由见习外科医生(耳鼻喉科住院医师)在指导下进行的耳廓成形术的听力结果--分析研究

Hamza Omar Shasho, Samer Mohsen
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摘要

耳膜成形术是耳科中心最常见的手术之一,影响成功率的因素很多,包括穿孔的大小和部位、咽鼓管的功能、翻修手术以及外科医生的专业知识。公认的事实是,由见习外科医生实施的穿孔闭合率低于由资深耳科医生实施的穿孔闭合率。与经验丰富的外科医生相比,见习外科医生进行的耳廓成形术往往会对中耳粘膜造成更多的先天性创伤,对听小骨的操作不够轻柔,手术时间延长,所有这些都可能对中耳结构造成更大的损伤,从而对 TM 的闭合率和听力结果产生负面影响。本研究旨在评估由实习医师在指导下成功完成的耳膜穿孔成形术的听力效果。研究设计了一项横断面分析研究,对 35 名年龄在 6 岁至 62 岁之间、被诊断为 TM 安全穿孔的患者进行了研究。所有患者都进行了两次听力检查,一次是手术前,另一次是手术后 3 个月。排除标准包括任何患有胆脂瘤、肿瘤、鼓室硬化症或听小骨侵蚀/固定的病例,因为本研究旨在研究封闭 TM 穿孔的唯一效果,而不考虑任何其他干扰因素。结果表明,在 500、1000、2000 和 4000 Hz 四个频率下,ABG 平均听力提高了 12.25 分贝,AC阈值提高了 10.6 分贝。四个频率的残余 ABG 平均值为 14.2 分贝。气导阈值的改善程度与年龄、性别、患侧耳、穿孔面积或病程之间没有相关性(所有测试的 p > 0.05)。虽然由受训者进行的耳廓成形术的穿孔闭合率低于经验丰富的外科医生,但由受训者在指导下进行的耳廓成形术的听力结果是可以接受的;不过,建议开展进一步的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Audiological results of myringoplasty performed by trainee surgeons (ENT residents) under supervision—analytic study
Myringoplasty is one of the most common surgeries performed in otology centers, with many factors influencing the success rate, including the size and site of perforation, function of the Eustachian tube, revision surgery, and expertise of the surgeons. It is well established that the perforation closure rate is lower when performed by trainee surgeons than by senior otologists. Myringoplasty performed by trainees tends to pose more iatrogenic trauma to middle ear mucosa, less gentle manipulation of ossicles, and prolonged operation time compared with operations performed by experienced surgeons, all of which might produce more damage to middle ear structures and consequently negatively affect the closure rate of TM and audiological outcome. This study aimed to assess the audiological outcomes of successfully closed perforation myringoplasty performed by a trainee under supervision. The study design was an analytic cross-sectional study of 35 patients aged between 6 and 62 years diagnosed with safe TM perforation. All patients had two audiograms, one before surgery and the other 3 months after surgery. The exclusion criteria included any case with cholesteatoma, tumor, tympanosclerosis, or ossicular erosion/fixation because this study aimed to study the sole effect of closing TM perforation without any other confounding factor. The results indicate a mean hearing improvement of 12.25 dB of ABG and 10.6 dB of AC thresholds at the four frequencies of 500, 1000, 2000, and 4000 Hz. The mean of the residual ABGs at the four frequencies is 14.2 dB. There were no correlations between the amount of air conduction threshold improvement and age, gender, side of the affected ear, area of perforation, or duration of disease (p > 0.05 for all tests). Although the rate of perforation closure in myringoplasties performed by trainees is lower than that of experienced surgeons, the audiological outcomes of myringoplasties performed by trainees under supervision were acceptable; however, further research is recommended.
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