听神经瘤引起突发性听力减退

为了避免听神经瘤的误诊误治，对１９８６～１９９５年收治听神经瘤１０４例中２３例（２４耳）首发症状表现为突发性听力减退者（占２３％）的病例进行分析。听力学检测：纯音听阈＞７１ｄＢＨＬ者１３耳，占５４．２％；听性脑干反应（ＡＢＲ）检测均有异常；耳蜗电图－ＳＰ／ＡＰ检测９耳中７耳＞０．４，占７７．８％；声反射检测１１耳均消失。眼震电图检测１８例，１７例异常（占９４．４％）。影像学检查ＣＴ阳性率８８．８％，阴性者行ＣＴ气脑造影或磁共振（ＭＲＩ）检查均能确诊。提示对突发性听力减退患者应常规检查ＡＢＲ，若异常应行颞骨ＣＴ，必要时ＭＲＩ影像学检查。     

高分辨率CT对颞骨外伤性面瘫的诊断价值

目的：探讨高分辨率CT（HRCT）对颞骨外伤性面瘫的诊断价值及对手术的指导意义。方法：据临床资料和颞骨HRCT表现,对29例拟行手术治疗的颞骨外伤性面瘫患者提出预测性诊断,并与术中所见进行对比。结果：CT显示骨折线走行情况与术中所见基本符合,不同类型的骨折引起的神经损伤具有各自的特点。面神经损伤的直接征象包括骨折线贯穿骨管、骨管断裂或断离;间接征象包括面神经局部增粗、骨管壁密度降低、膝状神经窝扩大、面神经受压等。各种征象与术中所见的符合率均在90％以上。结论：HRCT可明确显示颞骨骨折线的位置及走行,有助于判断面神经损伤范围、程度以及邻近结构破坏情况,为临床诊断及治疗提供可靠依据。     

听神经瘤引起突发性听力减退

为了避免听神经瘤的误诊误治，对１９８６￣１９９５年收治听神经瘤１０４例中２３例（２４耳）首发症状表现为突发性听力减退者（占２３％）的病例进行分析。听力学检测：纯音听阈〉７１ｄＢ ＨＬ者１３耳，占５４．２％，听性脑干反应（ＡＢＲ）检测均有异常；耳蜗电图－ＳＰ／ＡＰ检测９耳中７耳〉０．４，占７７．８％，声反射检测１１耳均消失。眼震电图检测１８例，１７例异常（占９４．４％），影像学检查ＣＴ阳性率８８．８     

不同类型及强度的对侧声刺激对畸变产物耳声发射的影响

目的 观察不同类型及强度的对侧声刺激对ＤＰＯＡＥ的影响。方法 以三种不同类型（白噪声，窄带噪声，纯音）及八种强度（阈上０－３５ｄＢ范围内，每档５ｄＢ）的对侧声刺激测试１２例正常人（２４耳）在有，无对侧声刺激出现时的ＤＰＯＡＥ幅值变化。结果（１）三种类型的对侧声刺激均能使ＤＰＯＡＥ幅值下降，白噪声抑制作用最大，窄带噪声次之，纯音抑制作用最小。（２）随对侧声刺激强度增加，抑制现象增加两垧显著相关。（     

正常听力青年人诱发性耳声发射测试

本文利用耳声发射分析仪ＣＥＬＥＳＴＡ５０３对２０名正常听力青年人进行了ＤＰＯＡＥ和ＴＥＯＡＥ测试，结果发现平均ＤＰＯＡＥ图中有两个反应高峰，分别位于１ｋＨｚ和６ｋＨｚ附近，两峰之间于３ｋＨｚ左右有一反应低谷。左右耳及性别差异对ＤＰＯＡＥ无显著性影响。ＤＰＯＡＥ的反应幅值随两个初始纯音强度的增加而升高，平均检测阈值在３０～４５ｄＢＳＰＬ之间。当初始音强度≤７０ｄＢＳＰＬ时，平均Ｉ／Ｏ函数曲线未见明显饱和现象。若采用不等强度的初始纯音（Ｌ１＝７０ｄＢＳＰＬ，Ｌ１－Ｌ２＝５ｄＢ）刺激，在中频部分（１．５～４ｋＨｚ）可获得较等强度初始纯音刺激时高的ＤＰＯＡＥ反应。由８０ｄＢｐｅＳＰＬ短声诱发的ＴＥＯＡＥ检出率为１００％，平均幅值４．１１±３．９９ｄＢＳＰＬ（ｘ±ｓ）。两种耳声发射之间有显著相关性。     

短时纯音暴露对正常人畸变产物耳声发射幅值及频谱时间序列的影响

探讨在耳蜗功能早期轻微损害时畸变产物耳声发射（ＤＰＯＡＥ）幅值及频谱时间序列的特征,促进ＤＰＯＡＥ的临床应用。方法：用 １３０ｄＢ ＳＰＬ的 ４ ｋＨｚ纯音对 １５例听力正常人（３０耳）进行 ３ ｍｉｎ的短时暴露,造成听力暂时性阈移后,用ＩＬＯ－９０耳声发射仪记录、分析暂时性阈移（ＴＴＳ）时ＤＰＯＡＥ的幅值、时间序列的特征,并与纯音暴露前进行对比。结果：正常人经过短时纯音暴露后,０．５,１,２ ｋＨｚ纯音和宽带噪声的声反射阈升高,纯音暴露前后０．５、１、２ ｋＨｚ与ＢＢＮ之间的平均反射阈差值分别为（９．７８±６．９８）,（８．０４±５．５８）,（１３．０±５．５８） ｄＢ ＨＬ和（８．８２±６．２３）,（５．７５±４．４２）,（９．０５±２．２７）ｄＢ ＨＬ,声反射阈差值缩小。纯音暴露前后６ ｋＨｚＤＰＯＡＥ幅值分别为（６．００±３．４５）和（１．７２±１. ２３） ｄＢ ＳＰＬ,降低４．２８ ｄＢ ＳＰＬ,时间序列变异系数为（５．１８±１．６３）％,时间序列曲线稳定性降低,ＤＰＯＡＥ幅值与时间序列结合发现８０％的人ＤＰＯＡＥ处于异常范围。结论：ＤＰＯＡＥ的幅值与时间序列结合分析有诊断耳蜗功能早期轻微受损的临床价值。     

连续纯音诱发的派生听性脑干反应

用新建立的派生处理技术在豚鼠和在人记录不同频率连续纯音诱发的听性脑干电位，技术要点是让连续纯音与另一瞬态声共同作用，求出所引起的脑干反应与该瞬态声单位作用时所得反应之差，此反应由连续纯音作用所致，经派生处理后提取，故称派生听觉脑干反应（ｄＡＢＲ），它是连续纯音所诱发脑干电活动的表达。从０．２５－６ｋＨｚ的连续纯音诱发的ｄＡＢＲ都呈现有分化较好的清晰波形，与通常短声或高频短音诱发的ＡＢＲ颇为相似。由     

畸变产物耳声发射临床应用价值的探讨

研究了７３例（１３９耳）纯音听阈正常耳及各种感音神经性聋耳的ＤＰＯＡＥ，发现ＤＰＯＡＥ对耳蜗功能异常的改变早于纯音测听，并可精确地反映耳蜗毛细胞在相关频率上的功能状态；ＤＰＯＡＥ幅值及引出率随纯音听阈的提高而下降，当纯音听阈＞５０ｄＢ（ＨＬ）时，ＤＰＯＡＥ幅值明显降低或缺失；蜗后病变耳ＤＰＯＡＥ正常，当蜗后病变累及耳蜗时，ＤＰＯＡＥ幅值可异常，其异常程度与纯音听阈不平行。认为ＤＰＯＡＥ有广泛临床应用价值。     

颅中窝-乳突联合进路面神经减压术

目的探讨颅中窝-乳突联合进路面神经减压手术适应症、手术方法效果。方法对2000年1月—2007年4月收治的5例外伤性面瘫（House-Brackmann分级Ⅳ-Ⅴ级）患者行颅中窝-乳突联合进路面神经减压术。结果5例行颞骨高分辨CT扫描均显示颞骨骨折,3例显示颅中窝底突起的骨碎片,流泪试验均为阳性。术后随访1-2年,2例面瘫Ⅳ级、2例面瘫Ⅴ级患者完全恢复,1例面瘫Ⅴ级患者恢复至Ⅲ级。结论根据颞骨高分辨CT扫描和流泪试验判断面神经损伤的部位以选择手术进路,颅中窝-乳突联合进路适于面神经全程减压术。     

高分辨CT扫描在颞骨骨折致面神经损伤中的应用

目的：探讨高分辨ＣＴ扫描在颞骨骨折致面神经损伤中的应用价值。方法：对２８例有面神经损伤的颅脑外伤患者行颞骨薄层ＣＴ扫描,根据颞骨ＣＴ扫描及临床征象行手术。结果：基本恢复６例,部分恢复１８例,无变化４例。结论：高分辨率ＣＴ可明确显示颞骨骨折的位置及走行,有助于手术前判断面神经损伤的部位及相关损伤,以选择适当的手术径路。     

Combined Subtemporal-Supralabyrinthine Approach to Geniculate Ganglion for Management of Facial Paralysis in Temporal Bone Fracture

Objective To investigate the clinical outcomes of facial never decompression via a combined subtemporal-supralabyrinthine approach to geniculate ganglion for management of facial paralysis in temporal bone fracture. Methods Eighteen patients with unilateral facial paresis due to temporal bone fracture were treated between March 2003 and March 2011. Facial function was House-Brackmann(HB) grade Ⅲ in 6 patients,HB gradeⅤ in 9 patients and HB grade Ⅵ in 3 patients. The preoperative mean air conduction threshold was 52 dB HL for the 15 cases with longitudinal temporal bone fracture and showed severe sensorineural hearing loss in the 3 cases with transverse temporal bone fracture. Fracture lines were detected in 15 cases on temporal bone axial CT scans and ossicular disruption was determined in 11 cases by virtual CT endoscopy. The geniculate ganglion or the tympanic mastoid segment of the facial nerve showed an irregular morphology on curved planar reformation images of the facial nerve canal. After an intact canal wall mastoido-epitympanectomy, the ossicular chain damage was evaluated. If the ossicular chain was intact, the supralabyrinthine recess was opened by drilling through the cells between the tegmen tympani and ossicular chain. If the ossicular chain was disrupted, the incus was removed to access the supralabyrinthine recess. The geniculate ganglion and the distal labyrinthine segment of the facial nerve were exposed. After completing facial nerve decompression, the dislocated incus was replaced, or a fractured incus was reshaped to bridge the space between the malleus and the stapes. Results Pronounced ganglion geniculatum swelling was found in 15 cases of longitudinal temporal bone fracture, with greater petrosus nerves damage in 3 cases and bleeding in 5 cases. Disrupted ossicular chains were seen in 11 cases, including dislocated incus resulting in crushing of the horizontal portion of the facial nerve in 3 cases and fracture of the incus long process in 1 case. In 3 cases of transverse fractures, dehiscence on the promontory, semicircular canal or oval window was found. All cases had primary healing with no complication. At follow-ups ranging from 0.5 to 3 years (average 1.2 years) , facial nerve function recovered to HB gradeⅠin 11 cases, Ⅱ in 5 cases and Ⅲ in 2 cases. Overall hearing recovery was 33 dB. Conclusion The clinical outcomes concerning facial nerve function and hearing recovery are satisfactory via a combined subtemporal-supralabyrinthine approach to the geniculate ganglion for facial nerve decompression in temporal bone fracture patients with facial paralysis.     

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.     

Contralateral labyrinthine concussion in temporal bone fractures

In this case presentation, three cases of labyrinthine concussion in the opposite ears of patients who had unilateral traumatic temporal bone fractures with facial paralysis are reported. The first patient was a 30-year-old male who had a right-sided longitudinal temporal bone fracture and labyrinthine concussion showing pure sensorineural hearing loss with a characteristic notch of 60 dB at 4000 Hz on the left side. The second patient was a 42-year-old male who had a right-sided traumatic facial paralysis owing to a mixed-type temporal bone fracture and labyrinthine concussion, demonstrating pure sensorineural hearing loss reaching its peak of 50 dB at 4000 Hz on the left. The third patient was a 19-year-old male who had a left-sided mixed-type temporal bone fracture and a right labyrinthine concussion exhibiting pure sensorineural hearing loss reaching 60 dB at 4000 Hz. For their facial paralyses, all three patients underwent middle cranial fossa or combined approach operations. The labyrinthine concussion in these patients was managed expectantly. At their 1-year follow-up, it was observed that the hearing loss owing to labyrinthine concussion persisted. Although labyrinthine concussion is not a rare complication of head injuries, it has rarely been reported in the medical literature. The main symptoms of labyrinthine concussion are hearing loss, tinnitus, and dizziness. The diagnosis mainly relies on audiometric tests, which reveal characteristic tracings reminiscent of acoustic trauma.     

颞骨骨折导致双侧面瘫的临床观察

目的探讨外伤性颞骨骨折导致双侧面瘫的临床特点、手术适应证及疗效。方法回顾北京电力医院收治的4例外伤致双侧颞骨骨折伴双侧面瘫患者的临床资料, 分析外伤导致颞骨骨折伴面瘫患者的临床特点,对比术前与术后面神经功能及听力的恢复情况,分析手术适应证及手术时机,并进行疗效评估。4例患者中车祸伤3例、头部挤压伤1例,均为双侧颞骨骨折同时伴有颅内外损伤,伤后全部有意识丧失史,所有患者清醒后即发现面瘫。术前面神经功能Sunnybrook评分为（9.0±2.00）分。颞骨高分辨率CT显示8侧颞骨骨折均为纵行骨折,膝状神经节局部结构紊乱6侧,砧骨长脚骨折2侧。结果8侧面瘫中1侧在保守治疗后好转,其余7侧在保守治疗5～12周无明显恢复, 行面神经减压术,其中3侧同时行人工听骨听力重建术。术后随访1年, 面神经功能评分为（78.1±3.55）分,与术前评分比较差异具有统计学意义（P<0.01）;平均听力较术前提高11.87 dBHL,与术前听力比较差异具有统计学意义（P<0.01）。结论车祸伤是造成双侧颞骨骨折伴双侧面瘫的主要原因。颞骨骨折导致双侧面瘫具有合并颅内外损伤较多、面神经骨管损伤较重等特点。面神经减压术对于保守治疗无效的患者具有积极治疗意义,手术越早疗效越好。颞骨骨折导致的传导性聋可同时行听骨链重建治疗。     

Surgical exposure of the facial nerve indications and techniques.

Lesions producing facial nerve palsy may occur within the temporal bone anywhere between the internal auditory canal and the stylomastoid foramen. Surgical exposure of this nerve may be necessary for decompression, grafting, rerouting, or removal of such lesions as acoustic tumour, meningioma, facial nerve neuroma, and cholesteatoma. Contemporary surgical exposure of the facial nerve has as its aim adequate exposure of the facial nerve at any point in its course, with preservation of hearing and vestibular function, without further injury to the facial nerve and the necessity for producing a mastoid cavity. When hearing and balance function are present, the transcanal-transtympanic approach to the horizontal segment of the facial nerve offers limited access to the facial nerve in its tympanic course. Wider exposure is obtained by postauricular transmastoid exposure of the tympanic and mastoid portions of the facial nerve. The middle fossa approach to the facial nerve offers access to the internal auditory canal and labyrinthine portions of the nerve, whereas the retrolabyrinthine approach offers access to the facial nerve in the posterior fossa. Total facial nerve exposure with preservation of hearing and balance function is obtained by the combined transmastoid and middle cranial fossa approach. In individuals who have lost all function of hearing and balance, the postauricular translabyrinthine approach offers total exposure of the facial nerve within the temporal bone and posterior fossa. The aim of this discussion was to present in succinct fashion a systematized approach to surgical exposure of the facial nerve within the temporal bone and posterior fossa.     

Facial paralysis in temporal bone trauma]

OBJECTIVE: To study the cause and treatment of facial paralysis in temporal bone trauma. METHODS: A retrospective review of 28 patients with facial paralysis resulting from temporal bone trauma was conducted, House-Brackmann(H-B) system was used to evaluate the recovery of facial nerve function, U test was employed for statistic analysis. RESULTS: Twenty-six cases underwent following up facial nerve function of all patients was recovery partly after surgery, 46% cases reached H-B II, 84% cases reached H-B III, comparing facial nerve decompression within 4 months of injury to beyond 4 months of injury, recovery to H-B II or more of facial nerve function was 60% and 0%, respectively. The difference was significant(P < 0.05). CONCLUSION: Surgery decompression is effective on facial nerve palsy caused by temporal bone trauma. It is recommended that surgery decompression be carried out as soon as possible since a better prognosis is obtained if it is performed within four months after injury.     

Vestibulotomy above a severely displaced facial nerve

CONCLUSIONS: Vestibulotomy above a severely displaced facial nerve represents a new surgical approach to achieve serviceable hearing. The lack of facial nerve injury and the potential for hearing restoration make this procedure feasible in patients who would otherwise be marginal or poor surgical candidates. OBJECTIVE: To investigate the feasibility of vestibulotomy above a severely displaced facial nerve. MATERIAL AND METHODS: Eight patients with severe congenital conductive hearing loss underwent vestibulotomy above a severely displaced facial nerve and hearing reconstruction between January 2000 and January 2002. All patients had congenital middle ear deformities. The facial nerves overhung and concealed the oval window niche or lay inferior to the oval window. The facial nerves were transposed in order to reach the oval window niche in four of eight cases. RESULTS: Hearing gain was 15 dB in 2 ears, 16-25 dB in 3 and > 26 dB in 3. There were no cases of postoperative facial paresis.     

听神经病的临床与听功能特征

目的:探讨听神经病的临床与听功能特征。方法:总结分析54例听神经病患者的临床资料、听力学测试及电生理检查情况。结果:纯音听力图呈上升型70耳,覆盆型25耳,平坦型5耳,下降型4耳;低频、中频及高频平均阈值为(67.63±15.30,43.61±16.28,32.25±14.80)dB HL。声导抗鼓室图全部正常,77耳镫骨肌声反射消失,31耳声反射阈部分增高。听性脑干反应(ABR)全部未引出。畸变产物耳声发射(DPOAE)正常引出,26例行对侧声抑制未受影响。16例言语识别率差,与纯音听阈不成比例。23例颞骨CT或MRI未见异常。10例伴有周围神经病。结论:ABR自波Ⅰ起缺失而DPOAE正常引出,言语分辨力差与纯音听阈不成比例,镫骨肌声反射及OAE交叉抑制异常,纯音听力图多呈上升型以低频损失为主,是听神经病听功能的重要特征。提示病损主要位于耳蜗内听神经纤维。应与一般的感音神经性聋和中枢性聋相鉴别。     

Hearing conservation in acoustic neuroma surgery via the posterior fossa

An increasing number of patients with an acoustic neuroma present with useful hearing in the tumour ear. Surgical removal of these tumours via the posterior fossa route may enable preservation of the cochlear nerve and otic capsule without increasing the morbidity to the facial nerve. The results of treating 51 cases of acoustic neuroma via the posterior fossa is presented. Forty four tumours measured less than 20 mm in diameter in the cerebellopontine angle and surgery was undertaken with hearing preservation as a principle objective. In 26 cases, the cochlear nerve was preserved anatomically and post-operative hearing at levels better than mean pure tone threshold of 50 dB or 50 per cent speech discrimination was recorded in 14 patients. The preservation of hearing represents a worthwhile surgical goal in selected patients with an acoustic neuroma without increasing the operative morbidity.     

儿童乳突-颞下迷路外面神经减压术8例临床分析

目的 探讨儿童颞骨骨折性面神经麻痹经乳突-颞下迷路外径路面神经减压术的疗效.方法 8例颞骨骨折性面神经麻痹患者分别在病情出现的1个月内,行经乳突-颞下迷路外径路面神经减压术,部分同期行听骨链重建术,随访1～2年,评估听力及面神经功能(H-B)程度.结果 术前H-B Ⅴ级7例、Ⅳ级1例,术后恢复Ⅰ级5例、Ⅱ级3例;术前2...