The Hearing Can Not Improvement Reasons Analysis After Surgery In Chronic Suppurative Otitis Media Or Middle Ear Cholesteatoma

Objective To investigate the effect of patients with chronic suppurative otitis media or middle ear cholesteatoma after tympanoplasty, some patients postoperative hearing does not improve or increase is not obvious possible reasons.Methods A retrospective analysis of the period from 2012 to 2105, visits to the First Affiliated Hospital of Guangxi Medical University, Department of Otolaryngology Head and Neck Surgery chronic otitis media, or middle ear cholesteatoma with complete follow-up records of 99 cases (101 ear disease) patients.45 male,54 female, aged 9-67 years, mean age 31.27±11.73 years, history of 3 months-ranging from 50 years, the average 10±9 36-year history. Preoperative ear endoscopy, pure tone audiometry testing, temporal bone CT and 3D reconstruction, eustachian tube function,according to the preoperative examination, clinical manifestations, intraoperative exploration situation, in three surgical methods, A:tympanoplasty (Ⅰ, Ⅱ, Ⅲ type)+if necessary Tympanotomy (48 ear disease), B:complete bi formula mastoidectomy and tympanoplasty (19 ear disease), C:open mastoidectomy and tympanoplasty (34 ear disease). Patients were followed up 3 Month-1 year, pure tone audiometry as surgery evaluation criteria, statistical analysis before surgery, after air conduction (AC) hearing, bone conduction (BC) hearing, air-bone gap(ABG) and other pure tone audiometry test results, combined with clinical data, intraoperative exploration results, the factors that may affect postoperative hearing does not improve.Results Postoperative follow-up,1 patient due to the surgical cavity after infection, graft survival film fails, the survival rate was 99%. No artificial ear bone prolapse surgery epithelization good ear incision healed without infection, ranging from dry ear four weeks-12 weeks.48 ear disease tympanoplasty+Tympanotomy when necessary, surgery in patients with pre-linguistic frequency bands, the average air conduction hearing is 48.54±19.13dB, average postoperative air conduction hearing is 33.61± 21.48dB, reducing the threshold of 12.57±13.06dB. The mean preoperative ABG was 29.65±10.83dB, mean postoperative ABG was:17.08±8.81dB, reducing the threshold:14.74±11.70dB. The mean preoperative ABG≤10dB accounted for 4.17%,≤11-20dB accounted for 20.83%, postoperative average ABG≤10dB accounted 29.17%,≤11-20dB 43.75%. postoperative hearing improvement, significant improvement accounted for 43.75%, increased by 45.83%, no significant change of 6.25%,4.17% worsening, not improving postoperative hearing accounted for 10.42%(5/48).19 ear disease row superlative style mastoidectomy and tympanoplasty, preoperative patient speech frequency segment, the average air conduction hearing is 62.37±15.05dB, average postoperative air conduction hearing is 44.30±19.60dB, reducing the threshold:17.81±14.54dB. The mean preoperative ABG was 36.14±15.49dB, mean postoperative ABG was:25.70 ±10.85dB, reducing the threshold:8.86±15.21dB. The mean preoperative ABG≤10dB accounted for5.26%,≤11-20dB accounted for 10.53%, postoperative average ABG≤10dB accounted 10.53%,≤11-20dB 31.58%. postoperative hearing improvement, significant improvement accounted for 57.89%, increased by 26.32%, no significant change of 5.26%,10.53% worsening, not improving postoperative hearing accounted for 15.79%(3/19).34 line open ear disease mastoidectomy and tympanoplasty, preoperative patient speech frequency segment, the average air conduction hearing is 59.49 ±17.17dB, average postoperative air conduction hearing is 46.38±13.99dB, reducing the threshold:16.98±13.51dB. The mean preoperative ABG was 42.00±14.22dB, mean postoperative ABG was:29.95±14.21dB, reducing the threshold:12.40±14.44dB. The mean preoperative ABG≤10dB accounted for 2.94%,≤11-20dB accounted for 5.88%, postoperative average ABG≤10dB accounted 14.71%,≤11-20dB 8.82%. postoperative hearing improvement, significant improvement accounted for 44.12%, increased by 50%, no significant change of 0%,5.88% worsening, not improving postoperative hearing accounted for 5.88%(2/34).Conclusion Chronic suppurative otitis media, or middle ear surgery, requires a combination of clinical manifestations, preoperative, intraoperative circumstances a reasonable choice of surgical approach, patients are able to achieve a reasonable hearing improved, and stapes fixed, small attic, in mucosal lesions ear, eustachian tube function and procedure are possible causes of postoperative hearing does not improve.