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目的探讨小儿胆脂瘤型中耳炎鼓室成形术最佳手术治疗策略。完壁式鼓室成形术和伴乳突根治的鼓室成形术作为治疗胆脂瘤型中耳炎的不同乳突处理方法,探讨其各自适应证及术后效果。方法对1997年4月—2003年10月间入院手术的4～14岁的胆脂瘤型中耳炎患者42例(45耳)的完整资料进行回顾性分析。随访时间为1～7年,平均(3.6±2.0)年。结果首次手术以完壁式鼓室成形术作为治疗方法的有20例(20耳),再发6耳,再发率30%,听力改善率77%(13/17);有22例(25耳)进行了伴乳突根治的鼓室成形术,再发1耳,再发率4%,听力改善率72%(18/25)。结论完壁式鼓室成形术具有保存生理性外耳道结构的优点,更有利于小儿胆脂瘤型中耳炎的治疗,但应常规行分期手术,克服易复发的缺点;对于分期手术时咽鼓管机能仍然较差者,建议改行伴乳突根治的鼓室成形术术式。
Objective To investigate the best surgical treatment of pediatric cholesteatoma otitis media tympanoplasty. Complete wall tympanoplasty and mastoid radical tympanoplasty as the treatment of cholesteatoma otitis media different mastoid approach to explore their respective indications and postoperative effects. Methods The data of 42 cases (45 ears) with cholesteatoma otitis media between 4 ~ 14 years admitted from April 1997 to October 2003 were analyzed retrospectively. Follow-up time was 1 to 7 years, with an average of (3.6 ± 2.0) years. Results For the first time, 20 cases (20 ears) were treated by wall tympanoplasty, and 6 cases were re-transmitted. The recurrence rate was 30% and the improvement rate of hearing was 77% (13/17). There were 22 cases (25 ears ) Were treated with tympanoplasty with mastoidectomy, with 1 second recurrence, a recurrence rate of 4% and a hearing improvement rate of 72% (18/25). Conclusion Endoscopic tympanoplasty has the advantages of preserving the structure of physiological external auditory meatus and is more conducive to the treatment of pediatric cholesteatoma otitis media, but should be routinely staged surgery to overcome the shortcomings of recurrence; eustachian tube function for staging surgery is still Poor, it is recommended to switch to mastoid radical tympanoplasty.