Objective  To analyze the efficacy and prognostic factors of dexamethasone in the treatment of patients with chronic suppurative otitis media (CSOM) after endoscopic tympanoplasty.

Methods  The clinical data of patients with CSOM in Hangzhou First People's Hospital from May 2019 to May 2024 were retrospectively analyzed. According to whether dexamethasone was used after surgery, the patients were divided into a control group (without dexamethasone) and an observation group (with dexamethasone). The treatment effects were compared between the two groups. According to the hearing recovery of all patients at 6 months after surgery, they were divided into a good efficacy group and a poor efficacy group. The influencing factors of poor postoperative efficacy were analyzed by multilogistic multifactorial regression, the predictive model of the nomogram was constructed by R software, and the receiver operating characteristic (ROC) curve and its area under the curve (AUC) were used to evaluate the predictive efficiency of the model.

Results  A total of 96 patients were included, with 50 in the observation group and 46 in the control group. The total effective rate of the observation group was significantly higher than that of the observation group (80.00% vs. 54.35%, P<0.05). The results of multifactorial Logistic regression showed that lesions of the auditory chain [OR=2.784, 95%CI(1.388, 5.583)], absence of tympanic tensor fasciae latae tendon [OR=2.765, 95%CI(1.211, 6.310)], stapes with only the base plate [OR=2.680, 95%CI(1.449, 4.960),] and not using adjuvant dexamethasone after the surgery [OR=2.776, 95%CI(1.200, 6.423)] were independent influencing factors on poor postoperative outcomes of CSOM. The AUC of the constructed nomogram demonstrated was 0.932. The calibration curve indicated a satisfactory agreement between predicted probabilities and actual outcomes. Decision curve analysis revealed that at a risk threshold of 0.691, the clinical net benefit derived from using the nomogram exceeded that of not applying the model.

Conclusion  The use of dexamethasone adjunctive therapy after CSOM is effective in improving hearing, and auditory chain lesions, stapes with only the base plate, and absence of tympanic tensor tendons may be associated with poor postoperative outcomes.

1.Khairkar M, Deshmukh P, Maity H, et al. Chronic suppurative otitis media: a comprehensive review of epidemiology, pathogenesis, microbiology, and complications[J]. Cureus, 2023, 15(8): e43729. DOI: 10.7759/cureus.43729.

2.Chong LY, Head K, Webster KE, et al. Topical versus systemic antibiotics for chronic suppurative otitis media[J]. Cochrane Database Syst Rev, 2021, 2(2): CD013053. DOI: 10.1002/14651858.CD013053.pub2.

3.董健菲, 戴艳红, 陈杰, 等. 经耳内镜鼓室成形术治疗鼓膜大穿孔的疗效分析[J]. 中华全科医学, 2023, 21(12): 2014-2017. [Dong JF, Dai YH, Chen J, et al. Effect of transauricular endoscopic tympanoplasty in the treatment of large tympanic membrane perforation[J]. Chinese Journal of General Practice, 2023, 21(12): 2014-2017.] DOI: 10.16766/j.cnki.issn.1674-4152.003279.

4.杨海弟, 高敏倩, 熊浩, 等. 耳内镜下中耳手术及鼓室成形术效果分析[J]. 中华耳科学杂志, 2017, 15(4): 403-407. [Yang HD, Gao MQ, Xiong H, et al. Feasibility and efficacy of endoscopic middle ear surgery and tympanoplasty[J]. Chinese Journal of Otology, 2017, 15(4): 403-407.] DOI: 10.3969/j.issn.1672-2922.2017.04.003.

5.顾翔, 熊颖, 贺海霞, 等. 早期鼓室注射地塞米松与曲安奈德在全聋型突发性耳聋疗效探讨[J]. 中华耳科学杂志, 2024, 22(3): 353-357. [Gu X, Xiong Y, He HX, et al. Early intra-tympanic injection of dexamethasone and triamcinolone acetonide for treatment of sudden total deafness[J]. Chinese Journal of Otology, 2024, 22(3): 353-357.] DOI: 10.3969/j.issn.1672-2922.2024.03.001.

6.Sharma SD, James AL. The influence of ciprofloxacin-dexamethasone ear drops on perforation closure rates after endoscopic tympanoplasty[J]. Otol Neurotol, 2021, 42(10): e1644-e1647. DOI: 10.1097/MAO.0000000000003236.

7.傅云春, 沈莉, 陈智斌. 干耳和湿耳状态的慢性化脓性中耳炎行耳内镜下Ⅰ型鼓室成形术的临床疗效[J]. 江苏医药, 2023, 49(2): 168-171. [Fu YC, Shen L, Chen ZB. Clinical efficacy of type Ⅰ tympanoplasty under otoscope in treating chronic suppurative otitis media with dry and wet ears[J]. Jiangsu Medical Journal, 2023, 49(2): 168-171.] DOI: 10.19460/j.cnki.0253-3685.2023.02.014.

8.中华医学会耳鼻咽喉头颈外科学分会耳科学组, 中华耳鼻咽喉头颈外科杂志编辑委员会耳科组. 中耳炎临床分类和手术分型指南（2012）[J]. 中华耳鼻咽喉头颈外科杂志, 2013, 48(1): 5. DOI: 10.3760/cma.j.issn.1673-0860.2013.01.003.

9.郝欣平, 李永新, 于子龙, 等. 纯音听力测试对慢性化脓性中耳炎患者听骨链状态的评估价值[J]. 中国耳鼻咽喉头颈外科, 2012, 19(4): 193-195. [Hao XP, Li YX, Yu ZL, et al. Predictive value of ossicular discontinuity in chronic suppurative otitis media using pure-tone audiometry[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2012, 19(4): 193-195.] DOI: 10.16066/j.1672-7002.2012.04.010.

10.朱玉博, 徐艳红, 李威, 等. 改良完壁式乳突切开术联合鼓室成形术治疗老年中耳胆脂瘤疗效及对听力恢复的影响[J]. 西部医学, 2023, 35(8): 1223-1227. [Zhu YB, Xu YH, Li W, et al. Effect of modified wall mastotomy combined with tympanoplasty on hearing recovery in elderly patients with middle ear cholestatoma[J]. Medical Journal of West China, 2023, 35(8): 1223-1227.] DOI: 10.3969/j.issn.1672-3511.2023.08.025.

11.李立恒, 张敏, 庄文杰. 鼓膜置管注药联合咽鼓管球囊扩张治疗成人难治性分泌性中耳炎的回顾性分析[J]. 中国中西医结合耳鼻咽喉科杂志, 2023, 31(5): 334-337. [Li LH, Zhang  M, Zhuang WJ. A retrospective analysis of 18 cases of refractory secretory otitis media treated with tympanic tube injection combined with Eustachian tube balloon dilation[J]. Chinese Journal of Otorhinolaryngology in Integrative Medicine, 2023, 31(5): 334-337.] DOI: 10.16542/j.cnki.issn.1007-4856.2023.05.004.

12.宋勇莉, 黄立桂, 温立婷, 等. 慢性化脓性中耳炎患者耳鸣的特点及影响因素分析[J]. 听力学及言语疾病杂志, 2019, 27(1): 38-41. [Song YL, Huang LG, Wen LT, et al. The characteristics of tinnitus in chronic otitis media and influence factors[J]. Journal of Audiology and Speech Pathology, 2019, 27(1): 38-41.] DOI: 10.3969/j.issn.1006-7299.2019.01.009.

13.Sugimoto H, Toya T, Watanabe Y, et al. Wideband frequency impedance for diagnosis of ossicular chain abnormality[J]. Acta Otolaryngol, 2023, 143(11-12): 958-964. DOI: 10.1080/ 00016489.2023.2292168.

14.杨学敏, 唐安洲, 韦福依, 等. 听骨链触动试验在慢性化脓性中耳炎术前评估的应用[J]. 中华耳科学杂志, 2017, 15(3): 295-300. [Yang XM, Tang AZ, Wei FY, et al. Ossicles tapping test in preoperative assessment for chronic suppurative otitis media[J]. Chinese Journal of Otology, 2017, 15(3): 295-300.] DOI: 10.3969/j.issn.1672-2922.2017.03.003.

15.Bartel R, Sanz JJ, Clemente I, et al. Endoscopic stapes surgery outcomes and complication rates: a systematic review[J]. Eur Arch Otorhinolaryngol, 2021, 278(8): 2673-2679. DOI: 10.1007/s00405-020-06388-8.

16.陈俊, 乔燕, 宋勇莉, 等. 鼓室硬化致镫骨固定一期鼓室成形术的疗效分析[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(7): 599-602. [Chen J, Qiao Y, Song YL, et al. The effect of one-stage tympanoplasty for stapes fixation with tympanosclerosis[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2020, 34(7): 599-602.] DOI: 10.13201/j.issn.2096-7993.2020.07.005.

17.Abdelgalil AI, Mohammed FF. Clinical, ultrasonographic and histopathological diagnosis of ceruminous gland tumors in cats[J]. Vet Res Forum, 2021, 12(3): 277-281. DOI: 10.30466/vrf.2020.108341.2569.

18.Hao Y, Yu X, Wang Y, et al. Diagnosis and management of unexplained conductive hearing loss with intact tympanic membrane: a systematic review[J]. Ear Nose Throat J, 2024, 19: 1455613241262129. DOI: 10.1177/01455613241262129.

19.朱敬, 顾兴华, 陈燕, 等. 鼓室成形术中保留锤骨柄和鼓膜张肌腱对听力重建效果的影响[J]. 实用临床医药杂志, 2017, 21(5): 138-139. [Zhu J, Gu XH, Chen Y, et al. Effect of retaining malleolar shaft and tensioning tendon of tympanic membrane on hearing reconstruction during tympanoplasty[J]. Journal of Clinical Medicine in Practice, 2017, 21(5): 138-139.] DOI: 10.7619/jcmp.201705042.