耳内镜下鼓室成形术治疗粘连性中耳炎的疗效及安全性分析

Efficacy and Safety of Endoscopic Tympanoplasty in Treating Adhesive Otitis Media

摘要: 目的：研究耳内镜下经外耳道鼓室成形术治疗粘连性中耳炎的临床效果和安全性，并探讨其在恢复中耳通气功能中的优势。方法：本研究回顾性分析了2021年至2023年间，在我科接受耳内镜手术治疗的粘连性中耳炎患者共21例(21耳)。患者术前均进行了详细的耳科检查、听力测试和颞骨CT扫描。手术方式采用经外耳道入路的全耳内镜手术，并根据病变范围行不同类型的鼓室成形术。术后1个月、3个月及6个月进行随访，观察患者术后的症状、鼓膜愈合率、听力改善情况及并发症。结果：共纳入21例粘连性中耳炎患者，其中9例行I型鼓室成形术，4例行II型鼓室成形术，8例行III型鼓室成形术。术后随访期内，所有手术耳无耳漏，鼓膜愈合率达到90.48% (19/21)。术前平均气导听阈为 43.57 ± 12.66 dB HL，术后降低至31.31 ± 8.85 dB HL，差异显著(P < 0.05)。术前平均气骨导差为21.31 ± 7.26 dB HL，术后缩小至8.93 ± 4.23 dB HL，差异显著(P < 0.05)。所有患者无面瘫等严重并发症发生。结论：耳内镜手术是一种安全、有效地治疗粘连性中耳炎的手术方式，尤其对于恢复中耳通气功能具有显著效果。

Abstract: Objective: To evaluate the clinical efficacy and safety of endoscopic transcanal tympanoplasty for adhesive otitis media (AOM) and explore its advantages in restoring middle ear ventilation. Methods: This retrospective study included 21 patients (21 ears) with AOM who underwent endoscopic ear surgery between 2021 and 2023. All patients underwent preoperative otoscopic examination, audiometry, and temporal bone CT. A purely endoscopic transcanal approach was used, with tympanoplasty types tailored to the extent of disease. Follow-up assessments at 1, 3, and 6 months postoperatively evaluated symptoms, tympanic membrane (TM) healing rate, audiometric outcomes, and complications. Results: Among 21 patients, 9 underwent type I, 4 type II, and 8 type III tympanoplasty. During follow-up, no otorrhea occurred, and the TM healing rate was 90.48% (19/21). Mean air conduction threshold improved significantly from 43.57 ± 12.66 dB HL preoperatively to 31.31 ± 8.85 dB HL postoperatively (P < 0.05). Mean air-bone gap decreased significantly from 21.31 ± 7.26 dB HL to 8.93 ± 4.23 dB HL (P < 0.05). No major complications such as facial nerve paralysis were observed. Conclusion: Endoscopic transcanal tympanoplasty is a safe and effective treatment for AOM, particularly in restoring middle ear ventilation.