200例耳硬化症手术患者临床特征分析

发布时间：2018-08-27 20:07

【摘要】：目的:通过总结耳硬化症患者的临床表现、听力学及影像学在耳硬化症诊断中的评估作用,统计术后的听力学改善情况,增强对耳硬化症的认识,并为耳硬化症患者个性化的手术治疗咨询提供依据。方法:行镫骨底板开窗+Piston人工听骨植入手术的耳硬化症患者200例,收集患者的年龄、性别、临床表现及伴随症状、纯音测听、声导抗的类型、卡哈切迹是否存在、盖莱实验的结果、高分辨率颞骨CT的表现等资料。术后3~6个月复查听力。结果:73%的患者伴耳鸣,4%伴耳闷胀感。卡哈切迹出现率80.79%,盖莱实验阴性率92.09%,颞骨CT阳性率45.66%。68%的患者鼓室导抗图为A型,As型曲线仅占22%。统计分析其中56例激光镫骨手术的听力改善情况,术后在250Hz、500Hz、1kHz、2kHz、4kHz骨气导差分别为25.54、16.25、13.75、6.34、15.96dB。与术前相比,这5个频率的骨气导差改善具有显著性差异。250Hz、500Hz、1kHz、2kHz骨导阈值分别改善2.05、1.51、3.75、3.93dB,而在4kHz骨导阈值却增加1.34dB。与术前相比,骨导阈值在250Hz、1kHz、2kHz的改善具有显著性差异,而在500Hz以及4kHz不存在显著性差异。结论:对于耳硬化症的诊断,需要结合病史、纯音测听、卡哈切迹、盖莱实验、高分辨率颞骨CT等综合判断。镫骨底板开窗+Piston人工听骨植入技术不仅可以改善患者的气导听阈值,还可以改善250Hz、1kHz、2kHz的骨导听阈值。
[Abstract]:Objective: to summarize the clinical manifestations of patients with otorsclerosis and evaluate the role of audiology and imaging in the diagnosis of otorsclerosis, to count the improvement of audiology after operation, and to enhance the understanding of otorsclerosis. And to provide the basis for individualized surgical therapy for patients with ear sclerosis. Methods: the age, sex, clinical manifestation and associated symptoms, pure tone audiometry, type of acoustic conductance, and the existence of Caha notch were collected in 200 patients with auricle sclerosis treated with Piston artificial ossclerosis implantation. The results of Guillay's experiment and the CT findings of high resolution temporal bone. Hearing was reexamined 3 ~ 6 months after operation. Results in 73% of the patients, 4% of them had tinnitus and 4% had a feeling of ear distention. The positive rate of CT in temporal bone was 45.66. 68%. The type A as curve was only 22. 9%. The hearing improvement of 56 cases of laser stapes operation was statistically analyzed. The difference of bone gas conductance at 250 Hz ~ 500 Hz ~ 1 kHz ~ 2 kHz ~ 4 kHz was 25.54 ~ 16.25 ~ 13.755 ~ 6.34 ~ 15.96 dB respectively. Compared with those before operation, there was significant difference in the improvement of bone gas conductance between the five frequencies. The bone conductance threshold of 250Hz1 500 Hz HzC 2kHz was improved by 2.05 卤1.51kHz 3.75-3.93dB respectively, but in 4kHz the bone conduction threshold increased by 1.34dB. There was significant difference in the improvement of bone conduction threshold at 2 kHz at 250 Hz, but there was no significant difference in 500Hz and 4kHz. Conclusion: for the diagnosis of otorsclerosis, it is necessary to combine the history, pure tone audiometry, Kahhar notch, Gailai experiment, high resolution temporal bone CT and so on. Piston artificial ossicular implantation with fenestration on the base of stapes can not only improve the threshold of air-conduction hearing, but also improve the threshold of 2kHz of 250Hz1 kHz.
【作者单位】：首都医科大学附属北京同仁医院耳鼻咽喉头颈外科;
【分类号】：R764.9

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