鼓室成形術之外耳道填塞時間長短與預後之關係

The Relationship between Packing Duration and Prognosis Following Tympanoplasty

許家禎(Chia-Chen Hsu) ； 朱繡棟(Sau-Tung Chu) ； 蕭安穗(An-Suey Shiao)

《中華民國耳鼻喉科醫學雜誌》 35卷5期 (2000/09) Pp. 305-309

https://doi.org/10.6286/2000.35.5.305

摘要

背景:慢性中耳炎是一常見耳科疾病，以今日鼓室成行術成功率之高，確實帶給病患相當大的幫助，但術後外耳道填塞時間的長短，會影響病患生活品質，若能在不影響預後的情形下，縮短填塞的時間，將更能給予病人生活上的方便。
方法:自1997年11月1998年12月之間，隨機挑選30例接受第一型鼓室成行術的慢行中耳炎患者，分別在7天(第一組)、14天(第2組)、21天(第3組)取出外耳道填塞物，觀察其接受修補的鼓膜和外耳道皮膚生長的情形。分析術前、術後感染以及預後和併發症的影響。
結果: 30名病患中，男性17名，女性13名，平均45.9歲。術前有較嚴重感染者或混合型感染者，外耳道皮膚生長情形較差，外耳道的肉芽組織形成，發生在綠膿桿菌和金黃色葡萄球菌的混合感染的病患身上比率也較高。術後細菌培養的結果也以此兩菌種為多。手術成功率方面3組之中並無明顯差異，唯一一例術後仍有殘餘穿孔者，經再次手術，預後良好。3組病患的預後再外耳道填塞時間的長短上並無統計上的差異。
結論: 3組的年齡、性別、原本聽力喪失的程度，術前和術後的細菌培養均不會影響3組之間的比較結果，細菌培養結果以綠膿桿菌和金黃色葡萄球菌為多，顯示此兩種菌種的頑固。若能早期治療，給予有效的抗生素，預後仍然相當不錯。雖然手術成功率和是否感染在3組中無差別，但是由於在混合感染的病例中，鼓膜和外耳道鼻膚生長評估的級別均較高，是否可以以此推論流膿耳和非流膿耳的手術預後相當，仍待進一步的確認。研究結果顯示，一般的病患在7，14 或21天取出填塞物其預後無法統計學上的差異。但建議在術前就有嚴重感染或混合型感染者，術後仍以放滿14天以上甚至21天，再行取出外耳道填塞物較佳。

關鍵字

鼓式成行術 ； 外耳道

並列摘要

BACKGROUND: Chronic otitis media is a common otologic disorder which may benefit from tympanoplasty. Unfortunately, the quality of life following tympanoplasty is decrased for patients owing to the long period of time required for external auditory canal packing. A shortened packing period may benefit patients if it can be achieved with-out affecting prognosis or causing complications.
METHODS: Thirty patients with chronic otitis media who underwent simple tympano-plasty between November 1997 and December 1998 were recruited for participation in the study. They were divided into there groups according to whether the duration of post-ooperative external auditor canal packing was seven, 14 or 21 dasy in length. Tympanic membrane growth and external auditory canal slin conditions were closely observed and analyzed as possible factors affecting prognosis. Pre-operative and post-operative cultures from lesions were used to identify the presence of infection.
RESULTS: Seventeen males and 13 females ranging between 19 and 69 years in age (mean 45.9 years) were recruited. Cases with severe and mixed infections had poorer skin growth, and higher incidence of post-operative canal granulation formation was observed in a group of cases with Staphylococcus and Pseudomonas mixed infections. Staphylococcus and Pseuomonas were the most common post-operative bacterial isolates. Only one patient failed to achieve tympanic mwmbrane growth which improved following surgical revision. There were no differences in prognosis among the three groups with differing external canal packing durations.
CONCLUSION:No difference between the three groups was found in terms of outcome although further study with larger numbers is needed to determine whether running ears have the same success rate as dry ears, since patients with running ears exhibited higher ranks of canal granulation formation in our study. Pre-and post-operative infections, age, sex, and hearing loss had no influence on outcome and there was no difference in progno-sis when the three groups were compard, The results of this study suggest that post-oper-ative canal packing for seven to 14 days is sufficient for most patients, while a period of seven to 14 days is sufficient most patients, while a period of 14 to 21 days duration may be more appropriate for cases of severe or mixed infection.

並列關鍵字

Tympanoplasty ； external auditory canal