Objective To investigate the clinical value of otoendoscopic surgery for cholesteatoma of middle ear mastoid process through external auditory canal.Methods A C-shaped incision was made in the external auditory canal and then the external auditory canal flap was separated to expose the tympanic anulus.If the flaccid part of the eardrum was perforated,the tympanic anulus was lifted.If the pars tensa membranae tympani was perforated,the anterior inferior tympanic anulus was preserved to expose the tympanic cavity,and the granulation tissue was removed within the tympanic cavity.Under the continuous perfusion,the bone of the lateral wall of the upper tympanic cavity was grinded,the cholesteatoma around the attic and auditory ossicles was removed,the bone of the mastoid was grinded,and the mastoid cavity cholesteatoma was removed.Gelatin sponge support was placed in mastoid cavity and tympanic cavity.According to the degree of destruction of the auditory ossicles,different types of artificial ossicles were placed.Tragus cartilage covered with perichondrium or biofilm was placed on the surface of mastoid cavity and attic.The tympanic membrane was repaired by tragus perichondrium built-in method or tragus cartilage-perichondrium dissection method.Finally,the external auditory canal flap was paved and the surgical cavity was filled.Results The median threshold of airway hearing was 52.0 dB HL (range,33.8-67.5 dB HL) before surgery,which was significantly higher than that at 6 months after surgery[25.0 dB HL (range,15.0-50.0 dB HL),Z=-6.454,P=0.000].The median threshold of airway bone conduction hearing before the operation was 35.0 dB HL (range,21.2-52.5 dB HL),which was significantly higher than that at 6 months after surgery[15.0 dB HL (range,3.8-27.5 dB HL),Z=-6.453,P=0.000].All the patients were followed up at 2 weeks,and 1,3,and 6 months after surgery.Afterwards,follow-ups were performed every 3 months until 24 months after surgery.All the patients had good tympanum healing,and 2 patients had recurrence at 1 year after surgery.All the patients had no complications such as facial paralysis or sensorineural deafness.Conclusions Combining continuous and non-continuous perfusion,otoendoscopic surgery for cholesteatoma of middle ear mastoid process through external auditory canal has a high healing rate of eardrum,few complications,and significant postoperative hearing improvement.It is a minimally invasive,safe,and effective surgical method.
维普
万方数据