耳显微手术中电钻和吸引器产生噪声分布及其对听力的影响
发布时间：2018-10-20 18:26
【摘要】： 目的中耳术后感音神经性耳聋的发生是其严重并发症之一,近两年受到人们的重视。本课题通过新型ER-7C声级计分别在尸头颞骨和活体上针对电钻和吸引器产生噪声进行描述,分析噪声的影响因素,探究中耳术后感音神经性耳聋的发生机制,为临床治疗提供了理论依据。 方法采用ER-7c型声级计,对耳显微手术中不同种类和不同规格的电钻及吸引器在9具尸头的12侧颞骨中产生的噪声进行测量,并以噪声的等效声压级的峰值(MAX)和RMS(均方根)为指标,分析噪声影响因素,以前瞻性研究随访20例单侧中耳手术者非手术耳听力变化,探究中耳术后感音神经性耳聋发生机制。 结果1.在9具尸头的12侧颞骨中测量噪声值如下:⑴不同直径的切割钻在乳突骨皮质产生噪声峰值的均值为120.4dB SPL～121.7dB SPL,RMS值为108.3dB SPL～110.6 dB SPL;⑵在乳突腔,不同直径的切割钻和金刚钻产生噪声峰值为116.8dB SPL～121.5dB SPL, RMS为105.4dB SPL～110.1dB SPL,其差别无统计学意义;(3)耳蜗开窗术记录噪声峰值在116.0dB SPL～131.5dB SPL,噪声RMS值为108.6dB SPL～124.9dB SPL,并且在3具尸头的3侧颞骨中记录到转动的金刚钻接触鼓阶内骨膜时噪声值超过130 dB SPL。(4)吸引器产生的噪声峰值在99.9dB SPL～128.7dB SPL,RMS在84.8dB SPL～117.2dB SPL;随着吸引器直径增大,噪声值也增加;但当吸引器直径超过2 mm后,其噪声值的差异无统计学意义。2.20例手术患者随访中发现7例(35.0%)患者非手术耳术后两周或一个月骨导阈值提高阳性,术后3个月骨导阈值基本恢复正常。 结论1.耳显微手术中电钻转动所产生的噪声值较大,尤其在耳蜗开窗时转动的金刚钻接触鼓阶内骨膜时噪声值更大,足以引起噪声性耳聋。因此改进耳显微手术的技术、缩短内耳受噪声暴露的时间对降低噪声性耳聋的发生率至关重要。2.耳显微手术中吸引器产生的噪声值较大,因此应选择合适的吸引器,尽量缩短噪声暴露时间,在靠近耳蜗时应选用直径1 mm的吸引器,以避免噪声性耳聋的发生。3.耳显微手术中电钻和吸引器噪音可引起非手术耳听力短暂阈值漂移,三个月后听力基恢复术前水平。
[Abstract]:Objective the occurrence of sensorineural deafness after middle ear operation is one of the serious complications, which has been paid more attention in recent two years. This paper describes the noise produced by electric drill and attractor on the temporal bone of cadaveric head and in vivo by a new type of ER-7C sound level meter, analyzes the influencing factors of noise, and probes into the mechanism of sensorineural deafness after middle ear operation. It provides a theoretical basis for clinical treatment. Methods the noise from 12 temporal bones of 9 cadavers was measured by using ER-7c type sound level meter, which was produced by different types and specifications of electric drill and attractor in 9 cadavers. Based on the (MAX) and RMS (root mean square) of the equivalent sound pressure level of noise, the factors influencing noise were analyzed. The hearing changes of 20 cases of unilateral middle ear surgery were followed up, and the mechanism of sensorineural hearing loss after middle ear operation was explored. Result 1. The noise values were measured in 12 sides of temporal bone of 9 cadaver heads as follows: (1) the mean value of noise peak in mastoid bone cortex by cutting drill of different diameters was 120.4dB SPL~121.7dB SPL,RMS value of 108.3dB SPL~110.6 dB SPL;2 in mastoid cavity. There was no significant difference between the noise peak of 116.8dB SPL~121.5dB SPL, RMS and that of diamond with different diameters. (3) the peak noise of cochlear fenestration was 108.6dB SPL~124.9dB SPL, and the RMS value of 116.0dB SPL~131.5dB SPL, was 108.6dB SPL~124.9dB SPL,. In three temporal bones of cadaveric heads, the noise value of the rotating diamond in contact with the periosteum of the inner drum step was over 130mol / 4) the peak noise produced by the attractor in 99.9dB SPL~128.7dB SPL,RMS increased with the diameter of the attractor at 84.8dB SPL~117.2dB SPL;. The noise value also increased, but there was no significant difference when the diameter of the attractor was more than 2 mm. 2. 7 patients (35.0%) had increased bone conduction threshold after 2 weeks or one month of non-operative ear surgery. The bone conduction threshold returned to normal 3 months after operation. Conclusion 1. The noise produced by electric drill rotation in ear microsurgery is larger especially when the diamond rotates in the cochlea fenestration and touches the periosteum in the drum step which is enough to cause noise deafness. Therefore, it is very important to improve the technique of microsurgery and shorten the time of noise exposure to the inner ear in order to reduce the incidence of noise-induced deafness. 2. In order to avoid noise-induced deafness, we should select suitable attractor to shorten the time of noise exposure and 1 mm diameter attractor near cochlea in order to avoid noise-induced deafness. The noise of electric drill and attractor can cause transient threshold shift of hearing in non-operative ears during microsurgery, and the level of hearing base recovers after 3 months.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R764
本文编号：2284013
[Abstract]:Objective the occurrence of sensorineural deafness after middle ear operation is one of the serious complications, which has been paid more attention in recent two years. This paper describes the noise produced by electric drill and attractor on the temporal bone of cadaveric head and in vivo by a new type of ER-7C sound level meter, analyzes the influencing factors of noise, and probes into the mechanism of sensorineural deafness after middle ear operation. It provides a theoretical basis for clinical treatment. Methods the noise from 12 temporal bones of 9 cadavers was measured by using ER-7c type sound level meter, which was produced by different types and specifications of electric drill and attractor in 9 cadavers. Based on the (MAX) and RMS (root mean square) of the equivalent sound pressure level of noise, the factors influencing noise were analyzed. The hearing changes of 20 cases of unilateral middle ear surgery were followed up, and the mechanism of sensorineural hearing loss after middle ear operation was explored. Result 1. The noise values were measured in 12 sides of temporal bone of 9 cadaver heads as follows: (1) the mean value of noise peak in mastoid bone cortex by cutting drill of different diameters was 120.4dB SPL~121.7dB SPL,RMS value of 108.3dB SPL~110.6 dB SPL;2 in mastoid cavity. There was no significant difference between the noise peak of 116.8dB SPL~121.5dB SPL, RMS and that of diamond with different diameters. (3) the peak noise of cochlear fenestration was 108.6dB SPL~124.9dB SPL, and the RMS value of 116.0dB SPL~131.5dB SPL, was 108.6dB SPL~124.9dB SPL,. In three temporal bones of cadaveric heads, the noise value of the rotating diamond in contact with the periosteum of the inner drum step was over 130mol / 4) the peak noise produced by the attractor in 99.9dB SPL~128.7dB SPL,RMS increased with the diameter of the attractor at 84.8dB SPL~117.2dB SPL;. The noise value also increased, but there was no significant difference when the diameter of the attractor was more than 2 mm. 2. 7 patients (35.0%) had increased bone conduction threshold after 2 weeks or one month of non-operative ear surgery. The bone conduction threshold returned to normal 3 months after operation. Conclusion 1. The noise produced by electric drill rotation in ear microsurgery is larger especially when the diamond rotates in the cochlea fenestration and touches the periosteum in the drum step which is enough to cause noise deafness. Therefore, it is very important to improve the technique of microsurgery and shorten the time of noise exposure to the inner ear in order to reduce the incidence of noise-induced deafness. 2. In order to avoid noise-induced deafness, we should select suitable attractor to shorten the time of noise exposure and 1 mm diameter attractor near cochlea in order to avoid noise-induced deafness. The noise of electric drill and attractor can cause transient threshold shift of hearing in non-operative ears during microsurgery, and the level of hearing base recovers after 3 months.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R764
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