鼓室硬化症与中耳胆脂瘤术后听力中短期随访对比分析

目的回顾性分析比较鼓室硬化症与中耳胆脂瘤手术治疗前后听力变化情况。方法对36例中耳胆脂瘤患者,31例鼓室硬化患者手术前后听力变化进行回顾性总结,听力情况以500,1000,2000,4000Hz的气骨导差值分别进行统计分析比较。结果两组患者血钙水平没有明显差异;术前听力下降鼓室硬化症组比中耳胆脂瘤组严重;术后听力两组均较术前有显著提高,且两组之间听力改善没有显著差别。中耳胆脂瘤组和鼓室硬化症组的术后气骨导差在500,1000Hz频率均明显低于术前。同时手术对于中耳胆脂瘤组听力改善在2000和4000Hz明显优于鼓室硬化症组。结论手术对于鼓室硬化症的听力改善效果与中耳胆脂瘤相似,尤其对于中低频听力的提高效果明确。     

不同分型鼓室硬化的听力学特点与术后疗效分析

目的 分析不同分型鼓室硬化患者的听力学特点,探讨其手术治疗效果,为术前评估提供参考。方法 回顾性分析135例(135耳)鼓室硬化手术患者,对比手术前后听力学资料。结果 Ⅰ、Ⅱ型鼓室硬化患者多表现为传导性耳聋(分别为71.4%、68.8%),Ⅳ型鼓室硬化患者中混合性耳聋出现的比例更高(66.7%)。各型鼓室硬化的听力曲线以平坦型为主。卡哈切迹出现率为13.3%(18/135),Ⅳ型鼓室硬化患者中38.9%患者听力图出现了卡哈切迹。各型鼓室硬化患者(除Ⅲ型鼓室硬化外)术后气骨导差(ABG)和气导平均听阈(PTA)均较术前降低。Ⅰ型鼓室硬化的手术成功率最高(79.0%),Ⅳ型鼓室硬化的手术成功率最低(63.9%)。结论 各型鼓室硬化患者听力图多呈现平坦型曲线,混合性耳聋最多见于Ⅳ型鼓室硬化,卡哈切迹的出现可提示镫骨的固定。手术清除鼓室内硬化灶是主要的治疗方式,Ⅰ型鼓室硬化术后成功率最高,Ⅳ型鼓室硬化最低。     

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。     

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。     

鼓室硬化症的病因与发病机制相关研究进展[综述]

鼓室硬化症是复发性慢性中耳感染的常见后遗症，其特点是进行性玻璃样变性、鼓膜和中耳腔黏膜下层钙化沉积物的积累。相对于钙化的数量及其对听骨链运动的干扰，患者会出现不同程度的传导性听力损失。尽管目前鼓室硬化症的病因与发病机制尚未完全阐明，但当前普遍认为它是不可逆的。手术治疗是迄今为止恢复听力最有效的方法，却不能阻止其病理变化的发生发展，因此明确本病的病因显得尤为重要。本文就鼓室硬化症的病因与发病机制的最新研究进展做一综述，以期对临床工作提供帮助。     

经耳道鼓室探查术手术入路的应用

经耳道鼓室探查术传统应用于传导性耳聋外科治疗，本文根据８例不同中、内耳疾患经此入路确诊及手术治疗的典型资料，对此入路应用范围进行了讨论。包括：病因不能肯定的传导性聋－不典型耳硬化症、先天中耳畸形；外伤后鼓膜完整的传导性聋；可疑中耳占位病变－先天胆脂瘤、胆固醇肉芽肿；外淋巴瘘和脑脊液耳漏等。此入践不但对中耳及相关内耳结构可充分暴露，术野清晰，且组织损伤小，操作易，是一种安全可靠的手术入路，但由于确切     

慢性化脓性中耳炎鼓室硬化的临床分析

目的：探讨鼓室硬化在慢性化脓性中耳炎中的发生率、听力下降类型及听力下降与硬化灶部位和程度间的关系。方法：回顾性分析101例行手术治疗的慢性化脓性中耳炎患者的资料，所有患者均有完整的病史及耳鼻咽喉科体检，均行纯音测听检查，术中病灶均有详细记录。结果：慢性化脓性中耳炎患者鼓室硬化发生率为35．64％，大部分患者（77．78％）长期干耳，听力曲线为传导性聋。鼓膜硬化者中92．86％的患者气骨导间距小于40dB，而鼓膜与鼓室均有硬化者中45．45％的患者气骨导间距大于40dB。结论：鼓室硬化的听力损失与硬化灶的部位和程度直接相关。     

鼓室硬化研究现状

鼓室硬化（tympanosclerosis）是中耳在长期慢性炎症愈合后所遗留的中耳结缔组织退行性改变，是引起传导性聋的重要原因之一。本病由von Trohsch于1869年首先描述。过去常称为鼓室硬化症，按全国自然科学名词审定委员会公布的医学名词统称为鼓室硬化。随着鼓室成形术、蹬骨手术的广泛开展和手术显微镜的普遍应用，本病逐渐受到重视。我们就本病的病因、病理和发病机制、临床表现和诊断、预防和治疗作一综述。     

耳内镜下中耳手术及鼓室成形术效果分析

目的探讨耳内镜下鼓室成形的可行性及疗效。方法回顾性分析2016年5月至2017年4月我科采用耳内镜下对42例慢性化脓性中耳炎、上鼓室胆脂瘤及鼓室硬化症的患者进行鼓室探查、上鼓室进路乳突根治加鼓室成型术,观察鼓膜愈合成功率,并比较手术前及手术后3个月平均气导听阈(PTA)及气骨导差(A-B gap)。结果42例患者术后鼓膜一期完全愈合40例(占95.2%),遗留穿孔2例(占4.8%)者均在门诊耳内镜下处理后完全愈合。术前患者平均气导听阈52.32±14.70 d B HL,术后3个月平均气导听阈30.59±12.16 d B HL,听力提高程度具有统计学意义(P<0.001)。3例患者术后出现皮瓣部分缺血坏死,经门诊处理后恢复。未出现严重感音神经性耳聋,无面瘫及眩晕并发症。结论:耳内镜下中耳手术及鼓室成形术具有良好的可行性。部分经过选择的中耳胆脂瘤也适合耳内镜下进行。耳内镜下具有视野广阔清晰,手术时间较短、术中出血量少、术后恢复快及听力效果良好、并发症少等优点,是未来中耳手术的一个热点及方向,但单手操作等缺点仍需术者熟练克服。     

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。     

An analysis of the single-stage tympanoplasty with over-underlay grafting in tympanosclerosis.

OBJECTIVES: Our objective was to analyze the results of tympanosclerosis surgery using over-underlay tympanoplasty and to find out the effect of single-stage surgery on hearing results. MATERIALS AND METHODS: Forty-two patients who were operated on for tympanosclerosis between July 1998 and February 2002 were included in the study. These were one-stage tympanoplasties, because second-stage operations and revisions were not included. Operative records and audiograms of the patients were obtained. Of the patients, 48% had bilateral tympanosclerosis. In three (7.1%) of the patients, tympanosclerosis and cholesteatoma occurred concomitantly. The cog was present in eight (20%) of 40 mastoidectomies. K?rner's septum was present in nine (22.5%) patients. The graft take rate was 95.2%. RESULTS: The pre- and postoperative air-bone gap values of the patients were not significantly different (p > 0.05). Thirty-three percent of the patients met the successful hearing criteria (air-bone gap <20 dB). However, 47% had an air-bone gap closure between 20 dB and 30 dB, whereas 20% had a gap of more than 30 dB. CONCLUSION: Single-stage surgery does not result in a satisfactory hearing improvement in most of the patients with tympanosclerosis. Only one third of the patients, most of whom had a mobile stapes, had satisfactory hearing results. Mobilization of a fixed stapes is not an effective option for hearing restoration in tympanosclerosis. Second-stage surgery for stapedectomy and placement of a prosthesis-like piston or total ossicular replacement prosthesis should be considered to obtain better hearing results in tympanosclerosis.     

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.     

外伤所致传导性耳聋的诊断与手术治疗(附20例报告)

目的 分析外伤所致传导性耳聋的症状体征、听力学表现及影像学特点,总结诊断要点和手术治疗效果.方法 回顾性分析解放军总医院2008年1月～2011年3月收治的具有明确外伤史、鼓膜完整的传导性听力下降患者20例.每位患者均进行详细病史询问、临床检查、听力测试和影像检查.行鼓室探查术,根据患者听骨链损伤的不同类型,行听骨链重建术.术后1～3个月复查纯音听力,比较术前和术后的纯音听阈,总结分析手术治疗效果.结果 本组20例患者,手术探查听骨链发现砧骨移位14例,包括砧镫关节脱位、锤砧关节分离以及二者兼具的听骨链损伤,锤骨移位且粘连固定2例,镫骨足弓骨折2例,砧骨长脚骨折1例,镫骨底板自前庭窗脱出1例;其中3例砧骨移位患者术中可见面神经明显水肿.根据鼓室探查情况行相应的听骨链重建术,15例行自体听骨雕凿后的听骨链重建术,1例行砧镫关节复位术,4例行人工听骨植入术,3例合并面瘫患者行听骨链重建术的同时行面神经减压术.术后1～3个月随访,患者自觉听力提高,纯音测听示言语频率内气导平均听阈恢复至30±11 dB,平均气骨导差为18±10 dB.伴有面瘫患者的面神经功能恢复至HBⅠ级.结论 有外伤史的患者如有听力下降,应行全面细致的耳科检查、听力学检查和高分辨颞骨CT扫描,如纯音测听气导听阈下降且存在明显的气骨导差,或颞骨CT显示听骨链形态异常,应考虑系听骨链中断引起的传导性耳聋.应根据听骨链损伤的不同类型,重建听骨链,恢复患者听力,合并面瘫者,同时行面神经探查减压手术.     

Tympanosclerosis and our surgical results

Tympanosclerosis is a sequel of chronic otitis media characterized by the deposition of calcareous plaques following hyaline degeneration in the fibrous layer of the tympanic membrane and inside middle ear mucosa. It usually results from prior middle ear infections. In this study, results of treatment and clinical findings of the patients with tympanosclerosis are presented. Our objective is to determine the changes in middle ear caused by tympanosclerosis and intervene in the more problematic zone and find out the more useful treatment protocol for patients. Preoperative features, middle ear findings detected during surgery and postoperative hearing levels of the patients who were operated in our clinic between January 1996 and June 2006 due to tympanosclerosis were evaluated. Surgical treatment was performed on a total of 37 patients including 25 females and 12 males between ages of 11 and 71. Preoperative tympanic membranes perforations were presented at a rate of 91% and average airway bone gap was 37.8 dB. Bilateral involvement was present in 59%. Conductive-type hearing loss was present at a rate of 81%, whereas mixed-type hearing existed at a rate of 19%. Sclerotic plaques were most commonly localized in the attic with a rate of 72%. Post-op outcome was found to be 27% in the patients with air bone gap between 0–20 dB. The best hearing result belonged to type 1 patients. Cases in which stapes footplate was fixated had the worst result in terms of hearing. Teflon piston was only applied in one patient. Our tympanoplasty success was found to be 67%. The most common treatment method of tympanosclerosis is surgery. Stapedectomy is recommended in surgery instead of mobilization techniques. However, there is often recurrence and there is no curative treatment. Therefore rehabilitation with hearing device can be preferred as an adjunct. In the recent experimental studies, good results with topical or systemic agents have also been promising.     

Use of glass ionomer cement in surgery of the incus-stapedial joint. An initial report of experiences

Chronic inflammations of the middle ear are characterised by perforation of the tympanic membrane as well as hearing loss, due to disintegration in the incudostapedial joint. Usually the perforation is easily restored by means of available modern procedures; on the other hand, failure of the reconstruction of the ossicular chain, especially of the incudostapedial joint, is not uncommon. Hence, the improvement of hearing capacity is transitory, since later, due to scars, graft lateralisation results in a dislocation of the primarily reconstructed ossicular chain. The patient's hearing capacity is then as poor as it has been before surgery. The aim of this study is to demonstrate the ways of satisfactory reconstruction of the incudostapedial joint by means of glass-ionomer cement: 1. Scar tissue connecting the ossicles in slight defects of the incudostapedial joint can be stabilised by glass-ionomer cement leading to a reasonable sound transmission. 2. If the incus has to be removed in case of a more serious defect, the columella can be properly fixed to the stapes by means of glass-ionomer cement without the risk of scar-induced lateralisation. 3. The fixation of the stapes prosthesis' wire loop to the incus can be effectively achieved by glass-ionomer cement.     

Tympanosclerosis: review of literature and incidence among patients with middle-ear infection

The aim of the study was to review the literature of tympanosclerosis especially its pathogenesis, to study the general incidence of tympanosclerosis among patients with chronic suppurative otitis media (CSOM), its association with cholesteatoma and also the type of hearing loss as well as its relation to the degree and site of tympanosclerosis. Seven hundred and seventy-five patients with CSOM were studied retrospectively. A full history was taken and thorough ENT examinations were carried out. Pure tone audiograms (PTA) of all patients were done and analysed. The operative finding of tympanosclerosis as well as middle-ear status were inspected. The incidence of tympanosclerosis was found to be 11.6 per cent (90 patients out of 775 CSOM cases). Most tympanosclerosis cases had dry ear, (85.6 per cent). Of the 57.8 per cent who had myringosclerosis, their PTA showed an AB gap 20-40 dB. When sclerosis affect both the tympanic membrane and middle ear, 61 per cent of patients had an AB gap > 40 dB. The association of cholesteatoma and tympanosclerosis may be regarded as uncommon, 2.2 per cent. The exact aetiology and pathogenesis of tympanosclerosis is as yet not well known. Our study concentrated on the clinical picture of tympanosclerosis among patients with CSOM. The majority of hearing loss associated with tympanosclerosis was of the conductive type.     

Hypermobility of the incudostapedial joint: a clinical entity

During exploratory tympanotomy for conductive deafness, the surgeon is occasionally perplexed to find no apparent cause for the air-bone gap. This unexplained deafness has been called "inner ear conductive hearing less" because of the apparent absence of pathology in the middle ear. The incudostapedial joint was studied in 68 vertically sectioned temporal bones and the anatomy is presented. Varying amounts of laxity is observed in the normal joint capsule at the time of surgery. A theory is suggested in which an elongated capsule allows incus motion without energy transmission to the stapes. It is proposed that hypermobility of the incudostapedial joint may exist and explain conductive hearing loss of undetermined etiology.     

Tympanosclerosis involving the ossicular chain: mobility of the stapes in association with hearing results

CONCLUSION: The preoperative bone conduction level provides not only prognostic information but also information on the mobility of the stapes in tympanosclerosis. The surgical results depend upon the stapes mobility. OBJECTIVES: We aimed to evaluate operative findings and hearing results of tympanosclerosis involving the ossicular chain, in order to understand the pathophysiology and to establish better surgical treatment of tympanosclerosis. PATIENTS AND METHODS: Between January 1998 and March 2004, 29 patients (29 ears) with tympanosclerosis involving the ossicular chain underwent tympanoplasty at our hospital. Patients with myringosclerosis only, or with an associated cholesteatoma, were excluded from this study. The clinical and operational records and pre- and postoperative pure tone audiograms were reviewed retrospectively. RESULTS: Intact canal wall tympanoplasty was applied to all 29 patients. A non-staged operation was performed on 21 patients, and a staged operation was performed on the remaining 8 patients. In 25 patients (86.2%), the sclerotic lesion of the ossicles was located in the epitympanum. In the remaining four, the sclerotic lamella coated only the ossicular chain. On average, the preoperative air conduction hearing level of 57.9 dB was significantly improved to 46.3 dB after tympanoplasty. The success rate of middle ear surgery was 65.5% (19 of 29 patients), according to the criteria of the Otological Society of Japan. In 16 patients (55.2%), the mobility of the stapes was preserved (group A), while in the remaining 13 patients (44.8%), the stapes was fixed (group B). The mean preoperative bone conduction of 25.5 dB in group A was significantly better than that of 37.2 dB in group B. The hearing result significantly improved in group A but not in group B. The success rates were 75% (12 of 16 patients) in group A and 53.8% (7 of 13 patients) in group B.     

Long-term outcomes of stapes surgery

ObjectiveHearing improvement following stapes surgery is generally good; however, we sometimes encounter patients where hearing loss gradually progresses over the long term. In this study, we investigated the causes of hearing loss in these cases.MethodsA total of 30 ears from 23 patients, who underwent stapes surgery at Kitasato University Hospital from 2001 to 2021 and were followed up for ≥5 years, were included in the study. Changes in air conduction (AC) and bone conduction (BC) thresholds were measured, and hearing evaluation was performed by calculating the air–bone gap (ABG) at the mean of 4 frequencies. Cases with a postoperative ABG of ≤10 dB at 6 months after surgery were classified into the following groups according to their hearing changes at 5 years after surgery: Group A (no ABG increase of ≥10 dB and no AC threshold increase of ≥10 dB) and Group B (an ABG increase of ≥10 dB and an AC threshold increase of ≥10 dB). In groups A and B, we examined factors affecting long-term postoperative results. In addition, the patients who underwent reoperation were examined.ResultsThe AC thresholds 6 months and 5 years after surgery decreased significantly compared with those before surgery (p < 0.01); however, the BC thresholds 6 months and 5 years after surgery did not vary significantly from those before surgery (p > 0.05). Group A included 16 ears from 13 patients (53.3%), and Group B included 3 ears from 3 patients (10.0%). There were no significant differences in age, sex, surgical method, piston type, piston length, presence of incudostapedial joint subluxation, computed tomography findings, and preoperative ABGs between groups A and B (p > 0.05). A total of 6 reoperations were performed in 3 ears from 3 patients, and there were 5 operations with the platinotomy hole to be closed by bone regrowth and 3 operations with the narrowed long process of the incus.ConclusionIn 10.0% of the patients who underwent stapes surgery, the ABG improved 6 months after surgery; however, the AC threshold and ABG increased 5 years after surgery. Our findings suggested that piston displacement and the platinotomy hole to be closed by bone regrowth are possible causes of hearing loss in cases where hearing loss progresses in the long term after stapes surgery.