A. Jha, Sanjeev Nirala, M. K. Sah, Kamaluddin Rain
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摘要

背景:慢性中耳炎通常因鼓膜穿孔而并发,最终导致听力丧失。本研究的目的是比较单独鼓膜成形术和皮质乳突切除术在COM(慢性中耳炎)粘膜失活型患者中移植物摄取方面的结果。方法:本研究为描述性、前瞻性、定性研究。本研究共纳入30例COM粘膜失活型患者,其中15例选择单独行鼓膜成形术,另外15例选择鼓膜成形术联合皮质乳突切除术。术前1周内进行纯音测听。6周后评估移植物摄取,并使用卡方检验比较组内和组间结果。结果:单纯鼓膜成形术与颞筋膜移植物加衬底技术行皮层乳突切除鼓膜成形术的移植物吸收率为86.66% (n=26),失败率为13.33% (n=4)。在小穿孔中移植物占88.9%(n=8),中等穿孔中移植物占85%,次全穿孔中移植物占79%。移植物摄取率以中央孔最高(86.9%),其次为后孔(84.6%),前孔最低(77.7%)。平均发病年龄27.7岁,年龄从15岁到60岁不等。在鼓膜成形术中,最常见的入路是渗透入路,在鼓膜成形术合并皮质乳突切除术的情况下,最常见的入路是姿势入路。结论:单纯鼓膜成形术的移植物吸收率与鼓膜成形术联合皮质乳突切除术的吸收率相当。手术的选择取决于外科医生的喜好。
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SURGICAL OUTCOME OF MYRINGOPLASTY WITH AND WITHOUT CORTICAL MASTOIDECTOMY IN CHRONIC OTITIS MEDIA MUCOSAL INACTIVE TYPE
Background: Chronic otitis media is usually complicated due to perforation of tympanic membrane and ultimately leading to hearing loss. The objective of this study was to compare the results of myringoplasty alone with myringoplasty with cortical mastoidectomy in COM (Chronic Otitis Media) mucosal inactive type in terms of graft uptake. Methods: This was a descriptive, prospective, qualitative type of study. A total of thirty patients of COM mucosal inactive type were included in the study of which 15 patients were selected alternatively for myringoplasty alone while another 15 patients were selected for myringoplasty with cortical mastoidectomy. Pure tone audiometry was done within 1 week prior to surgery. Graft uptake was assessed after 6 weeks and results were compared within and between the groups using Chi-square test. Results: Graft uptake rate of myringoplasty alone and myringoplasty with cortical mastoidectomy done using temporalis fascia graft and underlay technique was same 86.66% (n=26) and failure rate was 13.33% (n=4).The graft take was higher 88.9%(n=8) in small perforation worsened in medium (85 %) and then in subtotal perforation (79%). Graft uptake rate was highest in central perforation (86.9%) followed by posterior perforation (84.6%) and least in anterior perforation (77.7%). Mean age of presentation was 27.7 years, ranging from 15 to 60 years. Most common approach was permeatal in myringoplasty and postaural in case of myringoplasty with cortical mastoidectomy. Conclusions: The graft uptake rate myringoplasty alone are comparable to those of myringoplasty with cortical mastoidectomy. The choice of surgery is based on surgeon’s preference.
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