| Objective: The surgical methods for chronic suppurative otitis media(CSOM) have evolved from clearing the focus for the purpose of getting dry ear to functional reconstitution for the purpose of improving hearing. Due to the complexity of anatomical structures of the normal middle ears and relevant surgical concepts, various surgical methods result in different therapeutic effects. In this study, the clinical data of CSOM patients undergoing four different surgical methods were analyzed and their therapeutic effects were evaluated, in order to summarize the clinical results, as far as possible to achieve the standard treatment. Methods: Collect the clinical data of 239 CSOM patients(246 ears) undergoing different surgical methods in the department of Otorhinolaryngology Head and Neck Surgery in the Third People’s Hospital of Chongqing from June 2010 to April 2014. These cases were divided into four groups by surgical method: the radical mastoidectomy group(82 ears), the type I tympanoplasty group(40 ears), the intact bridge radical mastoidectomy with type I tympanoplasty group(30 ears), and the open radical mastoidectomy with type II tympanoplasty group(94 ears). These patients were compared in terms of the general condition, preoperative hearing and invaded extension of lesion during operation in order to analyze the clinical characteristics of patients undergoing different surgical methods. The follow-up period lasted for 9 to 36 months. The therapeutic effects of the four surgical methods for the treatment of CSOM were evaluated in terms of the rate of dry ear, hearing level, complications, quality of life and the satisfactory score after surgery, as well as healing of tympanic membrane after receiving tympanoplasty. Results:(1) In the radical mastoidectomy group, the number of patients with hypertension and diabetes mellitus was greater than those of the other three groups(all P<0.009), the mean values of the air and bone conductive hearing thresholds before operation were higher than those of the other three groups(all P<0.001), and the invaded extension of lesion during operation was more severe than those of the rest groups.(2) The rate of dry ear in the radical mastoidectomy group, the intact bridge radical mastoidectomy with type I tympanoplasty group and the open radical mastoidectomy with type II tympanoplasty group were 96.34%, 100% and 97.87% respectively, showing no statistically significant differences(P>0.05).(3) The mean values of the air and bone conductive hearing thresholds after operation in the radical mastoidectomy group were increased than those before operation(all P<0.05); the mean values of the air conductive hearing thresholds after operation in the three tympanoplasty groups were decreased than those before operation(all P<0.001)), while the mean values of the bone conductive hearing thresholds after operation showed no obvious changes(all P>0.05); there were no statistically significant improvements in the air conductive hearing thresholds in the three tympanoplasty groups(all P>0.05); the improvements in patient’s subjective hearing of the four surgical methods were 9.76%, 82.50%, 70.00% and 82.98% respectively, while the improvement in patient’s subjective hearing in the radical mastoidectomy group was much lower than those of the other three groups(all P<0.001). There were no statistically significant improvements in patient’s subjective hearing of the three tympanoplasty groups(all P>0.05).(4) Complications showed no statistically significant difference between the radical mastoidectomy group and the open radical mastoidectomy with type II tympanoplasty group(P>0.05). Compared with the type I tympanoplasty group and the intact bridge radical mastoidectomy with type I tympanoplasty group, the radical mastoidectomy group had a higher incidence of postoperative complications(all P<0.009). The healing rates of transplanted tympanic membrane in the three tympanoplasty groups were 95.00%, 100% and 97.87% respectively, showing no statistically significant differences(P>0.05).(5) The improvements in the overall quality of life of the four surgical methods were 70.73%, 80.00%, 80.00% and 79.79% respectively, showing no statistically significant differences(P>0.05); The basic satisfaction rates in the postoperative satisfaction ratings of the four surgical methods were 98.78%, 100.00%, 100.00% and 97.87%, and there were no statistically significant differences(P>0.05); the reduction rate of patient’s worry about illness were 89.02%, 90.00%, 93.33% and 95.74%, showing no statistically significant differences(P>0.05). Conclusion:(1) Assessment of the rate of dry ear indicate that the above four surgical methods achieve satisfactory effects in the treatment of CSOM.(2) Assessment of the satisfactory score after surgery and the quality of life indicate that the above four surgical methods achieve satisfactory effects in the treatment of CSOM.(3) The radical mastoidectomy group suffers from more complications and has a poorer preoperative hearing level, a broader extent of disease and more severe lesion degree than those of the three tympanoplasty groups.(4) The hearing levels of the patients in the three tympanoplasty groups after operation was obviously improved compared with those before operation, while the hearing levels of the patients in the radical mastoidectomy group after operation was declined.(5) It is feasible to select appropriate surgical method based on patient’s actual situation and perform tympanoplasty with the removal of lesions as much as possible. |
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