虚拟耳镜在先天性外耳道闭锁术前评估中的价值

目的：探讨虚拟耳镜在先天性外耳道闭锁术前评估中的价值。方法：选取20例先天性外耳道闭锁患者行颞骨薄层CT检查,其中8例接受外耳道成形术、鼓室成形术。螺旋CT获取原始图像数据,经软件三维重建后,以虚拟耳镜方式观察中耳等结构。结果：虚拟耳镜能够清晰显示镫骨、锤砧复合体、面神经（仅限鼓室段）、砧镫关节、圆窗龛及中耳腔等结构,与手术探查结果的符合率分别为87．5％、100．0％、i00．0％、75．0％、100．0％和100．0％。结论：虚拟耳镜有助于先天性外耳道闭锁的术前评估,使手术方案达到个体化。     

慢性中耳炎听骨链病变虚拟耳镜观察

目的 探讨虚拟耳镜对慢性中耳炎听骨链病变的评估作用。方法 慢性中耳炎95耳（82例），均经高分辨螺旋CT轴位、冠状位颞骨扫描，应用虚拟耳镜软件包进行图像三维重建。将术前虚拟耳镜与手术探查结果进行对比分析。结果 95耳慢性中耳炎术前经虚拟耳镜观察，提示86耳听骨链不同程度的破坏．术中证实67耳锤、砧骨破坏，15耳镫骨头或镫骨上结构缺失，4耳听骨链完整连续。结论 虚拟耳镜是术前评估中耳炎听骨链病变的可靠的影像学手段。     

CT定位行外耳道闭锁手术21例

目的：探讨使用CT定位打开骨性外耳道闭锁板行外耳道成形术治疗先天性小耳并外耳道闭锁的有效性和安全性。方法：对21例(22耳)先天性小耳并外耳道闭锁进行术前高分辨率CT检查,术前在CT定位和指导下打开骨性外耳道,一期进行耳廓、外耳道、中耳成形。结果：术后随访8个月～4年,听力平均提高28dB,耳廓外观满意,无外耳道再狭窄或闭锁。结论：高分辨CT定位、指导下打开骨性外耳道安全、快捷,一期进行耳廓、外耳道、中耳成形能达到满意的手术效果。     

虚拟耳镜对外伤性听骨链中断手术前后的评估作用

目的 探讨虚拟耳镜对鼓膜完整的外伤性听骨链中断手术前后的评估作用.方法采用高分辨螺旋CT轴位、斜冠状位颞骨扫描,应用虚拟耳镜软件,对选取的17例颞骨骨折患者和4例鼓膜钝挫伤患者进行图像三维重建.10例砧骨脱位或脱落经完壁式上鼓室进路听骨复位术;11例砧骨长脚断裂或脱位伴面神经麻痹则行听骨链成形术和面神经减压术.有9例患者术后复查虚拟耳镜.结果 17例颞骨骨折外伤性听骨链中断,其中砧骨长脚断裂3例,砧骨脱位9例,砧骨脱落5例;4例鼓膜钝挫伤砧骨脱位2例,砧骨脱落2例.颞骨CT显示骨折线和锤砧骨不规整.虚拟耳镜清楚显示锤砧关节与砧镫关节脱位,砧骨脱落或骨折,可见砧骨长脚与镫骨分离,砧骨体移位.手术证实,砧骨体脱出向后移位并有软组织包裹,砧骨长脚与镫骨之间软组织相连或分离.鼓膜顿挫伤术中见砧骨脱落呈外翻状.手术后3～6个月复查,虚拟耳镜见砧骨脱位者听骨链恢复接近正常,砧骨脱落者听骨连接完整.术后患耳听力明显提高达实用听力水平.外伤性听骨链中断的虚拟耳镜观察与手术证实符合率为100%.结论 虚拟耳镜为准确评估外伤性听骨链中断,确立个体化手术方案和术后随访提供可靠的直观依据.     

Korner 隔与外耳道骨性闭锁

的：分析外耳道骨性闭锁并发Korner隔(KS)的解剖特征及临床意义。方法：外耳道骨性闭锁并发KS异常的50例(耳)患者均行同步性听力重建术及全耳再造术,术前均行高分辨颞骨CT检查,常规采用轴、冠状位CT扫描。结果：39例KS较为完整,与鼓窦有明显分界;11例KS不完整,术中可见KS明显延长,分隔乳突气房与鼓窦,仅有极细小孔隙与乳突窦相通。41例于术中经解剖定向后终于破“隔”进入鼓窦;9例因脑膜低位、髁突后位等解剖障碍而中止手术,未探及到KS。结论：术前CT检查对观察KS异常有重要意义,对临床手术具有指导作用。     

先天性外耳道闭锁

探讨先天性外耳道闭锁的中耳畸形特点,治疗方法及其效果。方法回顾性分析１９９６年１月－１９９６年１月１０年间在我科接受手术治疗,并获随访,资料的先天性外耳道畸形４４例（５０耳）。结果先天性外耳道闭锁４４例中６例接受双耳手术,全部病例伴不同程度的再廓和听骨链畸形。     

听骨链CT扫描并三维重建的临床应用

目的:探讨CT仿真内镜(CTVE)显示中耳正常结构的显示方法,评价中耳病变特别是听骨链连接状态的价值及意义,确立显示听骨链及其他中耳结构的位点和方法。方法:选择40例无耳科疾病的志愿者(正常组)和30例疑有中耳疾病的患者(病例组),分别采用德国西门子(Siemens SOMATOM Sensation 16)螺旋CT机Inner Ear扫描程序对患者进行轴位扫描,重建原始图像,用Fly-through软件经选择的A、B、C点入路进行CTVE成像研究。重点显示听骨链连接状态,并对慢性中耳炎的显示结果与手术中探查图像进行对照。结果:正常组CTVE中锤骨、砧骨、鼓岬、面神经管水平段、外半规管隆凸显示率均为100%;而镫骨头、两足弓的显示率在3个显示层面则分别为57.5%、70.0%,97.5%;圆窗、卵圆窗为90.0%、93.0%、97.5%。在中耳炎、外伤、颞骨畸形等情况下可显示听小骨损伤、移位、中断、缺失和畸形。结论:CTVE在显示3个听小骨之间的链接关系(如中断等方面)有一定优势。通过选择恰当的入路,CTVE在显示听小骨及其链接关系以及病理状态方面有相当优势。通过比较CTVE在3个不同显示层面观察镫骨的能力,明确CTVE是断层影像的有利补充。     

先天性外耳道闭锁的外科治疗

对先天性外耳道闭锁畸形１３例中的１３耳进行了手术治疗，行单纯外耳道成形术３耳，鼓室开放术１例，鼓室成形术９耳。术后听力明显提高９耳，其中语言频率范围达到实用听力水平６耳。本文分析了外，中耳各部位畸形的相互关系，并对手术方法，操作技术进行讨论。     

先天性外耳道狭窄或闭锁的手术治疗

目的 探讨先天性外耳道狭窄或闭锁的手术方法及疗效.方法 回顾性分析54例先天性外耳道狭窄或闭锁行外耳道成形术和/或鼓室成形术患儿的临床资料,收集其病史、颞骨CT、听力学检查资料,将其分为外耳道狭窄组(23例25耳)和外耳道闭锁组(31例33耳),分别行外耳道成形术和/或鼓室成形术,术中均取腹股沟游离皮瓣,自制改良菱形皮...     

先天性外耳道闭锁的遗传方式分析

对先天性外耳道闭锁，有家族史的５例先证者进行系谱分析，均符合常染色体显性遗传，为单基因遗传病。     

Facial nerve lying lateral to ossicles in one case of congenital aural atresia

An abnormal facial nerve (FN) course can be found in a significant number of patients with congenital aural atresia. However, the literature does not include any cases in which the tympanic portion of the FN was displaced lateral to ossicles. We report a unique case of unilateral congenital aural atresia with this rare FN displacement. A review of the existing literature and a discussion are also provided.     

先天性外耳道骨性闭锁患者人工耳蜗植入的手术分析

目的探讨先天性外耳道骨性闭锁行人工耳蜗植入患者的听力学检查、影像学特征及手术径路的选择。方法收集2015年7月—2019年1月诊治的5例先天性外耳道骨性闭锁行人工耳蜗植入术的患者,回顾性分析其病史、听力学检查、影像学特征及手术径路。结果5例患者听力均表现为重度感音神经性聋。影像学表现为外耳道骨性闭锁,伴听骨链畸形,面神经走形异常,均无内耳畸形。5例患者均采用鼓窦径路,其中2例患者经面神经后下植入人工耳蜗。所有患者均为圆窗膜植入,植入电极过程顺利,术后开机反应佳。结论针对外耳道骨性闭锁畸形需行人工耳蜗植入的患者,应采用外耳道骨性闭锁的鼓窦径路的手术方式,开放部分乳突及鼓窦,取出畸形的听骨链,在此基础上,进一步暴露圆窗龛。对于面神经乳突段前移,完全遮挡圆窗龛的患者,则可转经面神经后下暴露圆窗龛。     

Vibrant Soundbridge implantation via a retrofacial approach in a patient with congenital aural atresia

Objective

A method of Vibrant Soundbridge (VSB) placement to the round window (RW) via the retrofacial approach with preoperative evaluation of the relationship between the facial nerve (FN) and RW by 3D-CT reconstruction was proposed for the treatment of congenital aural atresia (CAA) patient.

Analysis of the long-term hearing results after the surgical repair of aural atresia

OBJECTIVES: Careful surgical candidate selection guarantees a high probability of serviceable hearing postoperatively in congenital aural atresia (CAA) patients. The authors analyzed hearing results after CAA surgery with long-term follow-up (F/U) with respect to several clinical factors. STUDY DESIGN: This was a retrospective study. METHODS: The medical records of 93 CAA patients (100 ears) who underwent operations from January 1987 through December 2002 at Seoul National University Hospital were reviewed. Mean duration was 56.9 months. The authors evaluated the results of hearing after surgery over 3 year F/U with a view to clarifying the factors accounting for unsuccessful results. RESULTS: Approximately 64% of patients treated surgically achieved a considerable hearing gain over long-term F/U. Postoperative hearing remained relatively stable over the period from 6 months to 3 years postoperatively, yielding only 2.75 dB of aggravation. However, hearing results in revision cases deteriorated with time, which led to statistically higher air-conduction thresholds than those of primary cases at the 1 and 3 year F/Us. Resultantly, only 26.6% of patients having achieved a poor hearing gain post first surgery benefited from revision audiologically. The severity of microtia was found to help predict poor long-term hearing outcomes after CAA surgery. CONCLUSIONS: Nonrevision cases and cases with mild microtia appear to have acceptable and stable long-term hearing results. Disappointing long-term hearing results in revision, and severe microtia cases should lead to considerations of alternative options in these cases, such as bone-anchored hearing aids, which offer reliable and stable results.     

The Baha Softband. A new treatment for young children with bilateral congenital aural atresia

The Baha (bone-anchored hearing aid) Softband appears to be an effective mean of hearing rehabilitation for children with a congenital bilateral aural atresia who are too young for the amplification of a Baha on an implant. The aided hearing threshold with a Baha Softband is almost equal to that achieved with a conventional bone conductor. The speech development of the children studied with a Baha Softband is on a par with peers with good hearing.