摘要
目的观察采用耳甲软骨行Ⅱ型鼓室成形术后听力改善的情况,并分析可能的影响因素。方法回顾分析自2008年9月至2016年7月在空军军医大学第一附属医院耳鼻咽喉头颈外科行耳甲软骨Ⅱ型鼓室成形(鼓膜-软骨-镫骨连接)的患者,包括:单纯鼓室成形术,上鼓室切开+鼓室成形,开放式乳突切开+鼓室成形术患者共52例。所有患者于术前及术后2月,6月,1年及2年进行纯音测听,分别计算术前术后的气导听阈(AC),骨导听阈(BC)及气骨导差(ABG),分析术前术后听力的变化,并根据术后ABG将患者分成ABG>20dB,ABG≤20dB两组,比较两组患者年龄,性别,病程,术前听力,鼓室内粘膜情况及咽鼓管鼓口情况与术后听力改善的关系。结果 52例患者中行单纯鼓室成形13例,上鼓室切开+鼓室成形12例,开放式乳突切开+鼓室成形27例。术后随访期内1例患者术后2月出现外耳道深部闭锁,再次手术后恢复。1例患者术后5月出现外耳道霉菌感染,予局部处理后恢复,余患者恢复好,未见穿孔及胆脂瘤复发。术后患者的气导听阈较术前显著降低(t=4.006, P<0.05),气骨导差较术前明显缩小(t=3.926, P<0.05),而术前术后患者的骨导听力无显著统计学差异(t=0.47, P>0.05);咽鼓管鼓口病变在ABG>20dB,ABG≤20dB两组之间有显著差异(χ2=5.04, P<0.05)。结论本研究初步研究了耳甲软骨Ⅱ型鼓室成形术后的听力效果及可能的影响因素,结果显示患者术后听力改善明显,而咽鼓管鼓口病变与听力改善有显著相关性。因此术中评估咽鼓管鼓口的状态并做相应处理,有利于预测和改善术后听力。
Objective To report hearing outcomes after typeⅡtympanoplasty with concha cartilage grafts and possible factors affecting outcomes.Method Data from 52 patients who received typeⅡtympanoplasty(tympanic membrane-cartilage-stapes connection)from September 2008 to July 2016 by the authors were retrospectively analyzed.Operations included tympanoplasty,epitympanoplasty and wall-down mastoidectomy plus tympanoplasty.Pure tone audiometry was taken before and 2,6,12 and 24 months after operation.Air conduction(AC)and bone conduction(BC)thresholds and air bone gap(ABG)were analyzed.Based on post-operation ABG,patients were divided into two groups(ABG>20 dB and ABG≤20dB).Age,gender,disease duration,preoperative hearing,condition of tympanum mucosa and opening of eustachian tubae were compared between the two groups.Results Among the 52 patients,13 received tympanoplasty,12 received epitympanoplasty and 27 received wall-down mastoidectomy plus tympanoplasty.During the follow-up,deep external auditory canal atresia was seen in 1 patient 2 months after operation which was corrected with a revision procedure.Ear canal fungal infection developed in 1 case 5 months after operation and resolved following local treatment.No perforation or recurrence of cholesteatoma was observed.Air conduction threshold improved(t=4.006,P<0.05)with decreased air-bone gap(t=3.926,P<0.05)postoperatively,while bone conduction thresholds showed no statistically significant difference(t=0.47,P>0.05).In addition,condition of the eustachian tube opening was significantly different between the ABG>20dB and ABG≤20 dB groups(χ2=5.04,P<0.05).Conclusion This preliminary study shows that patients can obtain satisfactory hearing results after the typeⅡtympanoplasty with cartilage grafts.The condition of eustachian tube opening appears to be factor affecting postoperative hearing outcomes.
作者
宋勇莉
高伟
温立婷
岳波
查定军
邱建华
陈阳
SONG Yongli;GAO Wei;WEN Liting;YUE Bo;ZHA Dingjun;QIU Jianhua;CHEN Yang(Department of Otolaryngology Head and Neck Surgery,Xijing Hospital,PLA Air Force Military Medical University,Xi'an,710032)
出处
《中华耳科学杂志》
CSCD
北大核心
2018年第6期864-870,共7页
Chinese Journal of Otology
关键词
鼓室成形术
听骨链重建
软骨
Tympanoplasty
Ossicular Chain Reconstruction
Cartilage
