Clinical Study Of Endoscopic Autologous Auditory Bone Reconstruction In Chronic Suppurative Otitis Media

OBJECTIVE: To investigate the short-term efficacy and prognostic factors of tympanoplasty and auditory chain reconstruction in patients with chronic suppurative otitis media using autologous auditory bone under endoscopic otolaryngoscopy.METHODS: The clinical data of 43 patients with(ear)chronic suppurative otitis media treated by the Department of Otolaryngology of the xxxx between May 2015 and January 2021 were retrospectively analyzed,and all patients underwent tympanoplasty and auditory chain reconstruction using autologous auditory bone under endoscopy to investigate the postoperative efficacy of the patients and the factors affecting their postoperative hearing recovery results,and all patients before and after surgery All patients were evaluated audiologically before and after surgery,and the mean air-conducted hearing threshold,mean bone-conducted hearing threshold and the gap between air and bone-conducted hearing thresholds at each speech frequency(0.5 k Hz,1k Hz,2 k Hz and 4 k Hz)were counted in pure tone audiometry,and the changes of each value were compared before and after surgery.Factors associated with the postoperative hearing outcome were analyzed.The study was statistically analyzed using SPSS25.0 software,and the difference was considered statistically significant at p<0.05.RESULTS:(1)Among the 43 patients,29 were males,with an average age of45.21±12.86 years;14 were females,with an average age of 44.50±11.41years;the duration of the disease ranged from 0.25 to 60 years,with an average of 17.58±15.87 years;24 were affected in the left ear and 19 in the right ear.The eustachian tube was normally open in 24(55.8%)cases and abnormally open in 19(44.2%)cases;the long leg of the anvil in the auditory chain was missing in 10(23.3%)cases,the hammer bone or part of the stapes was missing in 29(67.4%)cases,the hammer bone or part of the stapes and anvil was missing,while the bottom plate of the stapes was still present in 4(9.3%)cases,which were divided into low injury,moderate injury and severe injury in order;other symptoms included vertigo in 3 cases,otalgia in 9 cases and tinnitus in 20 cases.(2)The mean preoperative air-conduction hearing threshold was47.09±11.82 d BHL,and the mean postoperative air-conduction hearing threshold was 40.90±12.43 d BHL,and the difference was statistically significant,and the difference of air-conduction hearing threshold in each frequency band gradually decreased with the increase of test frequency,among which the difference was statistically significant at 0.5k Hz and1 k Hz,while the difference at 2k Hz and 4k Hz was not The difference was not statistically significant at 2k Hz and 4k Hz.The mean preoperative bone conduction threshold was 26.37±11.20 d BHL,and the mean postoperative bone conduction threshold was 26.19±12.28 d BHL,with no statistically significant difference.The mean preoperative air-bone gap was 20.73±13.06 d B,and the mean postoperative air-bone gap was14.71±7.47 d B,with statistically significant differences.(3)Postoperative pure tone audiometry was performed,and cases with mean air-bone gap ≤20d B were considered effective,and those that did not satisfy were considered ineffective,and the postoperative efficiency rates of different factors were counted.The effective rates were 62% and 64%for males and females,respectively;71% and 53% for the left-sided and right-sided ears,respectively;different treatment rates for different parts of the tympanic membrane,with the lowest rate of 58% for perforations in the tense part,64% for perforations in the relaxed part,and 80% for patients without perforations;normal and abnormal eustachian tube function The effect of the degree of damage to the auditory chain on the efficiency was even more significant,with 91% and 63% for mild and moderate damage,respectively,while none of the five patients with severe damage was treated effectively.CONCLUSIONS:(1)In chronic suppurative otitis media,endoscopic tympanoplasty using autologous auditory bone and reconstruction of the auditory chain can be performed with good short-term efficacy and significant postoperative hearing improvement.(2)Hearing reconstruction using autologous auditory bone can effectively improve the mean air-conduction hearing threshold and air-bone gap in the affected ear,but the effect on the mean bone conduction hearing threshold is still small.(3)The use of autologous auditory bone reconstruction hearing,postoperative low frequency hearing improvement is more obvious,especially at 0.5k Hz,the effect is significant.(4)The factors affecting the postoperative hearing recovery effect include the air-bone gap at the time of admission,the function of the eustachian tube and the damage to the auditory chain.Due to the small number of related studies in China,the overall sample size is relatively small,and more influential factors still need to be confirmed by more and higher quality multicenter studies.