Predictive factors and risk quantification of recurrence of chronic suppurative otitis media after otoendoscopic surgery

LIU Chen; LIU Xing; NING Bo; LI Hua-chao; WANG Chi

doi:10.11659/jjssx.12E024056

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Predictive factors and risk quantification of recurrence of chronic suppurative otitis media after otoendoscopic surgery

Clinical Research | 更新时间：2025-07-31

- Predictive factors and risk quantification of recurrence of chronic suppurative otitis media after otoendoscopic surgery
- JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY Vol. 34, Issue 8, Pages: 680-684(2025)
- 作者机构：
  
  徐州市中心医院新城耳鼻喉科,江苏徐州 221000
- 作者简介：
- 基金信息：
- DOI：10.11659/jjssx.12E024056
  CLC： R764.21
- Received：11 December 2024，
  
  Published：25 August 2025
- 稿件说明：
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刘晨,刘星,宁博等.慢性化脓性中耳炎耳内窥镜术后复发的预测因素与风险量化研究[J].局解手术学杂志,2025,34(08):680-684.

LIU Chen,LIU Xing,NING Bo,et al.Predictive factors and risk quantification of recurrence of chronic suppurative otitis media after otoendoscopic surgery[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2025,34(08):680-684.
刘晨,刘星,宁博等.慢性化脓性中耳炎耳内窥镜术后复发的预测因素与风险量化研究[J].局解手术学杂志,2025,34(08):680-684. DOI： 10.11659/jjssx.12E024056.

LIU Chen,LIU Xing,NING Bo,et al.Predictive factors and risk quantification of recurrence of chronic suppurative otitis media after otoendoscopic surgery[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2025,34(08):680-684. DOI： 10.11659/jjssx.12E024056.

摘要

目的

探讨慢性化脓性中耳炎（CSOM）耳内窥镜术后复发的预测因素，并构建风险量化列线图模型。

方法

回顾性分析2021年2月至2023年2月在我院行耳内窥镜手术治疗的485例CSOM患者的临床资料，按照随访期间复发情况将患者分为复发组、未复发组。比较2组患者临床资料，采用

Cox

回归法分析术后复发的预测因素。基于这些预测因素构建风险量化列线图模型，以受试者工作特征（

ROC

）曲线验证模型的预测效能，采用

Hosmer

Lemeshow

拟合优度分析验证模型的校准度，采用决策曲线分析法（

DCA

）评估模型的临床净收益。

结果

随访6~39个月，中位数21（11，32）个月，术后复发率为14.64%（71/485）。合并反复上呼吸道感染（

=3.019，95%

：1.609~5.664）、合并慢性鼻-鼻窦炎（

=2.428，95%

：1.529~3.856）、合并腺样体肥大（

=2.214，95%

：1.381~3.551）、中耳风险指数（MERI）评分（

=2.863，95%

：1.445~5.675）、咽鼓管功能障碍问卷（ETDQ-7）评分（

=2.679，95%

：1.505~4.765）、术腔引流不畅（

=2.373，95%

：1.503~3.746）均为术后复发的危险因素（

0.05）。基于

Cox

回归分析的预测因素构建CSOM患者耳内窥镜术后复发的风险量化列线图模型，其中合并反复上呼吸道感染、合并慢性鼻-鼻窦炎、合并腺样体肥大、MERI评分、ETDQ-7评分、术腔引流不畅的风险值范围分别为0~65分、0~56分、0~52分、0~76分、0~64分、0~76分；模型预测术后复发的

ROC

曲线下面积、敏感度及特异度分别为0.928（95%

：0.875~0.948）、85.92%、88.89%；模型对术后复发的预测概率与实际概率比较，差异无统计学意义（

=0.142，

=0.706）；模型预测术后复发的阈值概率在4%~92%区间可获得临床净收益。

结论

CSOM患者耳内窥镜术后复发的预测因素包括合并反复上呼吸道感染、合并慢性鼻-鼻窦炎、合并腺样体肥大、MERI评分、ETDQ-7评分及术腔引流不畅，基于这些因素构建的风险量化列线图模型对术后复发的预测效能较高。

Abstract

Objective

To explore the predictive factors of recurrence of chronic suppurative otitis media （CSOM） after otoendoscopic surgery， and construct a risk quantified nomogram model.

Methods

The clinical data of 485 patients with CSOM who underwent otoendoscopic surgery in our hospital from February 2021 to February 2023 were retrospectively analyzed. The patients were divided into the recurrence group and the non-recurrence group according to the recurrence situation during the follow-up period. The clinical data of patients between the two groups were compared， and the predictive factors of postoperative recurrence were analyzed by

Cox

regression method. A risk quantified nomogram model was constructed based on these predictive factors. The predictive efficiency of the model was verified by

receiver operating characteristic

（

ROC

） curve， and the calibration degree of the model was verified by

Hosmer-Lemeshow

goodness of fit analysis， and the clinical net benefit of the model was evaluated by

decision curve analysis

（

DCA

） method.

Results

Follow-up ranged from 6 to 39 months， with a median of 21 （11， 32） months， the postoperative recurrence rate was 14.64% （71/485）. Combined with recurrent upper respiratory tract infections （

=3.019，95%

：1.609 to 5.664），combined with chronic rhinosinusitis （

=2.428，95%

：1.529 to 3.856），combined with adenoid hypertrophy （

=2.214，95%

：1.381 to 3.551），middle ear risk index （MERI） score （

=2.863， 95%

：1.445 to 5.675），the seven-item eustachian tube dysfunction questionnaire （ETDQ-7） score （

=2.679，95%

：1.505 to 4.765） and inadequate drainage of the surgical cavity （

=2.373，95%

：1.503 to 3.746） were the risk factors for postoperative recurrence （

0.05）. A risk quantified nomogram model of recurrence after otoendoscopic surgery in CSOM patients was constructed based on the predictive factors of

Cox

regression analysis，among them the risk value ranges of patients who combined with recurrent upper respiratory tract infections， combined with chronic rhinosinusitis， combined with adenoid hypertrophy， MERI score， ETDQ-7 score， and inadequate drainage of the surgical cavity were 0 to 65 points，0 to 56 points，0 to 52 points，0 to 76 points，0 to 64 points，and 0 to 76 points，respectively. The

area under the curve

ROC

， sensitivity and specificity of the model for predicting postoperative recurrence were 0.928 （95%

：0.875 to 0.948），85.92% and 88.89%， respectively. There was no significant difference between the predicted probability of postoperative recurrence and the actual probability （

0.05）. The threshold probability of postoperative recurrence predicted by the model in the range of 4% to 92% could obtain clinical net benefit.

Conclusion

The predictive factors of recurrence after otoendoscopic surgery in CSOM patients include combined with recurrent upper respiratory tract infections， combined with chronic rhinosinusitis， combined with adenoid hypertrophy， MERI score， ETDQ-7 score and inadequate drainage of the surgical cavity， the risk quantified nomogram model based on these factors is highly effective in predicting postoperative recurrence.

关键词

Keywords

references

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