目的探讨自体砧骨搭桥术在听骨链重建中的临床应用效果。方法回顾性分析68例自体砧骨搭桥听骨链重建患者，随访时间6～28个月，平均19．75个月。将自体砧骨塑形后桥接于完整的锤骨和完整活动的镫骨之间。观察术后并发症并行听力学疗效...目的探讨自体砧骨搭桥术在听骨链重建中的临床应用效果。方法回顾性分析68例自体砧骨搭桥听骨链重建患者，随访时间6～28个月，平均19．75个月。将自体砧骨塑形后桥接于完整的锤骨和完整活动的镫骨之间。观察术后并发症并行听力学疗效分析。结果术后无1例自体砧骨脱出，2例移位。平均纯音听力（pure tone average，PTA）的气导由术前（46．69±18．32）dB提高到（30．21±9．46）dB，骨导由（24．72±10．63）dB提高到（18．15±8．91）dB，气骨导差（air-bone gap，ABG）由（21．97±10．32）dB缩小到（12．06±9．46）dB。手术成功率（术后PTA-ABG≤20dB）为75％，术后骨导听力改善阳性率为66％（0．5、1、2、4kHz中至少有2个频率提高10dB）。筛选出随访在1年以上的50例患者，术后6个月PTA-ABG≤20dB占78％，1年为74％，最近1次为72％。结论当修复完整、活动的镫骨和完整锤骨之间的听骨链缺损时，采用自体砧骨搭桥因为操作便利，费用低廉，效果稳定，并发症少，听力恢复理想，在自体砧骨可以利用时应当视为首选。对其手术效果的听力评价除以术前、术后气骨导差的闭合程度为依据外，也应考虑术前、术后气导、骨导。展开更多
Objective:To investigate surgical indications, operative techniques, complications and auditory and speech rehabilitation for cochlear implant (CI) in children with otitis media with effusion (OME). Material and meth...Objective:To investigate surgical indications, operative techniques, complications and auditory and speech rehabilitation for cochlear implant (CI) in children with otitis media with effusion (OME). Material and methods:This is a retrospective review of records of 24children with bilateral profound sensorineural hearing loss and OME who were implanted during January 2011 to November 2014 in the Department of Otorhinolaryngology and Head and Neck Surgery at the PLA Hospital, using one-stage implantation via the facial recess approach and round window insertion. The incus was removed in 8 cases during the implantation procedure. Local infiltration of dexamethasone and adrenaline in the middle ear was also performed. Postoperative complications were examined. Preoperative and postoperative questionnaires including Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR), and the Meaningful Auditory Integration Scale (MAIS) were collected. Results: All electrodes were implanted successfully without any immediate or delayed complications. Inflammatory changes of middle ear mucosa with effusion were noted in all implanted ears. The scores of post-implant CAP and SIR increased significantly in all 24 cases (t ? ?25.95 and ?14.09, respectively for CAP and SIR, p<0.05). Conclusions:One-stage CI via the facial recess approach with round window insertion is safe and effective in cochlear implant candidates with OME, as seen in the 24 children in our study who achieved improved auditory performance and speech intelligibility after CI. Copyright ? 2015, PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).展开更多
Objective:The purpose of this study is to evaluate our experience with endoscopic repair of ossicular discontinuity at the incudostapedial joint,with or without an intact stapes suprastructure,and present our hearing ...Objective:The purpose of this study is to evaluate our experience with endoscopic repair of ossicular discontinuity at the incudostapedial joint,with or without an intact stapes suprastructure,and present our hearing results.We classify results based on the causative pathology,the type of ossiculoplasty,and type of Lesion.We demonstrate the ability to endoscopically place a total ossicular replacement prosthesis (TORP),measuring 4.25 mm,between the stapes footplate and the incus remnant to reestablish ossicular continuity.Methods:This was a retrospective case series conducted in tertiary referral center (Hopital de la Timone) Marseille,France.25 patients underwent incudostapedial rebridging ossiculoplasty between 2009 and 2013.Fifteen cases of chronic otitis media and 10 otosclerosis revisions were included in the study.Three different materials were used in ossiculoplasty,hydroxyapatite cement,incus remnant,and partial/total ossicular replacement prostheses.Audiometric results were evaluated before and after ossiculoplasty.Twelve month follow-up data is provided.Results:The mean postoperative air-bone gap was 15 dB (5-25 dB).Hearing results were better inotosclerosis revisions.Hydroxyapatite cement produced an air-bone gap of 5 dB,TORP placed under the incus produced a 12 dB gap,and TORP placed under the malleus resulted in a 12 dB gap and one deaf ear.In cases of chronic otitis media,the residual air-bone gap was 17 dB with PORP,12 dB with TORP,and 20 dB with incus transposition.Conclusion:The hydroxyapatite cement is effective in the reconstruction of ossicular discontinuity but the high price limits its utilization.TORP placed under the incus is a reliable and stable method of ossicular reconstruction that is cost effective and offers satisfactory hearing results in selected patients.展开更多
Background: The measurement of the piston length during stapedotomy is important and it may have significant effects on the surgical outcome.Objective: To determine the piston length in a group of otosclerosis patient...Background: The measurement of the piston length during stapedotomy is important and it may have significant effects on the surgical outcome.Objective: To determine the piston length in a group of otosclerosis patients who underwent primary stapedotomy.Material and methods: Between Sep 2013 and Sep 2014, 85 patients with diagnosed otosclerosis underwent primary stapedotomy. Teflon prosthesis of 0.6 mm of diameter was used in all patients. The distance between medial surface of the long process of incus and center point of the stapedial footplate measured. The piston length calculated by adding 0.25 mm for the thickness of footplate and 0.50 mm for placement of the prosthesis into the vestibule.Results: The distance between stapedial foot plate and incus ranged from 3.50 to 4.50 mm. The mean distance was 3.95 ± 0.16 mm. In majority of cases(74.1%) piston length was 4.75 mm followed by 4.50 mm in 15.3% and 5.00 mm in 5.9%. Piston length was 4.25 mm in 3.5% and5.25 mm in only 1.2% of patients. There was no significant post-operative complication and air bone gap closure obtained in all patients.Conclusion: The most common distance between foot plate and incus is 4.00 mm. No case needed a piston longer than 5.25 mm or shorter than4.25 mm.展开更多
文摘目的探讨自体砧骨搭桥术在听骨链重建中的临床应用效果。方法回顾性分析68例自体砧骨搭桥听骨链重建患者，随访时间6～28个月，平均19．75个月。将自体砧骨塑形后桥接于完整的锤骨和完整活动的镫骨之间。观察术后并发症并行听力学疗效分析。结果术后无1例自体砧骨脱出，2例移位。平均纯音听力（pure tone average，PTA）的气导由术前（46．69±18．32）dB提高到（30．21±9．46）dB，骨导由（24．72±10．63）dB提高到（18．15±8．91）dB，气骨导差（air-bone gap，ABG）由（21．97±10．32）dB缩小到（12．06±9．46）dB。手术成功率（术后PTA-ABG≤20dB）为75％，术后骨导听力改善阳性率为66％（0．5、1、2、4kHz中至少有2个频率提高10dB）。筛选出随访在1年以上的50例患者，术后6个月PTA-ABG≤20dB占78％，1年为74％，最近1次为72％。结论当修复完整、活动的镫骨和完整锤骨之间的听骨链缺损时，采用自体砧骨搭桥因为操作便利，费用低廉，效果稳定，并发症少，听力恢复理想，在自体砧骨可以利用时应当视为首选。对其手术效果的听力评价除以术前、术后气骨导差的闭合程度为依据外，也应考虑术前、术后气导、骨导。
基金supported by grants from the National Basic Research Program of China(973 Program)(#2012CB9679002011CBA01000)+1 种基金the National Natural Science Foundation of China(NSFC #81271082)the grants of the National Key Basic Research Program of China(973 Program),No.2014CB943003
文摘Objective:To investigate surgical indications, operative techniques, complications and auditory and speech rehabilitation for cochlear implant (CI) in children with otitis media with effusion (OME). Material and methods:This is a retrospective review of records of 24children with bilateral profound sensorineural hearing loss and OME who were implanted during January 2011 to November 2014 in the Department of Otorhinolaryngology and Head and Neck Surgery at the PLA Hospital, using one-stage implantation via the facial recess approach and round window insertion. The incus was removed in 8 cases during the implantation procedure. Local infiltration of dexamethasone and adrenaline in the middle ear was also performed. Postoperative complications were examined. Preoperative and postoperative questionnaires including Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR), and the Meaningful Auditory Integration Scale (MAIS) were collected. Results: All electrodes were implanted successfully without any immediate or delayed complications. Inflammatory changes of middle ear mucosa with effusion were noted in all implanted ears. The scores of post-implant CAP and SIR increased significantly in all 24 cases (t ? ?25.95 and ?14.09, respectively for CAP and SIR, p<0.05). Conclusions:One-stage CI via the facial recess approach with round window insertion is safe and effective in cochlear implant candidates with OME, as seen in the 24 children in our study who achieved improved auditory performance and speech intelligibility after CI. Copyright ? 2015, PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
文摘Objective:The purpose of this study is to evaluate our experience with endoscopic repair of ossicular discontinuity at the incudostapedial joint,with or without an intact stapes suprastructure,and present our hearing results.We classify results based on the causative pathology,the type of ossiculoplasty,and type of Lesion.We demonstrate the ability to endoscopically place a total ossicular replacement prosthesis (TORP),measuring 4.25 mm,between the stapes footplate and the incus remnant to reestablish ossicular continuity.Methods:This was a retrospective case series conducted in tertiary referral center (Hopital de la Timone) Marseille,France.25 patients underwent incudostapedial rebridging ossiculoplasty between 2009 and 2013.Fifteen cases of chronic otitis media and 10 otosclerosis revisions were included in the study.Three different materials were used in ossiculoplasty,hydroxyapatite cement,incus remnant,and partial/total ossicular replacement prostheses.Audiometric results were evaluated before and after ossiculoplasty.Twelve month follow-up data is provided.Results:The mean postoperative air-bone gap was 15 dB (5-25 dB).Hearing results were better inotosclerosis revisions.Hydroxyapatite cement produced an air-bone gap of 5 dB,TORP placed under the incus produced a 12 dB gap,and TORP placed under the malleus resulted in a 12 dB gap and one deaf ear.In cases of chronic otitis media,the residual air-bone gap was 17 dB with PORP,12 dB with TORP,and 20 dB with incus transposition.Conclusion:The hydroxyapatite cement is effective in the reconstruction of ossicular discontinuity but the high price limits its utilization.TORP placed under the incus is a reliable and stable method of ossicular reconstruction that is cost effective and offers satisfactory hearing results in selected patients.
文摘Background: The measurement of the piston length during stapedotomy is important and it may have significant effects on the surgical outcome.Objective: To determine the piston length in a group of otosclerosis patients who underwent primary stapedotomy.Material and methods: Between Sep 2013 and Sep 2014, 85 patients with diagnosed otosclerosis underwent primary stapedotomy. Teflon prosthesis of 0.6 mm of diameter was used in all patients. The distance between medial surface of the long process of incus and center point of the stapedial footplate measured. The piston length calculated by adding 0.25 mm for the thickness of footplate and 0.50 mm for placement of the prosthesis into the vestibule.Results: The distance between stapedial foot plate and incus ranged from 3.50 to 4.50 mm. The mean distance was 3.95 ± 0.16 mm. In majority of cases(74.1%) piston length was 4.75 mm followed by 4.50 mm in 15.3% and 5.00 mm in 5.9%. Piston length was 4.25 mm in 3.5% and5.25 mm in only 1.2% of patients. There was no significant post-operative complication and air bone gap closure obtained in all patients.Conclusion: The most common distance between foot plate and incus is 4.00 mm. No case needed a piston longer than 5.25 mm or shorter than4.25 mm.
