The hearing outcomes of modified canal wall down and canal wall up mastoidectomy and tympanoplasty
10.3760/cma.j.cn115330-20191015-00625
- VernacularTitle:开放式和完壁式乳突根治鼓室成形术后听力学效果分析
- Author:
Yu WANG
1
;
Tao PAN
;
Zhaoyi LU
;
Furong MA
Author Information
1. 北京大学第三医院耳鼻咽喉头颈外科 100191
- Keywords:
Tympanoplasty;
Mastoid;
Auditory threshold
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2020;55(8):748-753
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the effect of hearing improvement after canal wall down mastoidectomy and tympanoplasty(CWDM) and canal wall up mastoidectomy and tympanoplasty(CWUM).Methods:88 patients who underwent CWDM or CWUM in 2014-2017 with complete follow-up data were retrospectively studied. There were 45 males and 43 females, aged 12-68 years old, and the average follow-up time was 12.3 months. Among them, 42 cases underwent CWDM and 46 cases underwent CWUM. A series of improvements were made in the clinical practice of CWDM: (1) to expand the indications properly, including limited lesions with sclerotic mastoid and narrow tympanic sinus; (2) to form disciform cavity strictly during operation in order to retain the appropriate height of facial nerve crest; (3) to avoid the cleaning of mastoid cavity in the post-operation follow up, thus the operative cavity was effectively constricted; and (4) to transfer the temporal muscle flap in pneumatic mastoid to reduce the cavity. The condition of dry ear and the size of cavity were observed after operation. The average pure tone threshold (PTA) before/after operation and threshold changes of each frequency were compared between the two groups. SPSS 19.0 software was used to analyze the data.Results:The mastoid cavity of CWDM was significantly narrowed after operation and the width of the external auditory canal was close to the CWUM group. The postoperative PTA of the CWDM and CWUM group was reduced by 11.4 dB and 10.4 dB respectively, with no significant difference ( t=0.290, P=0.770). The average value of bone conduction threshold after operation was reduced by 1.8 dB and 1.9 dB respectively, with no significant difference ( t=-0.076, P=0.940). The mean value of ABG after operation was shortened by 9.6 dB and 8.4 dB respectively, with no significant difference ( t=-0.370, P=0.712). The threshold decrease of 1 000 Hz of CWUM was slightly better than that of CWDM, and the threshold decreases of the other frequencies of CWDM were slightly better than those of CWUM, however, the differences were not statistically significant ( P>0.05). Conclusion:Through the adjustment of indications and a series of intraoperative and postoperative improvements, CWDM can achieve the same effect of postoperative hearing improvement as CWUM.
