自体软骨和Tos改良联合进路鼓室成形术在中耳手术中的应用

目的 探讨自体软骨和Tos改良联合进路鼓室成形术在中耳手术中的临床应用.方法 对23例胆脂瘤型中耳炎用Tos改良的联合进路行鼓室成形术进行治疗,去除的上鼓室外侧壁和后鼓室外侧壁,用耳屏软骨重建,再视镫骨状况,同时用部分听小骨赝复体(PORP)或全听小骨赝复体(TORP)行Ⅲ型听骨链重建.所有病例随访3至5年.结果 所有23例患者在术后4至6周获得干耳,鼓膜愈合好,形态正常.软骨重建的上鼓室和后鼓室外侧壁无1例内陷.术后1年纯音听力,言语频率(500、1000、2000、3000、4000Hz)气导较术前提高≥30dB者8例(34.78%),20～29dB者9例(39.13%),10～19dB者4例(17.39%),听力无改善者2例(8.69%).随访3年,听力稳定,5年内无胆脂瘤复发.结论 Tos改良的联合进路鼓室成形术是胆脂瘤型中耳炎手术治疗的好方法,既彻底清除病灶,又保留外耳道后壁完整,术后能获得良好的听力.Tos改良术因去除了上鼓室和后鼓室外侧壁,用软骨重建可有效的防止新生鼓膜的内陷和继发胆脂瘤形成.     

耳内镜干、湿耳状态下Ⅱ型鼓室成形术疗效分析

目的比较耳内镜干、湿耳状态下Ⅱ型鼓室成形术的疗效, 评估湿耳下Ⅱ型鼓室成形术的可行性。方法回顾性队列研究。纳入安徽医科大学第一附属医院耳鼻咽喉头颈外科2018年1月—2020年10月40例耳内镜下Ⅱ型鼓室成形术的慢性中耳炎患者的临床资料。其中, 男14例、女26例, 年龄18～72岁。依据术前鼓室黏膜炎性状态分为湿耳组22例和干耳组18例。观察指标:(1)比较2组患者性别、年龄、病程、手术时间、术前骨气导差等基线资料;(2)比较2组患者术后3个月时听力改善情况;(3)观察2组患者鼓膜愈合情况, 比较手术前后4 kHz骨导听阈的变化以及术后并发症发生情况。结果 2组患者术后均获得干耳, 无再次流脓。(1)2组患者的年龄、病程、术前骨气导差、手术时间等基线资料比较差异均无统计学意义(P值均 > 0.05), 性别构成差异有统计学意义(P = 0.028)。(2)术后3个月听力改善情况:湿耳组、干耳组气导的平均听阈术前分别为(63.03±16.63)dB、(53.89±13.85)dB, 术后分别为(46.59±13.86)dB、(39.51±12.92)dB, 差异均有统计学意义(t...     

胆脂瘤型中耳炎高分辨CT特征性的表现

目的 研究胆脂瘤型中耳炎的高分辨CT特征,提高对其CT征象的认识. 方法 回顾性分析经手术证实的52例中耳胆脂瘤型中耳炎的患者的进行HRCT表现,观察盾板、上鼓室外侧壁、鼓窦入口等解剖结果的改变,并对咽鼓管鼓室口,听小骨破坏等进行分析.结果 52例胆脂瘤型中耳炎患者中,盾板变钝48例,合并上鼓室外侧壁破坏39例;听骨链完全缺失9例;砧骨完全缺失7例,仅砧骨长脚缺失34例,锤骨长脚部分缺失17例;鼓窦入口扩大44例.结论 蒲氏间隙增宽、盾板变钝和上鼓室外侧壁破坏、鼓窦入口扩大是胆脂瘤特征性的CT征象.     

耳内镜下新西兰兔中耳的解剖研究

目的　耳内镜下观察兔中耳解剖结构,探讨兔作为耳内镜解剖训练模型的可行性,为兔中耳相关的其他实验研究提供解剖学依据。 方法　5只（10耳）新西兰兔麻醉处死后,耳内镜下经外耳道入路观察兔鼓膜、中耳鼓室结构,辨别听小骨、上中下鼓室、面神经等。 结果　与人对比,新西兰兔听小骨由锤砧联合体和镫骨组成;上鼓室外侧壁部分骨质缺如,由鼓膜向上延续并覆盖;听泡类似于人的中、下鼓室,包含咽鼓管、面神经、鼓岬、前庭窗、蜗窗以及鼓室神经等结构,乳突为听泡尾侧的板障型骨管;面神经鼓室段水平走行于上鼓室下方骨壁内,后经锥隆起垂直走行于听泡后壁,经茎乳孔出听泡。 结论　新西兰兔中耳结构与人相似,既可作为耳科医生练习耳内镜操作的解剖模型,也可作为耳部三维解剖结构的教学标本。     

耳内镜下新西兰兔中耳的解剖研究

目的　耳内镜下观察兔中耳解剖结构,探讨兔作为耳内镜解剖训练模型的可行性,为兔中耳相关的其他实验研究提供解剖学依据。 方法　5只（10耳）新西兰兔麻醉处死后,耳内镜下经外耳道入路观察兔鼓膜、中耳鼓室结构,辨别听小骨、上中下鼓室、面神经等。 结果　与人对比,新西兰兔听小骨由锤砧联合体和镫骨组成;上鼓室外侧壁部分骨质缺如,由鼓膜向上延续并覆盖;听泡类似于人的中、下鼓室,包含咽鼓管、面神经、鼓岬、前庭窗、蜗窗以及鼓室神经等结构,乳突为听泡尾侧的板障型骨管;面神经鼓室段水平走行于上鼓室下方骨壁内,后经锥隆起垂直走行于听泡后壁,经茎乳孔出听泡。 结论　新西兰兔中耳结构与人相似,既可作为耳科医生练习耳内镜操作的解剖模型,也可作为耳部三维解剖结构的教学标本。     

乳突根治术后行外耳道后壁重建及鼓室成形术

目的：报道乳突根治行外耳道后壁重建及鼓室形成术的效果。方法：取自体髂骨咬碎填塞乳突术腔，表面复盖颞肌筋膜及外耳道皮瓣，重建形态结构完整的外耳道骨壁。结果：20例患者重建外耳道骨壁全部愈合，听力提高满意。结论：乳突根治术后重建外耳道后壁可恢复乳突及外耳道的正常形态，提高鼓室形成术及根治干耳的效果。     

下鼓室窦的应用解剖

目的　研究下鼓室窦的形态及变异 ,为下鼓室及迷路下显微外科手术提供应用解剖学资料。方法　用 2 0 0例骨标本在XSQ～Ⅱ型手术显微镜下解剖观察了下鼓室 ;其中 10例标本经CT扫描拍片后用X线图象对照解剖观察。结果　下鼓室底以复层窦或单复层窦混合存在者多见 ,无窦者仅见 3 0 % ,窦腔壁有 6 6 0 %的标本由片状骨板围成 ,骨柱或骨嵴构成者较少见。下鼓室窦向内侧与迷路下窦相连续 ,在岩部骨质内向下扩展可深至鼓部骨板下 1/3平面水平 ,见 12 0 % ,此窦在CT扫描中清晰可见。鼓室内侧壁的岬表面可见岬窦 ,出现率 2 6 0 % ,内侧壁的岬下有迷路下腔者见 5 7 0 %。下鼓室前壁有下鼓室隐窝者占 6 6 0 % ,前壁有下鼓室窦覆盖 ,无窦覆盖并见颈动脉管隆起者见 7 0 %。结论　下鼓室窦存在于底壁及内侧壁 ,对此区手术时保护颈内静脉及下鼓室神经切除术均有实际应用意义。     

耳内镜干、湿耳状态下Ⅱ型鼓室成形术疗效分析

目的 比较耳内镜干、湿耳状态下Ⅱ型鼓室成形术的疗效,评估湿耳下Ⅱ型鼓室成形术的可行性。方法 回顾性队列研究。纳入安徽医科大学第一附属医院耳鼻咽喉头颈外科2018年1月—2020年10月40例耳内镜下Ⅱ型鼓室成形术的慢性中耳炎患者的临床资料。其中,男14例、女26例,年龄18~72岁。依据术前鼓室黏膜炎性状态分为湿耳组22例和干耳组18例。观察指标：（1）比较2组患者性别、年龄、病程、手术时间、术前骨气导差等基线资料;（2）比较2组患者术后3个月时听力改善情况;（3）观察2组患者鼓膜愈合情况,比较手术前后4 kHz骨导听阈的变化以及术后并发症发生情况。结果 2组患者术后均获得干耳,无再次流脓。（1）2组患者的年龄、病程、术前骨气导差、手术时间等基线资料比较差异均无统计学意义（P值均 > 0.05）,性别构成差异有统计学意义（P = 0.028）。（2）术后3个月听力改善情况：湿耳组、干耳组气导的平均听阈术前分别为（63.03±16.63）dB、（53.89±13.85）dB,术后分别为（46.59±13.86）dB、（39.51±12.92）dB,差异均有统计学意义（t = 13.35、10.13,P值均 < 0.001）;骨导平均听阈术前分别为（30.30±13.48）dB、（26.25±9.94）dB,术后分别为（30.10±12.53）dB、（26.11±9.55）dB,差异均无统计学意义（t = 0.47、0.36,P = 0.642、0.723）。2组患者骨气导差术后均较术前显著降低,其中干耳组由（27.2 ± 9.4）dB降至（13.4 ± 6.4）dB,湿耳组由（32.7 ± 9.0）dB降至（16.5 ± 4.8）dB,差异均有统计学意义（t =10.24、14.34,P值均 < 0.001）。2组间比较,手术前后骨气导差以及术后骨气导差的降低值差异均无统计学意义（P值均 > 0.05）,2组手术前后4 kHz骨导听阈差异无统计学意义（P > 0.05）。（3）2组患者随访3个月,鼓膜均完全愈合,均未出现感音神经性聋、面瘫等并发症。结论 耳内镜湿耳状态下Ⅱ型鼓室成形术后患者的听力恢复及鼓膜愈合情况与干耳状态疗效相当,该手术是可行的。     

鼓室成型术中齿突及上鼓室前隐窝处理的临床意义

目的：探讨鼓室成型术中齿突及上鼓室前隐窝处理的临床意义.方法：采用改良乳突根治＋鼓室成型术治疗37例慢性中耳乳突炎,其中胆脂瘤型23例、肉芽型14例.术中对齿突进行解剖观察,并对其前方的上鼓室前隐窝病灶进行探察与处理.结果：术中见齿突明显下垂的长骨嵴型者9例（24.32%）,短骨嵴型28例 上鼓室前隐窝发现胆脂瘤22例、水肿肉芽13例、另有2例黏膜光滑.37例干耳时间为1～3月,平均1.5月.听力以0.5 Hz、1.0 Hz、2.0 Hz（听力级）3个语言频率气导及气骨导差缩小的平均值评定.术后平均气骨导差（15.27±5.00）dB,较术前（34.95±7.52 ）dB明显缩小（P＜0.01）.结论：齿突前方为上鼓室前隐窝,常是胆脂瘤或肉芽病灶隐匿部位,鼓室成型术中切除齿突和开放上鼓室前隐窝有利于彻底清除病灶,可减少术后病灶残留和复发.     

外耳道带蒂骨膜皮瓣鼓室成形术

<正> 作者用外耳道骨性段带蒂骨膜皮瓣行鼓室成形术47耳:Ⅰ型14耳,Ⅱ型2耳,Ⅲ型31耳。人工鼓膜完全成活85.1％,小穿孔12.8％,总成活率97.9％。因本组病例病变较重及听骨链重建尚存在一些问题,听力提高只占76.6％。用本瓣作鼓膜成形的优点:成活率高、功能效果好,干耳及上皮化快、不良反映少。作者还介绍了手术要点和提高     

先天性外耳道畸形多层螺旋CT的分析与研究

目的通过分析先天性外耳道畸形的多层螺旋cT表现,为临床提供准确、有效的影像信息。方法回顾性分析56例（64耳）婴儿（45天一6个月）先天性外耳道畸形患者的cT表现。结果56例先天性外耳道畸形患者双侧畸形者8例,单侧畸形者48例;合并中耳或内耳畸形者62耳,仅外耳畸形者2耳;鼓部无或轻度发育不良12耳,鼓部重度发育不良19耳,鼓部未发育33耳。结论多层螺旋cT对先天性外耳道畸形具有重要的诊断价值,是定制临床治疗方案的重要依据。     

Comparison of tranexamic acid (Transamin) and traditional therapy for sudden deafness

The effectiveness of tranexamic acid treatment for sudden deafness was studied in detail. The results of treatment with tranexamic acid administration in 19 cases (25 ears) of sudden deafness and two historical control groups using various treatments were compared by the chi square contingency test. The data suggested that tranexamic acid treatment may be superior to traditional treatments especially if treatment is begun early. Among ears treated with tranexamic acid, 11 ears (44%) were healed or recovered remarkably, 8 ears (32%) recovered slightly and 6 ears (24%) were unchanged or worsened. Fibrinolysis in the inner ear may be the pathophysiology of sudden deafness. Treatment with tranexamic acid starting within 4 days after onset of symptoms was most effective in patients whose initial audiogram was flat or concave, initial average hearing loss at 5 frequencies (250 Hz, 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz) was between 23 dB and 76 dB (mean; 45.1 dB) and was not accompanied by dizziness.     

先天性内耳发育畸形的高分辨率CT表现

目的探讨先天性内耳畸形的高分辨率CT表现。方法回顾性分析29例(46耳)婴幼儿先天性内耳发育畸形患者的CT表现,所有患者均做多层螺旋高分辨率CT横断面扫描及多平面重建,必要者利用容积再现技术对骨迷路进行三维重建。结果29例先天性内耳发育畸形患者双侧畸形者17例,单侧畸形者12例,内耳发育畸形共计46耳。具体分布如下:(1)Michel型(2耳),(2)耳蜗未发育(6耳),(3)共同腔畸形(5耳),(4)不完全分隔Ⅰ型(5耳),(5)不完全分隔Ⅱ型(传统Mondini型)(17耳),(6)耳蜗形态正常仅前庭及(或)半规管畸形(9耳),(7)单纯内耳道畸形(2耳)。结论高分辨率CT对先天性内耳骨迷路畸形具有重要的诊断价值,并可为人工耳蜗植入术适应证的选择提供重要依据。     

Changes in external ear position modify the spatial tuning of auditory units in the cat's superior colliculus

This study examines the influence of external ear position on the auditory spatial tuning of single units in the superior colliculus of the anesthetized cat. Unit responses to broad-band stimuli presented in a free sound field were measured with the external ears in a forward symmetrical position or with one or the other ear turned 40 degrees to the side; the ears are referred to as contra- or ipsilateral with respect to the side of the recording site. Changes in the position of either ear modified the spatial tuning of units. The region of space from which a stimulus was most effective in activating a unit is referred to as the unit's "best area". Whenever the contralateral ear was turned to the side, best areas shifted peripherally and somewhat upward, roughly in proportion to the magnitude of the change in ear position. A turn of the ipsilateral ear to the side had more variable effects, but best areas generally shifted frontally. Best areas located between approximately 10 and 40 degrees contralateral when the ears were forward were least affected by changes in ipsilateral ear position. Changes in ear position also modified the maximum response rates of many units. Units with best areas located within approximately 20 degrees of the frontal midline when the ears were forward exhibited a pronounced decrease in responsiveness when either ear was turned. Units with more peripheral best areas tended to show no change or a slight increase in responsiveness. The influence of ear position on the directionality of the external ears was determined by mapping the cochlear microphonic response to tones or one-third-octave bands of noise before and after turning the ear. When the ears were forward, maximum interaural intensity differences (IIDs) were produced by high-frequency sound sources (greater than or equal to 20 kHz) located 20-40 degrees from the frontal midline and by lower frequency sources located further peripherally. The influence of ear position on the locations from which maximum IIDs were produced was similar to the influence of ear position on unit best areas. Changes in ipsilateral ear position had different effects on high- and low-frequency IIDs that were comparable with the effects of changes in ear position on frontally and peripherally located best areas, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)     

Cholesterol Granuloma of the Tympanic Membrane Presenting as a Blue Eardrum

Intramembranous tympanic membrane cholesterol granuloma (CG) occurs infrequently. Here, the authors report a case of CG in the tympanic membrane presenting as a blue eardrum in the right ear. In addition, a pinhole perforation noted in the anterosuperior area revealed a brown discharge. High-resolution temporal bone CT showed a bulging mass shadow in the middle ear and a soft tissue dense lesion that filled both the epitympanum and mastoid cavity. Tympanomastoidectomy was performed under general anesthesia. New bone formation was confirmed in the mastoid antrum and epitympanum, and the epitympanum was blocked by new bone. The tympanic membrane revealed a round, brownish mass with a glistening surface and a severely thickened pars tensa. We herein report this case and review pertinent medical literature.     

正常中耳腔的CT仿真内窥镜技术

目的：探讨正常听骨链的CT仿真内窥镜(CTVE)成像技术方法及其对中耳结构显示程度。方法：15例无中耳疾病的健康人，层厚1mm、螺距1．0轴位薄层扫描，骨算法、0．1～0．2mm间隔重建，行CTVE成像，观察正常听骨链的情况。结果：采用CTVE技术，对锤骨、砧骨及锤砧关节及砧镫关节的显示率均能清晰的显示，砧镫关节呈“L”形。但镫骨底板和镫骨的前、后脚显示欠佳，约有1／3可以显示。结论：CTVE成像技术能很好地显示中耳腔内部的听骨链立体结构，特别是可以部分显示镫骨底板，该技术将在活体上对中耳腔形态及功能的研究有重要意义。     

Effectiveness of ear syringing in general practice: a randomised controlled trial and patients'' experiences.

BACKGROUND: Ear syringing is a common procedure performed for a variety of symptoms in primary care. Reports of its effectiveness vary considerably and no randomised controlled trials (RCTs) have been performed. AIM: To estimate the effect of ear syringing on hearing thresholds and on symptoms leading to ear syringing in general practice. DESIGN OF STUDY: Randomised single-blind controlled trial. Before-and-after self-assessments of symptoms. SETTING: Patients from three general practices in the Bristol area attending twice-weekly clinics dedicated to ear syringing over a 12-week period. METHOD: Patients were randomly assigned to have their hearing tested before and after ear syringing, or twice before ear syringing. Changes in hearing threshold were measured by pure tone audiometry (PTA). All patients completed sef-assessment forms of symptoms using Likert scales before, and one week after, ear syringing. RESULTS: Hearing threshold improved by 10 dB or more in 34% (95% confidence interval [CI] = 21% to 47%) of the intervention group and 1.6% of control group (number needed to treat = 3.1, 95% CI = 2.2 to 5.2, P<0.001). The levels of improvement in the intervention group ranged between 15 dB and 36 dB. The symptoms that most commonly improved included hearing on the phone, pain, a feeling of blocked ears, and hearing one-to-one. There was a strong relationship between the change thresholds, as measure using PTA, and self-reports of hearing improvement. Secondary analysis was unable to identify predictors of objectively measured improvement. CONCLUSION: Ear syringing improved hearing threshold in a substantial proportion of patients. An even larger proportion reported an improvement in symptoms. It was not possible to predict which patients would benefit.