Abstract: Objective　To explore the difference in curative effects of cotton absorption combined with budesonide suspension in type Ⅰ tympanoplasty under dry and wet ear conditions. Methods　A total of 66 patients with chronic suppurative otitis media at rest from Wuhan Xinzhou District People's Hospital and Huangshi Central Hospital from January 2018 to December 2020 were prospectively included. They were divided into four groups with the random number table method, including 17 cases in the dry ear observation group [11 males and 6 females, aged (36.23±7.39) years], 19 cases in the dry ear control group [12 males and 7 females, aged (37.28±7.29) years], 16 cases in the wet ear observation group [10 males and 6 females, aged (37.12±7.26) years], and 14 cases in the wet ear control group [9 males and 5 females, aged (37.75±7.17) years]. All patients underwent type Ⅰ tympanoplasty under otoendoscope, and the dry and wet ear observation groups were given cotton absorption combined with budesonide suspension to fix the tympanum and external auditory canal at the end of the operation. The preoperative eustachian function and levels of inflammatory factors [serum interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and high-sensitivity C-reactive protein (hs-CRP)] and air-bone gaps before operation and 1 month and 3 months after operation in the four groups were counted and compared, and the dry ear rate, dry ear time, eardrum healing rate, and hearing improvement rate 6 months after operation were counted. t test or ANOVA was used for the measurement data, and Chi-square test or Fisher's exact probability method was used for the count data. Results　There was no statistically significant difference in the preoperative eustachian function among the four groups before operation (P>0.05). The serum levels of IL-6, TNF-α, and hs-CRP in the four groups 1 month and 3 months after operation were higher than those before operation, and the air-bone gap was lower than that before operation; the serum levels of IL-6, TNF-α, and hs-CRP and air-bone gap 3 months after operation were lower than those 1 month after operation; 1 month and 3 months after operation, the serum levels of IL-6, TNF-α, and hs-CRP and air-bone gaps in the dry ear observation group and wet ear observation group were lower than those in the other two groups, with statistically significant differences (all P<0.05). Six months after operation, the dry ear rate was 16/17 (94.12%) in the dry ear observation group, 17/19 (89.47%) in the dry ear control group, 15/16 (93.75%) in the wet ear observation group, and 13/14 (92.86%) in the wet ear control group, without statistically significant difference among the four groups (P=1.000). The postoperative dry ear duration was (9.24±3.26) weeks in the dry ear observation group, (13.37±3.75) weeks in the dry ear control group, (9.11±3.17) weeks in the wet ear observation group, and (14.21±3.65) weeks in the wet ear control group; the postoperative dry ear durations in the dry ear observation group and wet ear observation group were shorter than those in the other two groups, with statistically significant differences (all P<0.05). Six months after operation, the healing rate of eardrum was 17/17 (100.00%) in the dry ear observation group, 18/19 (94.73%) in the dry ear control group, 15/16 (93.75%) in the wet ear observation group, and 14/14 (100.00%) in the wet ear control group, without statistically significant difference among the four groups (P=0.849). Six months after operation, the hearing improvement rate was 12/17 (70.59%) in the dry ear observation group, 7/19 (36.84%) in the dry ear control group, 13/16 (81.25%) in the wet ear observation group, and 6/14 (42.86%) in the wet ear control group; the hearing improvement rates in the dry ear observation group and the wet ear observation group were better than those in the other two groups, with a statistically significant difference (P<0.05). Conclusions　For chronic suppurative otitis media at rest without ossicular chain lesions, there is no significant difference in the eardrum healing rate or dry ear rate of type Ⅰ tympanoplasty under otoendoscope under dry and wet ear conditions. The application of cotton absorption combined with budesonide suspension can speed up the improvement of inflammatory factors in the patients' body, shorten the dry ear time, and improve the degree of hearing improvement.

Key words: Chronic suppurative otitis media, Wet ear, Tympanoplasty, Budesonide, Otoendoscope

摘要： 目的　分析耳内镜下应用纳吸棉联合布地奈德混悬液在干湿耳状态下行Ⅰ型鼓室成形术的疗效差异。方法　前瞻性纳入2018年1月至2020年12月武汉市新洲区人民医院和黄石市中心医院收治的66例慢性化脓性中耳炎静止期患者。采用随机数字表法分为4组，干耳观察组17例［男11例，女6例，年龄（36.23±7.39）岁］，干耳对照组19例［男12例，女7例，年龄（37.28±7.29）岁］，湿耳观察组16例［男10例，女6例，年龄（37.12±7.26）岁］，湿耳对照组14例［男9例，女5例，年龄（37.75±7.17）岁］。所有患者均行耳内镜下Ⅰ型鼓室成形术，干耳、湿耳观察组均在手术结束时给予纳吸棉联合布地奈德混悬液固定鼓室及外耳道。统计并比较4组患者术前咽鼓管功能，术前及术后1个月、3个月的炎症因子［血清白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、高敏C反应蛋白（hs-CRP）］水平以及气骨导差值，统计术后6个月的干耳率及干耳时间，术后6个月的鼓膜愈合率和听力改善率。计量资料采用t检验或方差分析，计数资料采用卡方检验或Fisher确切概率法。结果　4组患者术前咽鼓管功能差异无统计学意义（P>0.05）。4组患者术后1个月和术后3个月的血清IL-6、TNF-α、hs-CRP水平高于术前、气骨导差低于术前，术后3个月血清IL-6、TNF-α、hs-CRP水平和气骨导差低于术后1个月；术后1个月和术后3个月时，干耳观察组和湿耳观察组患者血清IL-6、TNF-α、hs-CRP水平和气骨导差低于另外两组，差异均有统计学意义（均P<0.05）。术后6个月干耳观察组干耳率为16/17（94.12%），干耳对照组17/19（89.47%），湿耳观察组15/16（93.75%），湿耳对照组13/14（92.86%），4组差异无统计学意义（P=1.000）。术后干耳观察组干耳时间为（9.24±3.26）周，干耳对照组（13.37±3.75）周，湿耳观察组（9.11±3.17）周，湿耳对照组（14.21±3.65）周，干耳观察组和湿耳观察组短于另外两组，差异均有统计学意义（均P<0.05）。术后6个月干耳观察组鼓膜愈合率为17/17（100.00%），干耳对照组18/19（94.73%），湿耳观察组15/16（93.75%），湿耳对照组14/14（100.00%），4组差异无统计学意义（P=0.849）。术后6个月4组听力改善率分别为干耳观察组12/17（70.59%），干耳对照组7/19（36.84%），湿耳观察组13/16（81.25%），湿耳对照组6/14（42.86%），其中干耳观察组和湿耳观察组优于另外两组，差异有统计学意义（P<0.05）。结论　对于不伴有听骨链病变的静止期慢性化脓性中耳炎，术前湿耳状态时进行耳内镜下Ⅰ型鼓室成形术鼓膜愈合率及干耳率同干耳状态无明显差异，术中应用纳吸棉联合布地奈德混悬液，能加快患者体内炎性因子下降，缩短干耳时间和提高听力改善程度。

关键词: 慢性化脓性中耳炎, 湿耳, 鼓室成形术, 布地奈德, 耳内镜