老年慢性化脓性中耳炎患者Ⅰ型鼓室成形术的疗效分析  

Analysis of therapeutic effect of tympanoplasty type Ⅰ in elderly patients with chronic suppurative otitis media

作　　者：吴宏[1] 张帅[1] 伍瑜 梅凌云[1] 贺楚峰[1] 蔡鑫章[1] 蒋璐[1] 吴丽莎[1] 金毅[1] 吴学文[1] WU Hong;ZHANG Shuai;WU Yu;MEI Lingyun;HE Chufeng;CAI Xinzhang;JIANG Lu;WU Lisha;JIN Yi;WU Xuewen(Department of Otorhinolaryngology Head and Neck Surgery,Xiangya Hospital,Central South University,Hunan Provincial Key Laboratory of Major Otorhinolaryngology Diseases,National Clinical Research Center for Geriatric Diseases,Changsha,410008,China)

机构地区：[1]中南大学湘雅医院耳鼻咽喉头颈外科、耳鼻咽喉重大疾病湖南省重点实验室、国家老年疾病临床医学研究中心(湘雅医院),长沙410008

出　　处：《临床耳鼻咽喉头颈外科杂志》2023年第2期92-96,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：湖南省自然科学基金(No:2022JJ30969,2021JJ31108)。

摘　　要：目的:总结行Ⅰ型鼓室成形术的老年慢性化脓性中耳炎患者的临床特点,首次从医学数据、患者评价多角度分析老年患者Ⅰ型鼓室成形术的疗效,为医生和患者合理决策治疗手段提供参考。方法:回顾性分析2016年5月-2022年2月期间行Ⅰ型鼓室成形术的44例(45耳)老年患者资料,术后随访6个月~3年;对患者的临床特点进行分析,总结术后移植物成功率,比较患者术前、术后听力水平;通过慢性耳病调查表(CES)评价患者术前、术后的生活质量,将获取的数据进行统计学分析。结果:44例(45耳)患者中,10耳(22.22%)具有发病诱因,听力下降、耳流脓、耳鸣患者的术耳分别为41耳(91.11%)、40耳(88.89%)、19耳(42.22%);混合性聋患者有25耳(55.56%);经手术确诊为鼓室硬化的患者有30耳(66.67%);移植物成功率为97.78%,术前、术后的骨导听阈差异无统计学意义,气导听阈及气骨导差具有统计学意义;术前、术后CES的“活动限制”“症状”“医疗资源占用”评分及其总分具有统计学差异。高血压或糖尿病对老年患者Ⅰ型鼓室成形术的疗效无显著影响。结论:Ⅰ型鼓室成形术对于老年患者安全且有效,患者术后生活质量显著提高,需增加老年患者就诊意识,合理使用手术方式治疗慢性化脓性中耳炎。Objective:To summarize the clinical characteristics of elderly patients with chronic suppurative otitis media who underwent type Ⅰ tympanoplasty,and to analyze for the first time the efficacy of type Ⅰtympanoplasty in elderly patients from multiple perspectives of medical data and patient evaluation,so as to provide reference for doctors and patients to make rational decisions on treatment methods.Methods:Forty-four elderly patients(45 ears) who underwent type Ⅰtympanoplasty from May 2016 to February 2022 were retrospectively analyzed,and were followed up for 6 months to 3 years.To analyze the clinical characteristics of patients,summarize the success rate of graft,and compare the hearing level of patients before and after surgery.The patients' quality of life before and after operation was evaluated by Chronic Ear Survey,and the scores obtained were statistically analyzed.Results:Of the 44 patients(45 ears),22.22%(10/45) of the ears had predisposing factors.The percentage of hearing loss,ear pus and tinnitus were 91.11%(41/45),88.89%(40/45) and 42.22%(19/45),respectively.Mixed deafness accounted for 55.56%(25/45).66.67%(30/45) patients were diagnosed as tympanosclerosis by operation.The graft success rate was 97.78%.There was no significant difference in bone conduction hearing threshold before and after surgery,but there was significant difference in air conduction hearing threshold and air bone conduction difference.The scores of "activity restriction","symptom","medical resource utilization" and their total scores of the preoperative and postoperative were statistically different.Hypertension or diabetes had no significant effect on the efficacy of type Ⅰ tympanoplasty in elderly patients.Conclusion:Type Ⅰtympanoplasty is safe and effective in elderly patients,and the quality of life of patients after surgery is significantly improved.It is necessary to increase the awareness of elderly patients to seek medical advice and use surgical methods reasonably to treat chronic suppurative otitis media.

关 键 词：化脓性中耳炎 鼓室成形术 老年人 治疗效果 生活质量 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]