Clinical Observation Of Titanium Artificial Ossicle In Stage ? Mastoidectomy And Tympanoplasty

Objective To investigate the effect of titanium artificial ossicle in stage I mastoidectomy and tympanoplasty.Methods From January 2013 to June 2017,80 patients(81 ears)with complete data of chronic suppurative otitis media and cholesteatoma in the otolaryngology department of Jiangsu People's Hospital were studied.All patients underwent mastoidectomy,tympanoplasty and primary titanium ossicular implantation.One patient underwent binaural surgery in stages.According to the operation methods,the patients were divided into complete mastoidectomy plus tympanoplasty and stage I artificial ossicular implantation(31 ears in complete ossicular implantation group),including 16 male ears and 15 female ears;age(41.2±7.3)years old;chronic suppurative otitis media 25 cases,6 cases of cholesteatoma in middle ear;18 cases of left ear and 13 cases of right ear.Open mastoidectomy plus tympanoplasty with stage I ossicular implantation(50 ears in open implantation group).Among them,there were 27 males and 23 females,aged(40.8±7.4)years,30 cases of chronic suppurative otitis media,20 cases of middle ear cholesteatoma,20 cases of left ear and 30 cases of right ear.The short-term effects of the two groups were compared.Results 1.Postoperative recovery Among 81 ears,1 case had suppurative infection of the posterior ear incision about 1 week after operation,and healed after dressing change;1 case had perforation of the edge of tympanic membrane about 1 month after operation.79 ears were dry after operation,the dry ear rate was 97.53%.No artificial ossicles were discharged,no cholesteatoma recurred and tympanic membrane perforated 6 months after operation.2.A comparison of the two groups' listening comprehension Before and 6 months after operation,pure tone audiometry(MADSEN Conera audiometer)was used to calculate the mean air conduction and bone conduction thresholds(0.5,1,2,4 KHz)and air-bone gap(ABG)before and after operation.In CWUT group,the mean preoperative airway tract was 58.74±10.46 d B HL,and the mean postoperatively airway tract was 38.68±11.34 d B HL,which was 20.06 d B HL,t =11.72,P<0.01.The preoperative ABG 39.16±10.28 d B HL was improved to 18.65 ±9.46 d B HL,and the postoperatively ABG decreased by 20.51 d B HL,t =11.98,P<0.01.There was no significant change in bone guideline.In CWDT group,the mean preoperative air conduction domain was 57.05±14.84 d B HL,and the postoperative air conduction domain was 37.06±12.33 d B HL,which was 19.99 d B HL,t =13.03,P<0.01.The preoperative ABG was 37.94 ±11.85 d B HL and improved to 19.90 ±9.42 d B HL after operation,with an average reduction of 18.04 d B HL,t =12.44 P<0.01.There was no significant change in bone conduction.There were significant differences in mean air conduction and ABG between the two groups before and after operation(P < 0.05),and there was no significant difference in mean bone conduction between the two groups before and after operation.Conclusion Titanium artificial ossicles implanted in the first stage of open and complete tympanoplasty can effectively improve hearing.Both methods have advantages and disadvantages.Titanium artificial ossicles implanted after complete tympanoplasty are worth promoting in ossicular chain reconstruction.