目的:穿孔边缘的修剪和外耳道(EAC)的填塞是修复慢性穿孔的基础方法。这项研究的目的是比较手术时间,移植结果,听力改善,以及在儿童中有或没有修剪穿孔边缘和EAC填塞的情况下内窥镜软骨下膜成形术的并发症。
方法:前瞻性,随机研究。
方法:三级转诊中心。
方法:将12岁以上慢性穿孔的小儿患者随机分为两组:穿孔切缘和EAC填塞(TPME)组或不穿孔切缘和EAC填塞(NTPME)组。操作时间,移植成功率,听力改善,比较两组并发症发生情况。
结果:52名患者最终被纳入研究。TPME组平均手术时间为31.4±4.2min,NTPME组平均手术时间为23.6±1.7min,差异有统计学意义(P<0.01)。TPME组和NTPME组的听觉饱满度率显着差异(P=0.000)。所有参与者均随访12个月;两组之间的移植成功率没有显着差异(88.5%vs.96.2%;P=0.603)。没有患者发生粘连性中耳炎。在术前和术后测量之间,TPME组的平均气-骨间隙改善了10.2±2.8dB,NTPME组的平均气-骨间隙改善了11.6±0.7dB;这在两组中是显著的(P<0.001)。
结论:与TPME技术相比,内窥镜软骨下膜鼓膜成形术NTPME缩短了手术时间,避免了听觉饱胀和EAC不适;但是,两种修复儿童大穿孔的技术在移植成功率和听力改善方面具有可比性。
OBJECTIVE: Trimming of perforation margins and external auditory canal (EAC) packing are basic procedures in underlay myringoplasty for repairing chronic perforations. The objective of this study was to compare the operation time, graft outcome, hearing improvement, and complications of endoscopic cartilage underlay myringoplasty with and without trimming of perforation margins and EAC packing in children.
METHODS: Prospective, randomized study.
METHODS: Tertiary referral center.
METHODS: Pediatric patients older than 12 years with chronic perforations were randomly divided into two groups: myringoplasty with trimming of perforation margin and EAC packing (TPME) group or no trimming of perforation margin and EAC packing (NTPME) group. The operation time, graft success rate, hearing improvement, and complications were compared between the two groups.
RESULTS: Fifty-two patients were ultimately included in the study. The mean operation time was 31.4 ± 4.2 min in the TPME group and 23.6 ± 1.7 min in the NTPME group; the difference was significant (P < 0.01). The rate of aural fullness significantly differed between the TPME and NTPME groups (P = 0.000). All participants were followed up for 12 months; the graft success rate did not significantly differ between the groups (88.5% vs. 96.2%; P = 0.603). No patients developed adhesive otitis media. Between the preoperative and postoperative measurements, the mean air-bone gap improved by 10.2 ± 2.8 dB in the TPME group and 11.6 ± 0.7 dB in the NTPME group; this was significant (P < 0.001) in both groups.
CONCLUSIONS: Endoscopic cartilage underlay myringoplasty NTPME shorted the operation time and avoided aural fullness and EAC discomfort compared with the TPME technique; however, graft success and hearing improvement were comparable between the two techniques for repairing large perforations in children.