摘要
目的探讨后鼓室胆脂瘤中耳病变特点、听力学特征与手术策略。方法回顾性分析解放军总医院耳鼻咽喉科2007年8月～2009年8月间经手术证实为后鼓室胆脂瘤中耳炎的患者48例(59耳)的临床资料,分析手术前后耳内镜、纯音测听及声导抗检查结果,比较不同的听力重建方法及其结果。结果 59耳中,45耳(76.27%,45/59)表现为鼓膜后上内陷袋形成,镫骨上结构可分为缺失(52.54%,31/59)、听骨连接(27.12%,16/59)与软连接(20.34%,12/59),其术前语频区听阈分别60.05±4.19、44.39±7.12与45.05±5.64dBHL,镫骨上结构缺失患者术前听阈明显高于听骨连接和软连接患者(P<0.01);术中经面神经隐窝入路,仔细清除卵圆窝及圆窗龛周围胆脂瘤上皮,必要时以耳内镜辅助下彻底去除胆脂瘤,重建听骨链分别应用德国宾格钛合金听小骨赝复体TORP59.32%(35/59),PORP11.86%(7/59);17耳(28.81%)听骨链连续性存在或破坏不明显,仅行病灶清除,以应用TORP的镫骨上结构缺失患者术后听力提高程度更为明显(P<0.01)。结论后鼓室胆脂瘤患者中耳病变以镫骨上结构破坏为主,可导致较重的传导性听力损失,经面神经隐窝入路便于暴露后鼓室病变,耳内镜有助于清除胆脂瘤,应用合适的听小骨赝复体重建听骨链可提高听力。
Objective To study the pathologic characteristics,auditory features,occicular chain reconstruction and surgical outcome for otitis media with cholesteatoma confined in posterior tympani cavity.Methods Forty-eight patients （ fifty-nine ears ） with cholesteatoma otitis confined in posterior tympani cavity in 301 Hospital from August,2007 to August,2009,were studied retrospectively.Oto-endoscopy,pure tone audiometry（PTA） and acoustic immitance mearsurement were performed preoperatively.Pre-and post-operative hearing levels and variety of surgical managements were compared.Results Retraction pocket was found in 45 ears 76.3% of the 59 ears,and lied in posterior-superior portion of tympani membrane.According to stapes and the stapes supra structures demage degree,ossicle chain was divided into three conditions：Stape suprastucture absence（52.5%）,ossicular connected（20.3%）and false fibre-connected（27.1%）,pre-operative hearing thresholds were 60.05±4.19,44.39±7.12 and 45.05±5.64 dB HL,respectively and had significant difference statistically.Cholesteatoma in posterior tympani cavity was removed by opening the facial recess.The otoscopy was used when it was aecessary.Ossicle chain reconstructions were performed using the prosthesis of TORP （59.3%） or PORP （11.9%）.Cholesteatoma elimination was performed in 17 ears（28.8%） with continuity existence of ossicular chain or without obvious damage.Hearing improvment in stape suprastucture absence group was better than other groups（P〈0.01）.Conclusion The stapesuprastucture destructions is the majn feature in patients of otitis media with cholesteatoma confined in posterior tympani cavity.The facial recess approach can provide reasonable exposure and otoscopy is helpful for removing cholesteatoma in posterior tympani cavity.Hearing improvement can be achieved by ossicle chain reconstructions through using ossicular prosthesis.
出处
《听力学及言语疾病杂志》
CAS
CSCD
北大核心
2010年第6期559-561,共3页
Journal of Audiology and Speech Pathology
基金
“十一五”国家科技支撑计划重大项目(2007BAI18B12,2007BAI18B14,2008BAI50B80)
关键词
胆脂瘤
后鼓室
听骨链重建
听力
Cholesteatoma； Posterior tympani cavity； Ossicle chain reconstruction； Hearing；
