On Applying Eardrum Endoscope In Surgery For Chronic Suppurative Otitis Media

Objective To seek an approach for treatment of chronic suppurative otitis media (CSOM) through investigating the application of eardrum endoscope in the surgery and exploring the feasibility of tympanoplasty (TP) and radical mastoidotomy (RM) by using this instrument. Methods 36 cases are diagnosed as different types of chronic suppurative otitis media according to the medical history and the pre-surgery examining results. 9 cases with simple otitis media are taken tympanoplasty by using eardrum endoscope. 27 cases with cholesteatomatous otitis media are taken different radical mastoidotomy and 5 of them are taken tympanoplasty as well. Clinical followed-up of the all cases are from 3 months to 2 years. Results (1)As for the 9 cases with simple otitis media, the transplanted tympanic membrances grow well after the surgery without perforation. 8 of them improve their hearing greatly, accounting for 88.9% of all. Average hearing threshold of air conduction before surgery is 39.0 8.2d B, and which is 23.9 4.8 d B after the surgery. Compared with the pre-surgery, t=5.53 ,P <0.01 , it shows significant differences in statistics.The average air conduction increases 16.8 9.6 d B. ?2)Among the 27 cases with cholesteatomatous otitis media, 16 have cholesteatoma in mastoid, tympanic aritrum and tympanic cavity, 7 in aditus of antrum and epitympanum, 3 in posterior tympanum, 1 has no cholesteatoma; 16 are taken radical mastoidotomy by open method, 7 are taken radical mastoidotomy without cutting the bridge, 3are taken intact canal wall mastoidotomy ; 5 of all are taken with one-stage tympanoplasty simultaneously. 3 months after surgery, 1 has continuous otorrhea, the others recove well. There is little change of the hearing for the 22 ears only taken with RM; The hearing of the 5 with one-stage tympanoplasty simultaneously are improved 6 months after surgery , and the average hearing threshold of air conduction is 20.2 7.2 d B. Compared with the pre-surgery, t=4.78 ,P <0.01 , which shows significant differences in statistics. (3)In all cases, 27 have well eustachian tube function, and there are any focus around the ostium tyrnpanicum tubae auditioriae .we clean the focus under the endoscope. (4)1 gets vertigo with nausea and vomiting after the surgery, others have no serious complications. Conclusions (1)In the operation, with its broad vision and multiangles, eardrum endoscope can clearly observe ostium tyrnpanicum tubae auditioriae and posterior tympanum and ossicular chain while microscope can not to do it easily. It can also clean miniature focus by its magnifying function. (2) Eardrum endoscope can observe ostium tyrnpanicum tubae auditioriae in a clear way and when focus is found pre-and intra- operation , it can be cleaned through one-stage tympanoplasty. So we can get the initial conclusion that it enlarges the indication of surgery. (3)By using eardrum endoscope the transplanted tympanic membrances grow well after the surgery pre-surgery, and the hearing is better than cases by microscope. (4)for the combination of endoscope and microscope, we can clean the focus completely, which can reduce the rate of residue and recurrence of cholesteatoma greatly. (5)Concerning the surgeon, they must bring the advantages of the endoscope into full play and avoid its disadvantages during the operation. And they must master the corresponding knowledge and skills, and take the basic training in this respect.