保留镫骨肌在耳硬化症手术治疗中的意义

在过去 2 5年里 ,治疗耳硬化所致的传导性听力损害的方法是通过外科手术恢复中耳传导系统的功能 ,现有的许多手术操作都要切断镫骨肌 ,这就降低了中耳的保护和传导作用。 Fowler通过仅切除镫骨前脚及足板前部来保留镫骨肌 ,这种技术因耳硬化的发展使足板再固定而被淘汰。Portmann和 Claverie是通过在肌腱连接镫骨的下方切断镫骨两脚。Padovan仅行镫骨足板切除术。Cusse是在近镫骨处切断镫骨肌腱 ,再把它固定于人工镫骨上以此来保留镫骨肌。但保留镫骨肌有无意义 ?值得进一步研究。研究对象为 6 7例患者 ,均有传导性或混合性聋 ,并行如下检…     

鼓室硬化症鼓室成型术25例临床分析

目的：总结手术治疗鼓室硬化症的临床经验。方法：回顾性总结2001年11月至2005年2月我科经治的25例鼓室硬化症临床资料。手术均在全麻显微镜下采用剥除硬化灶,修补鼓膜或加听骨链重建行Ⅰ期鼓室成型术。采用颞肌筋膜修补鼓膜,以自体乳突骨皮质或陶瓷人工听骨重建听骨链。结果：病灶侵及鼓膜、鼓岬、砧锤骨、镫骨及周围,均呈板障型乳突,无并发胆脂瘤。听力提高15?dB以上24例（96%）,术后4例有眩晕。结论：尽量清除硬化灶,形成宽大的鼓室,并重建鼓膜和听骨链,手术疗效与病灶影响听骨链程度有关,精确、熟练的耳显微外科技术是成功的关键。     

镫骨手术治疗耳硬化症的术式选择

目的：探讨镫骨手术治疗耳硬化症的最佳术式,提高治疗效果。方法：总结了耳硬化症的镫骨手术７１例（耳）体会。其中镫骨提高术３１例,镫骨部分切除术３４例,镫骨全切除术６例。结果：术后随访,镫骨提高术和镫骨部分切除术具有同样稳定的近、远期听力效果。结论：认为镫骨提高术操作简便易行,前庭反应轻,应作为镫骨手术首先考虑的术式,即使镫骨撼动时足弓折断,也不影响后续手术的进行。     

耳硬化症治疗沿革和中国之切入点

耳硬化症由Valsava于1704年首次发现[1],而Anton von Trltsch于1872年首次使用了耳硬化症(otosclerosis)一词,以区别于鼓室硬化症(tympanosclerosis)[2]。正常情况下,人类耳囊自发育完成后即不再改变,在骨组织中亦很难见到活化的成骨细胞和破骨细胞,然而,在耳硬化症患者中,耳囊骨质的重吸收和骨化交替发生,这种以原发性迷路包囊骨海绵样变性为病理特征的疾病即为耳硬化症[3]。     

耳硬化症镫骨手术疗效观察

目的探讨耳硬化症治疗中各种术式的疗效.方法收集我院1964～2003年资料完整的部分耳硬化症病例,分别统计术耳手术前后0.25k、0.5k、1k、2kHz频率平均骨气导差,按不同术式(镫骨撼动术、镫骨足板切除足弓复位术、镫骨切除Teflon小柱植入术及镫骨活塞术)统计手术前后平均骨气导差的缩小值,t检验分析各术式间的差异,x2检验分析各术式再次手术率的差异,随访手术远期效果.结果经t检验发现,镫骨足板切除足弓复位术及镫骨活塞术听力提高明显优于镫骨撼动术及镫骨切除Teflon小柱植入术,镫骨撼动术及镫骨足板切除足弓复位术再次手术率明显高于镫骨切除Teflon小柱植入术及镫骨活塞术;镫骨活塞术术后远期效果较好.结论四种术式中镫骨足板切除足弓复位术听力提高最佳,其次为镫骨活塞术,两者之间无明显差异,明显高于镫骨撼动术及镫骨切除Teflon小柱植入术组;镫骨活塞术是治疗耳硬化症最理想术式,术后近期及远期效果较佳且再次手术率最低.     

激光在耳硬化症手术中的应用

激光应用于医学已经有三十多年的历史,目前已广泛应用于临床多种专业,本文主要介绍激光在耳硬化症疾病病治疗中的应用概况。     

极晚期耳硬化症的镫骨手术治疗

极晚期耳硬化症（far-advanced otosclerosis,FAO)经镫骨手术治疗后常常能有效地使用助听器，获得满意的效果。但临床上易被误诊为重度感音神经性耳聋，失去治疗机会。因此极晚期耳硬化症的正确诊断非常重要。     

手术治疗鼓室硬化症的效果分析

我科对 85例鼓室硬化症患者施行手术治疗 ,结果分析如下。1　资料与方法85例患者中 ,男 53例 ,女 32例 ;年龄 1 4～ 41岁 ,病程 3～ 40年。进行手术时间在发病后 3～ 5年2 5例 ,>5～ 1 0年 30例 ,>1 0～ 2 0年 1 0例 ,>2 0～30年 1 2例 ,>30～ 40年 8例。均在干耳 1个月后行手术治疗。耳镜检查 :除 1例鼓膜完整外 ,余均为鼓膜中央性干性穿孔 ,32例残余鼓膜有大小不等的白色硬化斑块 ,所有患者咽鼓管均通畅。听力损失 :语言频率气导在 30～ 75 d B,其中 >60 d B者 1 3例 ,气骨导差在 1 8～ 55d B之间。手术均采用剥除硬化灶 ,修补鼓膜或加…     

鼓室硬化的手术疗效观察

目的:观察鼓室硬化手术采用综合技术的疗效。方法:回顾性分析151例(167耳)鼓室硬化(不含单纯鼓膜钙化)患者的临床资料。167耳均清除病灶并按需采用综合技术:①探孔开放上鼓室、乳突腔等;②自体骨片盾板修复,或碎骨填塞乳突腔;③听骨处理分为保持听骨链完整和听骨链重建;④可吸收膜片(透明质酸或聚二氧杂环乙酮)防再粘连;⑤鼓索神经弹压听骨;⑥铒-YAG激光或小凿清除面神经管骨质增生。术后1个月内测听力,出院3个月后复查1次,以后6个月~1年随访1次,以最后1次为随访结果(取0.5、1.0、2.0 kHz HL语频均数)。结果:167耳术前、术后气骨导差(ABG)分别为(39.74±12.54)dB和(20.68±11.80)dB,P<0.01。成功71耳(42.5%),有效48耳(28.7%),总有效率为71.3%(119耳)。167耳随访3~60个月,平均(11.01±10.24)个月,随访的ABG为(20.67±13.52)dB,与术前比较,P<0.01;与术后比较,P>0.05。随访12个月以上者96耳,ABG为(21.94±11.16)dB,与167耳随访结果比较,P>0.05。结论:应用综合技术能促进术后听力改善,并维持远期疗效。三骨全固定仍是治疗难点,对镫骨切除术应慎重对待。     

鼓室硬化类型与手术疗效(附40例临床分析)

目的 探讨硬化灶累及中耳部位与术前听力损失类型的关系、不同手术方式治疗鼓室硬化症的效果。方法 回顾性分析40例鼓室硬化患者术前资料,术中病灶记录,评估术后听力改善水平。结果 传导性耳聋的病例中最常见病灶侵及上鼓室、锤砧关节周围,而混合性耳聋的病例中病灶累及鼓岬的概率明显高于传导性耳聋的病例。术后气骨导间距小于20dB 18耳,成功率40%,Ⅰ型鼓室硬化症术后听力改善最显著(P＜0.05)。结论 听力损失的性质与硬化灶的范围及累及中耳的部位直接相关。手术处理是治疗鼓室硬化症的主要手段,手术方式则根据病变累及的范围和程度决定。     

Surgical treatment of tympanosclerosis

Tympanosclerosis as a cause of conductive hearing loss may require corrective surgery in carefully selected cases, although results of treatment have been controversial and must be viewed with caution. Currently available surgical techniques are reviewed and outcomes discussed.     

鼓室硬化症的手术治疗(附136例病例分析)

目的介绍我们对鼓室硬化症的手术方法，分析不同手术治疗方法与效果的关系。方法136例鼓室硬化症病人按Wielinga等的分类方法分成四型：Ⅰ型4l例，Ⅱ型49例，Ⅲ型36例，Ⅳ型10例。鼓膜完整者56例，鼓膜干性穿孔者54例，鼓膜穿孔伴耳流脓者26例。手术前常规进行纯音测听和中耳分析，得出各型不同情况下的气骨导差均值。硬化灶的手术处理分为：（1）对Ⅰ型病例适度剔除鼓膜上的硬化灶；（2）对Ⅱ型病例多数采用单纯剔除硬化灶＋撼动听骨链的方法。少数病人切除砧骨和锤骨头，用人工听骨重建听骨链；（3）Ⅲ型和Ⅳ型病例，一律将砧骨和锤骨头切除，清除上鼓室病灶，采用PORP或TORP重建听骨链。对镫骨底板不活动的病例，采用特氟隆活塞型人工镫骨重建听骨连接；对于镫骨底板不活动而炎症尚未控制者。行二期镫骨小窗手术。结果由于术后流脓以及听骨赝复物脱出等原因，总失败率为10．29％。剔除失败病例后，术后1年的纯音测听结果与术前比较有明显改善：Ⅰ型病例气骨导差平均改善13．75dB，Ⅱ型平均改善22．93dB，Ⅲ型和Ⅳ型平均改善29．14dB，所有病例听力均恢复到实用水平。结论手术处理是治疗鼓室硬化症的主要手段，手术方式则根据病变累及的范围和程度决定。根据我们的资料，对Ⅱ型以上的鼓室硬化症均可采用听骨赝复物重建听骨链，且采用人工听骨赝复的远期效果较好。     

Hearing results of surgery for tympanosclerosis

Between January 1990 and December 2003, 117 patients were surgically treated for tympanosclerosis at a tertiary referral center. The objective of our study was to review the hearing results in this cohort. The patients were divided into three groups: predominant involvement of tympanic membrane (33 cases), predominant fixation of malleus or/and incus (72 cases), and stapedial fixation (12 cases). Preoperative and postoperative air–bone gap (ABG), and pure tone average (PTA) were compared after short-term and long-term follow-up, and statistical significance was determined. After surgery, air–bone gap was improved by 11.7 dB after short-term, and by 10.9 dB after long-term observation period. The improvement of ABG was not significantly different between the groups. Pure tone average (PTA) was improved by 15.2 dB in short-term period, with decrease of results in the long-term follow-up to 10.3 dB. Successful hearing result as judged by ABG was obtained in 66.7% with affected tympanic membrane, in 65.3% with malleus or/and incus fixation, and in 50.0% with stapedial fixation. Statistical analysis confirmed significant improvement of hearing for all groups. Highly significant difference was noted for low frequency ABG (0.5, 1, and 2 kHz). Hearing improvement on ABG was preserved after long-term observation. No significant sensorineural hearing loss was seen in this series. Surgery for tympanosclerosis results in significant improvement of ABG and PTA. Most of the improvement is obtained in lower frequencies. Long-term results are comparable to short-term results, with slight hearing deterioration in stapedial fixation.     

Surgical treatment of tympanosclerosis

During the 5-year period (1971-1976), 45 patients at the Shea Clinic underwent reconstructive surgery for tympanosclerosis. The most common ossicular chain problem was found to be malleus and incus fixation (33%); malleus, incus, and stapes fixation (22%); and stapes fixation (13%). The most successful reconstructive approaches included removal of tympanosclerosis from tympanic membrane or isolated plaque from ossicular chain, the use of the Partial Ossicular Replacement Prosthesis (PORP), and the Total Ossicular Replacement Prosthesis (TORP).     

Surgical treatment of tympanosclerosis

OBJECTIVE: To report the hearing results of the surgical treatment of tympanosclerosis. STUDY DESIGN: A retrospective review of surgically treated cases of tympanosclerosis. SETTING: A tertiary referral center. PATIENTS: One hundred fifteen patients with middle ear tympanosclerosis operated on between 1987 and 1996, with an average age of 36 years (range 18-59 years). Cases were classified into four groups according to Wielinga and Kerr. Those with an associated cholesteatoma were excluded. INTERVENTION: Depending on the ossicular status, either mobilization of the major ossicles or epitympanic bypass procedure, mobilization of the stapes or stapedectomy. MAIN OUTCOME MEASURES: The postoperative pure-tone average was compared with the preoperative levels by use of conventional audiometry. The air-bone gap was measured. RESULTS: The average postoperative air-bone gap was 18.0+/-10.21 dB in the type II group (attic fixation of the malleus-incus complex with a mobile stapes). 21.8+/-9.5 dB in the type III group (mobile malleus-incus complex, if present, with stapes footplate fixation), and 22.92+/-10.03 dB in the type IV group (fixation of both the stapes footplate and the malleus-incus complex). Patients with a fixed malleus and mobile stapes had significantly better hearing results than those with stapes fixation (p = 0.042, Mann-Whitney U test). CONCLUSION: In ossicular attic fixation, atticotomy and mobilization of ossicles yielded better results than did the epitympanic bypass procedure. The difference, however, did not reach statistical significance. Patients with fixed stapes treated with stapedectomy displayed good hearing results immediately after surgery, but the air-bone gap deteriorated after some time.     

鼓室成形术治疗不同类型鼓室硬化患者的近期疗效分析

目的探讨鼓室成形术治疗不同类型鼓室硬化患者的近期疗效。方法回顾性分析2008年2月至2011年2月间有完整资料且随访半年以上、经鼓室成形术治疗的33例鼓室硬化患者(I型8例,II型9例,III型2例,IV型14例)的临床资料,其中8例行鼓室探查+鼓膜成形术,25例行开放式乳突根治+鼓室成形术,以言语频率气导平均听力改善15dB以上或达应用听力水平为手术成功标准,评估其疗效。结果 33例患者术前言语频率气导平均听阈为54.09±9.76dB HL;术后半年随访时平均听阈为38.85±8.42dB HL,总手术成功率为63.64%(21/33),其中鼓室探查+鼓膜成形术8例中4例(50%)手术成功,开放式乳突根治+鼓室成形术25例中17例(68%)手术成功。结论鼓室成形术是治疗鼓室硬化的有效手术方法,开放式乳突根治+鼓室成形术能有效清除听骨链周围不同范围的硬化灶。     

Current considerations in the etiology and diagnosis of tympanosclerosis

Current concepts of formation of tympanosclerosis in the middle ear are reviewed, as are various clinical considerations. Ultrastructural changes are discussed. A differential diagnosis includes disorders affecting middle ear sound conduction, with the most prevalent involving otosclerosis and cholesteatoma.