耳手术中电钻和吸引器噪声对非手术耳的影响

目的探讨耳显微手术中电钻及吸引器产生的噪音对非手术耳听力的影响。方法采用ER-7c声级计记录中耳手术中不同规格的切割钻、金钢钻和吸引器噪声,比较非手术耳术前、术后2周、术后1月及术后3月的纯音测听骨导阈值。骨导听阈0.25～8.00kHz至少2个或2个以上频率减少≥10dB为术后骨导听阈下降阳性,增加≥10dB为术后骨导听阈提高阳性。结果手术中不同规格的电钻和不同大小吸引器头产生的噪声强度分别为107.5～113.7dBSPL和96.7～110.5dBSPL;20例手术患者随访中发现7例（35.0%）患者非手术耳术后2周或1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。结论耳显微手术中电钻和吸引器噪声可引起非手术耳听力短暂阈值漂移,三个月后听力基本恢复术前水平。     

改良乳突根治术后外耳道后壁重建与鼓室成形

目的 探讨改良乳突根治术后外耳道后壁重建与鼓室成形的可行性.方法 37例(37耳)已行改良乳突根治术且听力为传导聋的患者,采用耳甲腔或耳甲艇软骨和带血管蒂的颞肌筋膜瓣重建外耳道后壁,同期耳屏软骨软骨膜复合物连同听骨链重建鼓室成形.结果 37耳均获得接近正常解剖生理的外耳道,术后3～4周干耳,用耳屏软骨软骨膜复合物修补的鼓膜愈合佳,形态正常.行听力重建的32耳术后听力骨气导差较术前平均缩小了27 dB(500、1000、2000、4000 kz的均值).其中获得完整资料的病例有27耳,随访1～3年,听力结果 稳定.结论对镫骨底板未固定、鼓室未上皮化、耳咽管功能良好的改良乳突根治术后患者,手术重建外耳道后壁及鼓室成形可获得较好的临床效果.     

改良乳突根治术后外耳道后壁重建与鼓室成形

目的 探讨改良乳突根治术后外耳道后壁重建与鼓室成形的可行性.方法 37例(37耳)已行改良乳突根治术且听力为传导聋的患者,采用耳甲腔或耳甲艇软骨和带血管蒂的颞肌筋膜瓣重建外耳道后壁,同期耳屏软骨软骨膜复合物连同听骨链重建鼓室成形.结果 37耳均获得接近正常解剖生理的外耳道,术后3～4周干耳,用耳屏软骨软骨膜复合物修补的鼓膜愈合佳,形态正常.行听力重建的32耳术后听力骨气导差较术前平均缩小了27 dB(500、1000、2000、4000 kz的均值).其中获得完整资料的病例有27耳,随访1～3年,听力结果 稳定.结论对镫骨底板未固定、鼓室未上皮化、耳咽管功能良好的改良乳突根治术后患者,手术重建外耳道后壁及鼓室成形可获得较好的临床效果.     

改良乳突根治术后外耳道后壁重建与鼓室成形

目的 探讨改良乳突根治术后外耳道后壁重建与鼓室成形的可行性.方法 37例(37耳)已行改良乳突根治术且听力为传导聋的患者,采用耳甲腔或耳甲艇软骨和带血管蒂的颞肌筋膜瓣重建外耳道后壁,同期耳屏软骨软骨膜复合物连同听骨链重建鼓室成形.结果 37耳均获得接近正常解剖生理的外耳道,术后3～4周干耳,用耳屏软骨软骨膜复合物修补的鼓膜愈合佳,形态正常.行听力重建的32耳术后听力骨气导差较术前平均缩小了27 dB(500、1000、2000、4000 kz的均值).其中获得完整资料的病例有27耳,随访1～3年,听力结果 稳定.结论对镫骨底板未固定、鼓室未上皮化、耳咽管功能良好的改良乳突根治术后患者,手术重建外耳道后壁及鼓室成形可获得较好的临床效果.     

改良乳突根治术后外耳道后壁重建与鼓室成形

目的 探讨改良乳突根治术后外耳道后壁重建与鼓室成形的可行性.方法 37例(37耳)已行改良乳突根治术且听力为传导聋的患者,采用耳甲腔或耳甲艇软骨和带血管蒂的颞肌筋膜瓣重建外耳道后壁,同期耳屏软骨软骨膜复合物连同听骨链重建鼓室成形.结果 37耳均获得接近正常解剖生理的外耳道,术后3～4周干耳,用耳屏软骨软骨膜复合物修补的鼓膜愈合佳,形态正常.行听力重建的32耳术后听力骨气导差较术前平均缩小了27 dB(500、1000、2000、4000 kz的均值).其中获得完整资料的病例有27耳,随访1～3年,听力结果 稳定.结论对镫骨底板未固定、鼓室未上皮化、耳咽管功能良好的改良乳突根治术后患者,手术重建外耳道后壁及鼓室成形可获得较好的临床效果.     

改良乳突根治术后外耳道后壁重建与鼓室成形

目的 探讨改良乳突根治术后外耳道后壁重建与鼓室成形的可行性.方法 37例(37耳)已行改良乳突根治术且听力为传导聋的患者,采用耳甲腔或耳甲艇软骨和带血管蒂的颞肌筋膜瓣重建外耳道后壁,同期耳屏软骨软骨膜复合物连同听骨链重建鼓室成形.结果 37耳均获得接近正常解剖生理的外耳道,术后3～4周干耳,用耳屏软骨软骨膜复合物修补的鼓膜愈合佳,形态正常.行听力重建的32耳术后听力骨气导差较术前平均缩小了27 dB(500、1000、2000、4000 kz的均值).其中获得完整资料的病例有27耳,随访1～3年,听力结果 稳定.结论对镫骨底板未固定、鼓室未上皮化、耳咽管功能良好的改良乳突根治术后患者,手术重建外耳道后壁及鼓室成形可获得较好的临床效果.     

改良乳突根治术后外耳道后壁重建与鼓室成形

目的 探讨改良乳突根治术后外耳道后壁重建与鼓室成形的可行性.方法 37例(37耳)已行改良乳突根治术且听力为传导聋的患者,采用耳甲腔或耳甲艇软骨和带血管蒂的颞肌筋膜瓣重建外耳道后壁,同期耳屏软骨软骨膜复合物连同听骨链重建鼓室成形.结果 37耳均获得接近正常解剖生理的外耳道,术后3～4周干耳,用耳屏软骨软骨膜复合物修补的鼓膜愈合佳,形态正常.行听力重建的32耳术后听力骨气导差较术前平均缩小了27 dB(500、1000、2000、4000 kz的均值).其中获得完整资料的病例有27耳,随访1～3年,听力结果 稳定.结论对镫骨底板未固定、鼓室未上皮化、耳咽管功能良好的改良乳突根治术后患者,手术重建外耳道后壁及鼓室成形可获得较好的临床效果.     

改良乳突根治术后外耳道后壁重建与鼓室成形

目的 探讨改良乳突根治术后外耳道后壁重建与鼓室成形的可行性.方法 37例(37耳)已行改良乳突根治术且听力为传导聋的患者,采用耳甲腔或耳甲艇软骨和带血管蒂的颞肌筋膜瓣重建外耳道后壁,同期耳屏软骨软骨膜复合物连同听骨链重建鼓室成形.结果 37耳均获得接近正常解剖生理的外耳道,术后3～4周干耳,用耳屏软骨软骨膜复合物修补的鼓膜愈合佳,形态正常.行听力重建的32耳术后听力骨气导差较术前平均缩小了27 dB(500、1000、2000、4000 kz的均值).其中获得完整资料的病例有27耳,随访1～3年,听力结果 稳定.结论对镫骨底板未固定、鼓室未上皮化、耳咽管功能良好的改良乳突根治术后患者,手术重建外耳道后壁及鼓室成形可获得较好的临床效果.     

改良乳突根治术后外耳道后壁重建与鼓室成形

目的 探讨改良乳突根治术后外耳道后壁重建与鼓室成形的可行性.方法 37例(37耳)已行改良乳突根治术且听力为传导聋的患者,采用耳甲腔或耳甲艇软骨和带血管蒂的颞肌筋膜瓣重建外耳道后壁,同期耳屏软骨软骨膜复合物连同听骨链重建鼓室成形.结果 37耳均获得接近正常解剖生理的外耳道,术后3～4周干耳,用耳屏软骨软骨膜复合物修补的鼓膜愈合佳,形态正常.行听力重建的32耳术后听力骨气导差较术前平均缩小了27 dB(500、1000、2000、4000 kz的均值).其中获得完整资料的病例有27耳,随访1～3年,听力结果 稳定.结论对镫骨底板未固定、鼓室未上皮化、耳咽管功能良好的改良乳突根治术后患者,手术重建外耳道后壁及鼓室成形可获得较好的临床效果.     

Postoperative change in wideband absorbance after tympanoplasty in chronic suppurative otitis media

ObjectiveTo identify the wideband absorbance (WBA) of reconstructed TM comparing with perforated and normal TM, and to investigate the efficacy of WBA to predict postoperative hearing outcome.MethodsNinety-eight adults (128 ears) with normal TM and 40 patients (40 ears) who were diagnosed with chronic suppurative otitis media (CSOM) and underwent tympanoplasty type 1 were enrolled. Pure tone audiometry and WBA were measured before and 6 and 12 months after surgery. Finally, only 29 patients in CSOM group completed all the tests.ResultsSignificant differences in WBA were observed between normal ears, CSOM, and reconstructed ears at middle to high frequencies. During follow-up, absorbance decreased at low frequencies and increased at middle to high. Significant positive correlation at low to middle frequency was observed between change in air-bone gaps (ABG) and absorbance at corresponding frequencies.ConclusionWBA in patients with CSOM was significantly different from normal TM, and a significant change in WBA was observed after tympanoplasty with improvement of ABG. WBA may be a useful tool for monitoring the postoperative change in absorbance of sound energy in the middle ear.     

耳外科手术中电钻产生噪声的评估

目的 探讨耳显微外科中电钻产生噪声的大小及其影响因素,以及耳蜗开窗术时噪声的特点.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在9具尸头的12侧颞骨中产生的噪声进行测量,并分别对噪声的等效声压级的峰值(MAX)和RMS(均方根)值进行统计学分析.结果 在9具尸头的12侧颞骨中测量噪声值如下:(1)不同直径的切割钻在乳突骨皮质产生噪声峰值的均值为120.4 dB SPL～121.7 dB SPL,RMS值为108.3 dB SPL～110.6 dB SPL;(2)在乳突腔,不同直径的切割钻和金刚钻产生噪声峰值为116.8 dB SPL～121.5 dB SPL,RMS为105.4 dB SPL～110.1 dB 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～131.5 dB SPL,噪声RMS值为108.6 dB SPL～124.9 dB 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.结论 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.     

鼓室成形术影响听力疗效相关因素分析

目的 探讨鼓室成形术听力疗效的相关影响因素.方法 报告118例（126耳）鼓室成形术,对可能影响听力疗效的16项因素进行分析.结果 病程短、病变轻、术前有较大骨气导间距、咽鼓管通畅、术中保留锤骨柄、选取适当术式以及术后完好鼓膜状态则听力效果较好,10项单因素经统计学分析均有显著性意义（P＜0.05）.结论 鼓室成形术听力疗效受多种因素影响,主要与病变程度及手术方法有关.     

水杨酸钠对噪声性听力损失影响的实验观察

目的　观察水杨酸钠能否减轻噪声引起的听力损失。方法　将 3 6只健康且耳廓反射正常的花色豚鼠随机分为水杨酸钠实验组、生理盐水对照组、水杨酸钠对照组和噪声暴露组。噪声暴露采用 10 5dBSPL的 4kHz窄带噪声下暴露 2h ,连续 5d。水杨酸钠给药为每天 0 5g/kg体重连续10d。由短声诱发听性脑干反应 (auditorybrainstemresponse ,ABR) ,连续测试其阈值 ;而后取动物双侧耳蜗荧光染色后光镜下行毛细胞计数和形态学观察。结果　ABR阈值测试显示 ,实验组动物在噪声暴露结束后 2 4h的听力略好于对照组 ;形态学观察表明 ,实验组细胞核异常数据低于对照组。结论　水杨酸钠可能在一定程度上具有拮抗噪声引起的听力损失及保护耳蜗毛细胞的作用     

Evaluation of the relation between audiometric and psychometric measures of hearing after tympanoplasty

The objective of this prospective study was to evaluate the relation between audiometric and psychometric measures after tympanoplasty from the perspective of preoperative selection of patients and postoperative assessment of the results of reconstructive middle ear surgery. Hearing (dis)ability was measured by means of pure-tone audiometry and a validated self-assessment questionnaire: the (modified) Amsterdam Inventory of Auditory Disability and Handicap (m)AIAD. Average hearing thresholds and (m)AIAD scores were evaluated for 80 patients, pre- and 12 months postoperatively. The average improvement of the air conduction threshold in the operated ear was 5.4 (±14.3) dB; the average improvement in the (m)AIAD score was 2.9 points (±12.1). Although not very strong, the audiometric improvement and increase in (m)AIAD score are significantly related. After the calculation of postoperatively measured mean scores on the (m)AIAD for different 10-dB intervals of postoperative hearing loss averaged over both ears, an interesting relation between the (m)AIAD score and hearing losses emerges. The (m)AIAD score is almost independent of hearing loss for postoperative hearing levels between 25 and 40 dB. Residual hearing loss has to become less than 25 dB before a smaller hearing loss corresponds with a higher (better) (m)AIAD score. For losses larger than 40 dB the (m)AIAD score clearly decreases with increasing hearing loss. Finally, even small residual hearing losses lead, on average, to (m)AIAD scores that are substantially lower than the score for normally hearing subjects. In general, the patient benefit seems related to the magnitude of improvement in the air-conduction thresholds, rather than to the achievement of a certain threshold level. In addition, even small residual hearing losses (less than 25 dB HL) still lead, on average, to (m)AIAD scores that are substantially lower than the scores for normally hearing subjects.     

咽鼓管功能对行Ⅰ型鼓室成形术的慢性中耳炎患者短期听力影响分析

目的 通过对耳内镜下Ⅰ型鼓室成形术治疗慢性化脓性中耳炎患者的临床资料分析,探讨咽鼓管功能对其听力影响。方法 收集诊断为慢性化脓性中耳炎患者42例,结合声导抗正负压平衡试验和咽鼓管功能障碍评分量表(ETDQ-7)将分为咽鼓管功能障碍患者作为研究组(25例),将咽鼓管功能正常患者作为对照组(17例),对比分析两组患者手术前后听力的变化。结果 研究组术前与术后气导平均听阈、骨导平均听阈均高于对照组,差异具有统计学意义(P <0.05);研究组术后气导平均听阈和骨导平均听阈的改善值均高于对照组,差异无统计学意义(P> 0.05);研究组术后4 k Hz气导听阈改善值低于对照组,差异无统计学意义(P> 0.05);研究组术后8 k Hz气导听阈改善值低于对照组,差异有统计学意义(P <0.05)。结论 良好的咽鼓管功能不会增加Ⅰ型鼓室成形术对慢性化脓性中耳炎患者平均听力的改善程度,但有利于患者术后高频听力的恢复。     

Pediatric type 1 cartilage tympanoplasty outcomes: A comparison of short and long term hearing results

Objective

Tympanoplasty is a commonly used procedure in children as in adults. The purposes of this study were to evaluate and report the long term results of type 1 cartilage tympanoplasty in pediatric population. Short term and long term hearing outcomes were compared according to age and perforation location.

Results of revision tympanoplasty for chronic non-cholesteatomatous otitis media

Objective

To evaluate the success rate for revision tympanoplasty using different graft materials, to compare results of primary and re-tympanoplasty using the same technique and to analyse the effect of potential influencing factors on closure of tympanic membrane (TM) and hearing outcome.

Methods

Study included all patients, who underwent tympanoplasty (n = 617) and re-tympanoplasty (n = 94) for chronic otitis media without cholesteatoma in the period between September 1998 and 2007. The data of all patients on preoperative disease, perforation size and localization, middle ear status, surgical approach, graft material, adjunctive procedures, pre- and postoperative morphological (otomicroscopy) and functional (hearing examination evaluating pure-tone audiogram) results were analyzed. All operations were performed using an underlay technique and either the retroauricular or transcanal approach. The temporal fascia, perichondrium or cartilage-perichondrium composite grafts were used for the reconstruction of TM. Ossiculoplasty was performed as needed. The interrelation between multiple pre-operative parameters and post-operative morphological (closure of the perforation) and functional (hearing level) outcomes was analysed.

Results

Successful closure rates of the TM perforation were 93.6% and 90.2% of the patients in the primary and revision tympanoplasty groups, respectively. Graft take rate and hearing results did not depend on graft material. Structural changes were found more frequently in the re-tympanoplasty group (63.4% comparing to 29.5% of primary cases). Ossiculoplasty was performed more often in revision cases (24.4% comparing to 11.4% of primary cases). Successful hearing (ABG within 20 dB) for primary tympanoplasties was achieved in 81.1%, and for retympanoplasty - in 69.5% of the cases. (p < 0.01). There were no interrelation between any estimated parameters and the graft take rate for either primary or revision tympanoplasty.

Conclusions

There is no evidence of increased risk of graft failure in re-tympanoplasty cases when compared to primary tympanoplasty operations. Hearing results depend on structural changes in the middle ear (ossicular abnormalities and tympanoscerosis) which in revision cases are found more often. No differences were found between fascia, perichondrum or cartilage-perichondrium grafts in terms of graft healing and hearing results.     

The interaction of hearing loss and level-dependent hearing protection on speech recognition in noise

Abstract

Objectives: To determine the effects of different control settings of level-dependent hearing protectors on speech recognition performance in interaction with hearing loss. Design: Controlled laboratory experiment with two level-dependent devices (Peltor^® PowerCom Plus? and Nacre QuietPro^®) in two military noises. Study sample: Word recognition scores were collected in protected and unprotected conditions for 45 participants grouped into four hearing profile categories ranging from within normal limits to moderate-to-severe hearing loss. Results: When the level-dependent mode was switched off to simulate conventional hearing protection, there were large differences across hearing profile categories regarding the effects of wearing the devices on speech recognition in noise; participants with normal hearing showed little effect while participants in the most hearing-impaired category showed large decrements in scores compared to unprotected listening. Activating the level-dependent mode of the devices produced large speech recognition benefits over the passive mode at both low and high gain pass-through settings. The category of participants with the most impaired hearing benefitted the most from the level-dependent mode. Conclusions: The findings indicate that level-dependent hearing protection circuitry can provide substantial benefits in speech recognition performance in noise, compared to conventional passive protection, for individuals covering a wide range of hearing losses.     

耳内镜下利用岛状软骨-软骨膜为修补材料的儿童Ⅰ型鼓室成形术

目的 评估耳内镜下利用岛状软骨-软骨膜为修补材料儿童Ⅰ型鼓室成形术的临床预后,分析相关影响因素及远期疗效.方法 收集2016年3月-2020年9月北京儿童医院耳鼻咽喉头颈外科就诊的64例鼓膜穿孔患儿临床资料,患儿年龄4～17岁,中位年龄8岁5个月.分析患儿年龄、性别、穿孔原因、是否合并化脓性中耳炎、鼓膜穿孔部位及大小、...