[Surgical approach and efficacy evaluation for tympanosclerosis under endoscopic surgery]
- PMID: 41073293
- DOI: 10.3760/cma.j.cn115330-20241003-00556
[Surgical approach and efficacy evaluation for tympanosclerosis under endoscopic surgery]
Abstract
Objective: To evaluate the surgical management and clinical efficacy of endoscopic operation for tympanosclerosis (TS). Methods: A retrospective analysis was conducted on 228 patients with TS who underwent endoscopic surgery at Shaanxi Provincial People's Hospital between January 2019 and December 2023. There were 79 males and 149 females, aged 18-68 years (median 50 years). Surgical management, perforation healing rate, pre-and post-operate hearing characteristics, and complications were analyzed. The air conduction threshold values at 500 Hz, 1 000 Hz, 2 000 Hz and 4 000 Hz, average air conduction pure tune audiometry (AC-PTA), and air-bone conduction (ABG) pre-and post-operation were compared. Statistical analysis was performed using SPSS 25.0. Results: All 132 cases of type Ⅰ tympanosclerosis underwent myringoplasty. Among 55 cases with type Ⅱ tympanosclerosis, 33 (60.0%) received typeⅠand 22 (40.0%) received type Ⅱ tympanoplasty. Of 16 cases with type Ⅲ tympanosclerosis, 10 (62.5%) underwent type Ⅰand 6 (37.5%) underwent type Ⅱtympanoplasty. Among 25 cases with type Ⅳ, 5 (20.0%) underwent type Ⅰ, 13 (52.0%) type Ⅱ, and 3 (12.0%) type Ⅲ tympanoplasty, while, 4 (16.0%) underwent tympanoplasty with autologous cartilage. The average follow-up period was 8.2 months (6 months to 3 years); The overall healing rate of the tympanic perforation was (97.8%)223/228. All cases exhibited improved air conduction hearing threshold at all frequencies, AC-PTA and ABG postoperatively. The differences between types Ⅰ, Ⅱ at 500 Hz, 1 000 Hz, 2 000 Hz, 4 000 Hz, AC-PTA and ABG were statistically significant (all P<0.001 for type Ⅰ, all P<0.05 for type Ⅱ). In type Ⅲ, improvements were significant for all tested parameters except at 4 000 Hz (all P<0.05) and no statistically significant difference were found in type Ⅳ. No severe complications such as profound sensorineural hearing loss or facial nerve paralysis were encountered. Conclusion: Totally, endoscopic transcanal surgery is an effective management for tympanosclerosis, providing favorable short-term hearing outcomes with an acceptable safety profile.
目的： 探讨全耳内镜下治疗鼓室硬化的手术方式及临床疗效。 方法： 回顾性分析2019年1月至2023年12月于陕西省人民医院行全耳内镜手术治疗的鼓室硬化患者228例，其中男79例，女149例；年龄18~68岁，中位年龄50岁；分析各型鼓室硬化症患者手术方式选择、穿孔愈合率、术前听力特点及并发症情况，比较手术前后各频率气导阈值、平均气导听阈及气骨导差。以SPSS 25.0软件对数据进行统计学分析。 结果： 132例Ⅰ型鼓室硬化症患者均行Ⅰ型鼓室成形术；55例Ⅱ型鼓室硬化患者中行Ⅰ、Ⅱ型鼓室成形术的分别为33例（60.0%）和22例（40.0%）；16例Ⅲ型鼓室硬化患者中行Ⅰ、Ⅱ型鼓室成形术的分别为10例（62.5%）和6例（37.5%）；25例Ⅳ型鼓室硬化患者中行Ⅰ、Ⅱ、Ⅲ型鼓室成形术的分别为5例（20.0%）、13例（52.0%）和3例（12.0%），4例行自体软骨架高鼓室成形（16.0%）。术后平均随访8.2个月（6个月至3年），鼓膜愈合率97.8%（223/228）。所有患者各频率气导听阈、气导平均听阈较术前均提高，气骨导差较术前降低。Ⅰ、Ⅱ型各频率听阈、气导平均听阈及气骨导差与术前相比差异有统计学意义，Ⅰ型（P值均<0.001），Ⅱ型（P值均<0.05）；Ⅲ型除4 000 Hz 外，其余各频率、气导平均听阈及气骨导差与术前相比差异有统计学意义（P值均<0.05）；Ⅳ型与术前相比差异无统计学意义。所有患者术后均未出现重度感音神经性聋、面神经麻痹等严重并发症。 结论： 全耳内镜下经外耳道手术是治疗鼓室硬化的有效方法，术后短期听力改善良好且安全。.