Endoscopic tympanoplasty with inlay cartilage graft in an university hospital

Abstract Introduction Tympanoplasty is the surgical procedure aimed at the reconstruction of the tympanic membrane and restoration of the sound conducting mechanism. It can be performed with several types of access and grafts and is considered successful when it achieves complete closure of the tympanic perforation and sound conduction improvement. Objective To describe the prevalence of successful closure of tympanic perforations and auditory results of endoscopic tympanoplasty with an inlay tragus cartilage graft. Methods Retrospective study developed at a tertiary referral hospital. Patients with central tympanic perforations and intact ossicular chains operated with endoscopic tympanoplasty with inlay tragus cartilage graft were included. The neo-tympanum integrity index was evaluated, and the preoperative and postoperative auditory parameters were compared using the paired Student's t-test. Results We identified 83 endoscopic tympanoplasties with inlay cartilage, of which 63 (76 %) had an intact neo-tympanum and 20 (24 %) had residual perforations. The preoperative air-bone gap was, on average, 18 ± 8.9 dBHL, and the postoperative 11 ± 10 dBHL (p = 0.0005), showing reduction in 71 % and complete recovery in 27 %. The mean preoperative speech recognition threshold was 35 ± 13.5 and the postoperative SRT was 27 ± 14.4 (p = 0.0002). The preoperative tritonal mean was 34 ± 14.3 and the postoperative was 24 ± 15 (p = 0.0002). Conclusion In this series, endoscopic tympanoplasties with inlay tragus cartilage graft showed a 76 % prevalence of complete closure of the tympanic perforation, with significant improvement in the auditory parameters.

摘要 引言：鼓室成形术（tympanoplasty）是旨在重建鼓膜（tympanic membrane）、恢复传声机制的外科手术。该术式可通过多种手术入路及移植物方式实施，当实现鼓膜穿孔（tympanic perforation）完全闭合且传声功能改善时，即判定为手术成功。
研究目的：描述采用耳屏软骨内嵌移植物（inlay tragus cartilage graft）行内镜下鼓室成形术（endoscopic tympanoplasty）后，鼓膜穿孔完全闭合的发生率及听觉预后情况。
研究方法：本研究为某三级转诊医院（tertiary referral hospital）开展的回顾性研究。纳入接受内镜下鼓室成形术并使用耳屏软骨内嵌移植物的中央性鼓膜穿孔（central tympanic perforations）且听骨链（ossicular chains）完整的患者。评估新鼓膜（neo-tympanum）完整性指数，并采用配对t检验（paired Student's t-test）比较术前与术后的听觉参数。
研究结果：本研究共纳入83例内镜下软骨内嵌鼓室成形术病例，其中63例（76%）新鼓膜完整，20例（24%）存在残余穿孔。术前气骨差（air-bone gap）平均为18±8.9 分贝听力级（dBHL），术后为11±10 dBHL（p=0.0005），气骨差较术前降低71%，27%的患者实现完全听力恢复。术前言语识别阈（speech recognition threshold）平均为35±13.5，术后言语识别阈为27±14.4（p=0.0002）。术前三频纯音平均阈值（tritonal mean）为34±14.3，术后为24±15（p=0.0002）。
研究结论：本系列病例中，采用耳屏软骨内嵌移植物的内镜下鼓室成形术，鼓膜穿孔完全闭合率为76%，各项听觉参数均得到显著改善。