widespread popularization of innovative and applicable technology, and then to the feasibility of exploring the future innovative concepts. Endoscopic technology is another revolutionary push for the development of otosurgery after the microscope.
摘要: 显微镜的应用在耳外科史上是具有里程碑式的意义，它使得耳科医生处理中耳病变更加清晰和精细，帮助耳科医生将处理范畴拓展至侧颅底区域，极大地推动了耳外科的发展。近20年来，随着内镜设备研发水平的不断提高和内镜技术的逐步完善，耳内镜技术在国内的应用呈现了爆发式的发展，中国耳科医生经历了从最初耳内镜技术的尝试，到创新适用技术的广泛推广普及，再至未来创新理念的可行性探索。耳内镜技术是继显微镜后，对耳外科发展的再次革命性推动。.

Objective: To explore the safety and reliability of retrosigmoid approach BONEBRIDGE implantation in patients with auricle reconstruction using skin expansion flap. Methods: A retrospective analysis was conducted on 43 congenital aural atresia cases (43 ears) who underwent BONEBRIDGE implantation from September 2019 to January 2023 in Beijing Tongren Hospital. 30 males and 13 females were included in this work. The implantation age was 9-36 years old (median age=10 y/o). All cases underwent auricle reconstruction surgery using the posterior ear flap expansion method, with 36 cases using the single expanded postauricular flap method and 7 cases using two-flap method. BONEBRIDGE implant surgery was performed during the third stage of auricle reconstruction or after all stages. The hearing improvements were evaluated by comparing the changes in pure tone hearing threshold and speech recognition rate of patients before and after BONEBRIDGE implantation. Routine follow-up was conducted to observe the hearing results and complications. SPSS 14.0 software was applied for data statistical analysis. Results: All 43 patients healed well and had no surgical complications when discharge. The average bone conduction hearing threshold after surgery was (8.2±6.6) dBHL, and there was no statistically significant difference compared to the preoperative [(8.1±5.7) dBHL] (P=0.95). After surgery, the threshold of hearing assistance with power on was significantly lower than that without hearing assistance [(32.8±4.6) dBHL vs (60.5±5.5) dBHL], and the difference was statistically significant (P<0.001). The speech recognition rate of monosyllable words, disyllabic words and short sentences in quiet environment increased to 72%, 84%, and 98% respectively. The differences were statistically significant (P<0.001). The speech recognition rate of monosyllabic words, disyllabic words, and short sentences in noise environment was significantly increased by 70%, 80%, and 92% respectively (P<0.001). After a follow-up of 4 to 47 months (median=24 months), the hearing results were stable and the aesthetic outcomes were satisfying. One patient had delayed hematoma around coil of the implant. After aspiration and compressed dressing for one week, hematoma was not recurrent. Conclusion: For patients after auricle reconstruction using expanded postauricular flap, the preference of retrosigmoid approach is a good choice in terms of safety and reliability of operation, as well as aesthetic appearance.
目的： 探讨主动选择乙状窦后骨桥植入在先天性外中耳畸形患者皮肤扩张法耳廓再造术后的安全性和可靠性。 方法： 回顾性分析2019年9月至2023年1月在首都医科大学附属北京同仁医院行骨桥植入的43例（43耳）先天性外中耳畸形外耳道骨性闭锁或狭窄患者的临床资料。其中男性30例，女性13例；接受骨桥植入术时年龄9~36岁，中位数年龄10岁。所有患者均采用耳后皮瓣扩张法耳廓再造手术，其中扩张单皮瓣法36例，扩张双皮瓣法7例。于第三期术中或三期耳廓再造术后行乙状窦后骨桥植入手术。通过比较骨桥植入前后患者纯音听阈和言语识别率的变化，评估其听力改善效果。术后定期随访观察听力效果及并发症发生情况。应用SPSS 14.0软件进行数据统计分析。 结果： 43例患者术后均一期愈合。术后平均骨导听阈为（8.2±6.6）dBHL，与术前［（8.1±5.7）dBHL］相比差异无统计学意义（P=0.95）。术后开机助听听阈较未助听条件下听阈明显下降［（32.8±4.6）dBHL比（60.5±5.5）dBHL］，差异有统计学意义（P<0.001）。骨桥助听后，患者安静环境下单音节词、双音节词及短句的言语识别率分别提高至72%、84%和98%，与非助听相比差异有统计学意义（P值均<0.001）；助听后噪声环境下单音节词、双音节词及短句的言语识别率分别提高至70%、80%和92%，与非助听相比差异有统计学意义（P值均<0.001）。术后随访4~47个月（中位数24个月），患者助听效果稳定，耳廓外形较好。1例患者在术后6个月时出现植入体线圈周围血肿，经穿刺引流及加压包扎后血肿消退，无复发。 结论： 对于耳后皮瓣扩张法耳廓再造术后的患者，主动选择乙状窦后骨桥植入，既可减少手术瘢痕，达到外形美观的效果，又能获得术后稳定的助听效果，手术安全可靠。.

Exoscope has been used in otoneurologic surgery in several reports. However, most ear surgeries are performed using either microscope or endoscopy today. The purpose of this study is to present our subjective and objective experience of using this instrument in our institution.
Sixteen ears with different severity and condition in 15 consecutive patients were enrolled. A questionnaire with 12 questions was sent to different participants, including surgeons, residents, medical students, and scrub nurses in the operation room. The total score and average score of each item were calculated and analyzed.
Exclusive exoscopic operation was performed on 13 patients with 14 procedures. A combination of endoscopy-exoscope and microscope-exoscope was used in one patient, respectively. There were no complications. Hearing recovery or disease extirpation was achieved in most patients. Twenty participants in the operation room filled out the questionnaire. There was no significant difference between the different groups. High ratings were reported in terms of image quality, stereoscopic effects, magnification rate, and the same field of view as the surgeon. Worse ratings were reported in items related to limited working space, increase in eye strain by video observation, and focusing difficulty.
Exoscopic ear surgery is feasible, safe, and effective in managing various otologic conditions involving external ear, middle ear, mastoid, and lateral skull base. Its high-definition image quality, stereoscopic effects, sufficient magnification, reliability and teaching value made it a potential instrument in general ear surgeries. Further improvements to current drawbacks can be anticipated.

Cartilage has undergone rapid development in ear surgery since Heermann used the grid cartilage technique to repair large perforations of the tympanic membrane. Cartilage has been widely used in tympanoplasty, ossicular chain reconstruction, reconstruction of the lateral wall of the upper tympanic cavity and the posterior wall of the external auditory canal due to its advantages of convenient sampling, high stability, good elasticity, low metabolic rate, easy survival and strong plasticity. This paper reviews the use of cartilage in tympanoplasty and discusses the possibility of placing cartilage on the stapes head for reconstruction of the auditory chain in type Ⅱ tympanoplasty.
摘要: 自Heermann采用条栅状软骨技术修补鼓膜大穿孔后，软骨在耳外科手术中获得了快速的发展。因软骨具有取材方便、稳定性高、弹性好、代谢率低、易于存活和可塑性强等优点，已广泛应用于鼓膜成形术、听骨链重建术、上鼓室外侧壁及外耳道后壁的重建中。本文就软骨在鼓室成形术中的应用作一综述，并探讨在Ⅱ型鼓室成形术中将软骨置于镫骨头上行听骨链重建的可能性。.

Objective: To introduce a new self-developed irrigation device(SID) that does not employ a sheath or an irrigation-suction system and evaluate to its efficiency in transcanal endoscopic ear surgery (TEES) for attic cholesteatoma. Methods: 38 patients who were subjected to TEES for attic cholesteatoma between October 2019 to June 2021 were included in this study, including 17 males and 21 females with an average age of (38.6±11.9) years. SID and underwater continuous drilling were used during operation. Width of endoscope and irrigation speed were measured when SID was applied. The operating time, surgical view and complications were compared between two groups. Results: The width of the endoscope was 3.5-4.6 mm in diameter and the irrigation speed was 20-40 ml/min when SID was used. SID cleaned the lens at the tip of the endoscope and created a clear field of view during TEES. The operation time was (86.6±18.1) min. The skin of the external ear canal was found injured during operation in 3 patients, but there were no complications such as necrosis of the flap, stenosis of external ear canal, sensorineural hearing loss, facial paralysis and cerebrospinal fluid leakage. Conclusions: SID is simple and enhances the efficacy of TEES, providing a new irrigation choice in TEES for attic cholesteatoma.
目的： 介绍一种简易的耳内镜持续灌流装置的制作，并观察其在上鼓室胆脂瘤手术中的应用。 方法： 回顾性分析2019年10月至2021年6月在西安交通大学第二附属医院接受持续灌流耳内镜上鼓室胆脂瘤手术的患者38例，其中男性17例，女性21例，年龄（38.6±11.9）岁。测量安装灌流装置后耳内镜的直径、使用该装置的灌流速度和手术的时间，分析术中术野暴露情况及术后并发症。 结果： 安装自制灌流装置后耳内镜直径为3.5~4.6 mm，灌流速度可达20~40 ml/min；持续灌流模式下术野清楚，手术时间为（86.6±18.1）min。3例患者术中出现耳道皮肤损伤。无皮瓣缺血坏死、耳道瘢痕狭窄、感音神经性听力损失、脑脊液漏及面神经麻痹等术后并发症。 结论： 该自制持续灌流装置简单、实用，为水下耳内镜上鼓室胆脂瘤手术灌流方式提供了一种新选择。.

OBJECTIVE: Facial canal dehiscence (FCD), typically found in the tympanic segment, is a risk factor for facial nerve injury. An imaging scoring method was proposed to identify FCD based on ultra-high-resolution CT.
METHODS: Forty patients (21 females and 19 males, mean age 44.3 ± 17.4 years), whose tympanic facial canal (FC) was examined during otological surgery, were divided into the FCD group (n = 29) and the control group (n = 11) based on surgical findings. Imaging appearance of tympanic FC was scored 0-3: 0 = no evident bony covering, 1 = discontinuous bony covering with linear deficiency, 2 = discontinuous bony covering with dotted deficiency, and 3 = continuous bony covering. Both lateral and inferior walls were assigned a score as LFCD and IFCD, respectively. An FCD score was calculated as LFCD + IFCD. The diagnostic value of the FCD score was tested using the ROC curve.
RESULTS: The inter-observer agreement was moderate for the lateral wall (Cohen\'s κ coefficient 0.416, 95% CI 0.193-0.639), and good for the inferior wall (Cohen\'s κ coefficient 0.702, 95% CI 0.516-0.888). In the FCD group, the most common appearance for both walls was discontinuous bony covering with linear deficiency (LFCD = 1, 22/29, 75.9%; IFCD = 1, 15/29, 51.7%). An FCD score of less than 4 was associated with high sensitivity (0.82) and specificity (0.93) for identifying FCD, with an AUC of 0.928.
CONCLUSIONS: Using the proposed scoring method, FCD score < 4 could identify FCD of the tympanic segment with high concordance with surgical findings.
CONCLUSIONS: • Imaging appearance of the tympanic facial canal (FC) is divided into four types based on ultra-high-resolution CT images. • The most common appearance of FC with facial canal dehiscence (FCD) is discontinuous bony covering with linear deficiency. • An FCD score, consisting of scores of the lateral and inferior walls, less than 4 is highly indicative of FCD.

暂无摘要。