耳内镜下鼓膜成形术

我科2005-06-2009-08在耳内镜下行鼓膜成形术67例,疗效满意,报告如下。1资料与方法1.1一般资料67例患者中,男29例,女38例;年龄16～57岁,平均33.4岁。其中左耳39例,右耳28例,均为单耳。外伤性穿孔43例(64.2%),包括掌击伤     

耳屏软骨-软骨膜鼓膜成形术的疗效观察

目的探讨耳屏软骨软-骨膜作为移植材料用于鼓膜大穿孔修补术的临床效果。方法对我院2006年4月～2009年4月收治的96例(96耳)鼓膜紧张部大穿孔病例，采用自体耳屏软骨-软骨膜作为移植材料完成I型鼓室成型术，所有病例均采用内植法I期完成，并与同期用颞肌筋膜修补的82耳相同病变进行比较。术后对鼓膜愈合情况、听力恢复效果等进行定期观察。结果软骨-软骨膜复合物行鼓膜修补术鼓膜愈合的长期有效率为97．9％（94/96)；颞肌筋膜组为96.3%(79/82)。两组的听力结果差异无统计学意义。随访2年，听力检测结果稳定。结论对于紧张部大穿孔的病例采用耳屏软骨-软骨膜复合物行鼓膜修复术是可行的，并获得满意的听力效果。     

Peri-umbilical superficial fascial graft myringoplasty—a simple alternative

We present new material in the surgical repair of the perforated tympanic membrane. Forty-two patients with a unilateral tympanic membrane perforation and eight patients with bilateral perforations had their perforations closed with peri-umbilical superficial fascia via a transtympanic route. Of the 58 tympanic membranes repaired, 51 were successful while seven failed. The technique is cost-effective and quick, making bilateral repairs possible under the same anaesthetic.     

用异种组织“长杭825”行鼓膜成形术的实验研究

本实验研究对异种组织“长杭825”(CH)进行了光镜、透射及扫描电镜下组织学观察及氨基酸测定,以兔硬脑膜(DM)做对照。发现CH的胶原纤维束与人鼓膜近似,CH中未见细胞;氨基酸测定显示CH中酪氨酸含量约为DM的1/8,谷氨酸、赖氨酸含量也少于DM。推测其抗原性较低。用大耳白兔行鼓膜成形术,结果表明:两种材料同属支架组织移植。CH手术成功率为91.6％,DM成功率95.8％,二者无统计学差异(P>0.05)。两种材料分别在同一只兔子的背部两侧皮下埋藏进行自身对照,结果表明:CH与DM组织学反应无统计学差异(p>0.05)。     

Myringoplasty and tympanoplasty—results related to training and experience

The results of surgery in a series of 452 ears having either myringoplasty (281 ears) or tympanoplasty (171 ears) were studied in relation to the experience of the surgeons. The trainees received an annual course in temporal bone dissection and were given daily surgical instruction in the operating theatre. The 142 ears operated by them showed less disease than those operated upon by the programme chairman (114 ears) and by the faculty (196 ears). The performance of the trainees was safe, and as to healed tympanic membrane and hearing results all studied parameters were statistically equal to those of the faculty. Repair of anterior perforations proved to be the most difficult and the overall results of both the faculty and trainees left place for improvement. On-line recording of surgical data and annual evaluation of an individual surgeon's results is suggested as a necessary means for continuous post-graduate training.     

The internal carotid artery in relation to middle ear surgery

The paper describes three cases of an unusual and serious vascular problem encountered during middle ear surgery, involving a markedly abnormal course of the internal carotid artery. The management of these cases, and a review of the features of other arterial anomalies encountered in the middle ear is presented.     

耳后进路全翻-内植法鼓膜成形术138例临床分析

目的探讨鼓膜成形术的改进术式。方法采用耳后进路,取乳突骨膜作为移植材料,分离外耳道后壁皮瓣,连同残余鼓膜后缘全部翻转向前,于皮瓣下植入乳突骨膜封闭穿孔的方法行鼓膜成形术138例,观察疗效。结果鼓膜穿孔一期愈合132例(95．65％),术后3个月内患者听力均有不同程度提高,随访1年以上无穿孔复发。结论本术式术野显露清晰,取膜及手术可经同一切口进行,受穿孔面积及位置因素影响较小,适用范围宽,成功率高,有广泛应用价值。     

Optimal graft thickness for different sizes of tympanic membrane perforation in cartilage myringoplasty: a finite element analysis

OBJECTIVE: The purpose of this study was to determine, using finite element analysis, the optimal graft thickness for cartilage myringoplasty in patients with different sizes of tympanic membrane (TM) perforations. STUDY DESIGN: We developed a cartilage plate-TM-coupled model using high-resolution computed tomography and finite element analysis. The geometric models of the perforated TM were generated using Patran and ANSYS software. METHOD: Three different sizes of TM perforations (15%, 55%, and 85%, representing small, medium, and large perforations, respectively) were created in the pars tensa. A cartilage plate was used to repair the eardrum perforation, and the new TM-cartilage coupled complex was loaded into our three-dimensional biomechanical model for analysis. The frequency-amplitude responses for different cartilage thicknesses were compared with those for natural TM. RESULTS: Our results show that, first, in cases with 85% perforation, the frequency-amplitude responses that were most similar to natural TM at lower frequencies were for graft thicknesses of 0.2 mm and for 0.1 mm at higher frequencies. Second, in cases with 55% posterior perforation of the TM, assessment of the predicted vibration amplitude of different thicknesses of the cartilage plate showed that a cartilage plate of less than 0.2 mm had a frequency response function similar to that of a natural TM in umbo and stapes footplate displacement. Finally, for a central perforation involving 15% of the TM, a cartilage plate of less than 1.0 mm showed a frequency response function similar to that of TM in umbo and stapes-footplate displacement. CONCLUSIONS: On the basis of our biomechanical analysis, the optimal thickness of a cartilage graft for myringoplasty appears to be 0.1 to 0.2 mm for medium and large TM perforations. For small perforations, a cartilage of less than 1.0 mm is a good compromise between mechanical stability and low acoustic transfer loss.     

Does flying after myringoplasty affect graft take rates?

Does flying after myringoplasty affect graft take rates? Flying at altitude soon after myringoplasty may theoretically have an adverse effect on graft take rates owing to variation in external air pressure, together with suboptimal Eustachian tube function, causing graft displacement. We wished to assess the effect of flying after myringoplasty by comparing success rates of patients flying within a week postoperatively (n = 37) with a control group (n = 37) by carrying out a retrospective, controlled cohort study. The primary outcome measure was graft success, defined as a 100% closure at first outpatient follow‐up (2.5 months). Our results showed that there was no difference in early graft success rates between the flying group (32/37: 86%) and non‐flying group (29/37: 78%)(P = 0.32; 95% CI of difference: −9% to 27%). In conclusion, flying at altitude in a pressurized environment within a week of myringoplasty does not adversely affect early operative success.