A method for ossicular reconstruction with tragal cartilage autografts

Reconstruction of the ossicular mechanism using a tragal cartilage autograft frequently presents problems, including displacement of the cartilage graft, maintenance of firm and accurate contact between the graft and ossicular remnants, and loss of stiffness of the graft. To avoid these problems, we have used the cartilage graft and overlying perichondrium of appropriate size, with a tunnel made between the outer perichondrium and the cartilage to accommodate remnants of the incus or handle of the malleus. The graft has a small perichondrial flap on the other end for firm anchorage to the arch of the stapes or the footplate. This allows the cartilage graft to be firmly anchored with the adjacent ossicular remnants. The presence of perichondrium with the graft helps to maintain nutrition, stiffness, and the configuration of the cartilage. With minor modifications, we have used this technique in 115 patients to reconstruct different types of ossicular defects, with commendable hearing results. Of the 115 operated ears, an air-bone gap closure within 10 dB was found in 14.8%, within 15 dB in 34.8%, and within 20 dB in 24.4% of ears. In another 20.8% of cases, the air-bone gap closure remained in the range of 25 dB or less. The longest follow-up was 13 years 7 months. The presented technique is easy and effective and solves most of the problems of cartilage ossiculoplasty.     

Inversion of the stapedial reflex in ossicular chain lesions

In ears with minor conductive hearing loss of traumatic origin, it is sometimes possible to invert the deflection of the stapedial reflex by application of a small underpressure in the external auditory meatus of the injured ear (probe ear). This inversion can be explained by an ossicular discontinuity bridged by soft tissue.     

鼓室硬化的颞骨HRCT表现与手术对照分析

目的鼓室硬化的颞骨CT表现在不同听骨链病变程度下的特点分析。方法将手术确诊的111例鼓室硬化患者按听骨链的破坏程度分为A、B、C组,分别探讨对应的CT的特异性及非特异性表现。结果非特异表现A与B、C组的出现率差异有统计学意义(P<0.05),BC组之间差异无统计学意义(P>0.05)。CT对听骨链中断的漏诊率为51.61%。特异影像表现3组出现率差异无统计学意义(P>0.05),鼓膜钙化影平均出现率为59.46%,鼓室鼓窦钙化骨化影平均出现率仅为26.13%。结论鼓室硬化的术前CT表现大部分表现为非特异影像,各项非特异CT表现随听骨链的破坏程度加重出现率增高。特异性CT表现鼓室鼓窦的钙化或骨化影出现率较低,鼓膜钙斑的出现率较高。     

虚拟耳镜对慢性中耳炎听骨链病变的诊断价值

目的探讨虚拟耳镜观察对慢性中耳炎听骨链病变的诊断价值。方法112例（128耳）慢性化脓性中耳炎患者,高分辨率CT扫描获取病变部位的原始图像数据,经三维重建后,以虚拟耳镜方式观察听骨链病变情况,然后与手术结果进行比较分析。结果128只患耳中,胆脂瘤性中耳炎55耳,非胆脂瘤型慢性化脓性中耳炎73耳。与手术结果比较,虚拟耳镜对慢性化脓性中耳炎听骨链病变的诊断敏感度、特异度及准确度分别为93.75%、81.25%、90.63%。结论虚拟耳镜能清晰显示听骨链结构及其空间关系,可以提高听骨链病变的术前诊断效率,有助于化脓性中耳炎手术方案的制定。     

虚拟CT耳镜对先天性耳畸形听骨链病变的诊断价值

目的 通过虚拟CT耳镜观察,探讨其对先天性耳畸形听骨链病变的诊断价值.方法 对30例(43耳)先天性耳畸形患者,高分辨率CT扫描获取病变部位的原始图像数据,经三维重建后,以虚拟CT耳镜方式观察听骨链病变情况,然后与手术探查结果对比分析.结果 虚拟CT耳镜清楚显示发育不全的听小骨及畸形听骨链状态,其中外耳道闭锁21例(3...     

钛质人工听小骨在开放式鼓室成形术中的疗效观察与应用体会

目的 探讨Ⅰ期钛质人工听小骨听力重建在慢性中耳炎和中耳胆脂瘤患者中的临床疗效及应用体会。 方法 回顾性分析行开放式鼓室成形术并接受Ⅰ期钛质人工听小骨听力重建的慢性中耳炎或中耳胆脂瘤患者65例临床资料,比较术前及术后1、3、6个月听力情况和气骨导差(ABG)。 结果 术后第1、3、6个月,纯音气导听阈均值(PTA)较术前降低,差异有统计学意义(P<0.05);术后6个月ABG均值较术前降低,差异具有统计学意义(P<0.05);术后ABG≤20 dB者达39耳(P<0.05)。 结论 开放式鼓室成形术加Ⅰ期钛质人工听小骨行听骨链重建治疗慢性中耳炎和中耳胆脂瘤能够有效提高患者的听力水平;选择适当的手术适应证、良好的手术技巧及围手术期处理是取得成功的保证。     

High-resolution computerized tomography for ossicular replacement prostheses

IntroductionTo study the accuracy of high-resolution computed tomography (HRCT) for assessing the ossicular structures in cadaveric temporal bone by the distance between temporal bone elements is of great interest.ObjectivesTo record the distances between the malleal neck and both the stapedial head and footplate by HRCT. Further, after partially opening the temporal bone toward the ossicular structure, to record the actual distances between those structures during surgical dissection.Material and methodsThis study compared actual and HRCT measurements of cadaveric temporal bone. We studied, measured, and recorded distances within and between various structural elements. All data are reported as means and were analyzed to prove the accuracy of HRCT to assess ossicular structure from the temporal bone.ResultsThis study included the temporal bones of 10 male and 10 female cadavers (mean age, 70.4 years). By surgical dissection, the distances between the malleal neck and the stapedial head and footplate were 3.40 and 5.30 mm, respectively (measured from the bone); by HRCT, the corresponding values were 3.35 and 5.29 mm. The intraclass correlation coefficients for assessing ossicular structure in contrast to the actual measurements were 0.901 (malleal neck to stapedial head) and 0.923 (malleal neck to stapedial footplate) (p < 0.05). There were no differences between the actual malleal neck to stapedial head (p = 0.793) or footplate (p = 0.242) measurements.ConclusionHRCT produced statistically comparable, reliable, and accurate measurements compared with actual measurements in cadaveric temporal bone.     

人工听骨在鼓室成形术中的应用

目的评价人工听骨在鼓室成形手术中的应用效果。方法对解放军总医院耳鼻咽喉头颈外科2004年9月至2006年4月施行的中耳炎手术中，接受人工听骨部分赝复物——多孔聚乙烯听骨赝复物（Partialossicularreplacementprostheses，PORP，美国美敦力公司）植入进行听骨链重建的患者42例进行随访。对随访半年以上、资料完整的38例（38耳）进行回顾性总结，应用SPSS统计软件进行疗效分析。计算语言频率（0．5，1，2kHz）气导平均听力及气骨导差，比较不同手术方式和PORP植入方式对疗效的影响。结果38耳鼓膜修补后1个月复查均愈合良好，但术后3个月时发现2例听骨脱出（均为术中人工听骨表面未置软骨片者）。38耳术前气导听力33．75～68．5dBHL，平均为（56．82±13．64）dB；骨导听力0～47．5dB，平均为（20．217±12．099）dB；术后气导听力平均为（34．23±15．04）dB，与术前相比t=3．682，P〈0．01。术前气骨导差（ABG）16．25～62．5dB，平均（36．625＋12．189）dB，其中21-30dB的9耳，〉30dB的24耳。术后ABG平均为（21．064±12．243）dB，与术前相比较，t=5．552，P〈0．01。其中术后ABG差≤20dB的19耳，20～30dB的9耳，〉30dB的8耳。术后ABG≤20dB者及ABG较术前缩小15dB者（术后听力提高有效）共28耳，总有效率为76-3％。结论PORP是一种可在听骨链重建中推广的人工听骨材料，术后取得良好的听力效果，但应注意避免术后听骨脱出。     

Experimental ossicular fixations and the middle ear's response to sound: evidence for a flexible ossicular chain

A human temporal-bone preparation was used to determine the effects of various degrees of artificial ossicular fixation on the sound-induced velocity at the input-side (the umbo of the malleus) and the output-side (the stapes) of the ossicular chain. Construction of various degrees of attachment between an ossicle and the surrounding temporal bone provided a range of reduction in ossicular mobility or "fixations". The results demonstrate different effects of the fixations on the umbo and stapes velocity: fixations of the stapes or incus produce larger reductions in sound-induced stapes velocity (as much as 40-50 dB with extensive stapes fixation), than reductions in umbo velocity (typically less than 10 dB). Fixations of the malleus produce similar-sized changes in both umbo and stapes velocity. These differential effects are consistent with significant flexibility in the ossicular joints (the incudo-malleolar joint and the incudo-stapedial joint) that permits relative motion between the coupled ossicles. The existence of flexibility in the ossicular joints indicates that joints in the ossicular chain can effect a loss of sound-induced mechanical energy between the umbo and the stapes, with a concomitant reduction in the sound-induced motion of the stapes. The introduction of such losses in sound transmission by the joints raises questions concerning the utility of three ossicles in the mammalian ear. The consequences of ossicular flexibility to ossicular-chain reconstruction is discussed. Also, as examined in a more clinically directed paper [Laryngoscope 115 (2005) 147], the different effects of the various ossicular fixations on the motion of the umbo and malleus may be useful in the diagnosis of the site of fixations in humans with conductive hearing losses caused by such pathologies.     

Isolated congenital ossicular anomalies

Conclusions: Isolated congenital ossicular anomalies are diverse. Our proposed modified Teunissen and Cremers classification will be helpful for the evaluation of congenital ossicular anomalies as well as the prediction of surgical outcome. Objectives: The aim of this study was to describe isolated congenital ossicular anomalies encountered in patients who have normal eardrums and to evaluate their surgical outcome based on their classification. Patients and methods: A total of 78 patients (94 ears) with congenital ossicular anomalies were reviewed. The preoperative and postoperative audiological findings, surgical findings, and temporal bone CT results were analyzed. Results: Twenty-one types of ossicular anomalies were identified in this study. A stapes footplate fixation was the most common anomaly and this was usually bilateral. However, the anomalies that were associated with the incus and malleus were usually unilateral. The congenital ossicular anomalies were classified into five types according to the status of the stapes footplate. Using this modification of a prior classification system, the more severe anomalies of the stapes footplate could be identified, and the worst postoperative hearing result could be predicted.