虚拟耳镜对鼓室成形术前后鼓室结构的观察

目的 探讨虚拟耳镜在鼓室成形术中的临床评估作用.方法 应用虚拟耳镜观察耳病患者102例(204耳),72例(75耳)完成鼓室成形术和外耳道鼓室成形术,其中慢性中耳炎53例(55耳),先天性外耳道闭锁1 9例(20耳).结果 23耳慢性化脓性中耳炎胆脂瘤型,虚拟耳镜观察19耳听骨链破坏,手术证实23耳均有听骨腐蚀;32慢性化脓性中耳炎骨疡型,虚拟耳镜观察29耳听骨链不同程度破坏,手术证实23耳锤骨和砧骨侵蚀,11耳镫骨头或镫上结构缺失;20耳先天性外耳道闭锁,中耳畸形,术前提示18耳听骨畸形,2耳小鼓室无听骨链,手术证实17耳外耳道闭锁,听骨严重畸形,2耳镫骨缺失,1耳前庭窗闭锁.2耳术后突然听力下降,复查虚拟耳镜发现移植听骨与鼓膜脱离.虚拟耳镜与手术探查符合率,中耳炎为92%,先天性外耳道闭锁、中耳畸形为100%.结论 虚拟耳镜为鼓室成形术术前病变程度及术后疗效评估提供可靠的影像学依据.

Evaluation of virtual endoscopy in tympanoplast

OBJECTIVE To study the clinical usability of virtual endoscopy(VE) in tympanoplasty.METHODS A total of 102 patients (204 ears) were observed by virtual endoscopy. Tympanoplasty was performed in 72 cases (75 ears) including 53 cases (55 ears) with chronic otitis media and 19 cases (20 ears) with congenital microtia and middle ear dysmorphia. Ossicular chain reconstruction was conducteded in 65 ears at the same time. RESULTS The ossicular chain was showed eroded in 19 ears of 23 patients with cholesteatoma otitis media pre-operatively by VE, but was found eroded in all of 23 ears during operation. The ossicular chain was showed eroded in 29 ears of 32 patients with osteitis otitis media pre-operatively by VE, but during operation it was found 23 ears with malleus and incus eroded, 11 ears without head of stapes or up-structure of stapes. VE showed 18 ears with congenital microtia and middle ear malformation and 2 ears with small tympanic cavity and no ossicular chain preoperatively, and operation proved 17 ears with severe ossicular malformation, 2 ears without stapes, 1 ear with vestibular window atresia. There were 2 ears with sudden hearing loss after tympanoplasty, the VE showed ossicular displacement. The coincidence rates between VE and operation view were 92 % in patients with otitis media and 100 % in patients with congenital microtia and middle ear malformation. CONCLUSION VE can supply reliability data for evaluation of the damaged ossicular chain and efficacy of tympanoplasty.