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。     

Tympanosclerosis revisited

Tympanosclerosis is a common clinico-pathological entity encountered by the otosurgeon. Its pathogenesis and optimum management have eluded the otologists since time immemorial. The present study was undertaken to study the incidence of tympanosclerosis amongst patients with chronic suppurative otitis media and to study the correlation between the degree of hearing loss and the site of tympanosclerosis. Audiometric and operative findings of 200 patients of chronic suppurative otitis media were analysed. The incidence of tympanosclerosis was found to be 19% (3d cases out of 200 patients). Most cases of tympanosclerosis had a dry ear on presentation (78.9%). When tympanosclerosis was confined only to the tympanic membrane. 83.3% of the cases had an air-bone-gap less than 40 dB. On the other hand, when tympanosclerosis affected both the tympanic membrane and the middle ear. 75% of the cases had an air-bone-gap more than 40 dB. The hearing loss associated with tympanosclerosis was of the conductive type in the majority of cases. Ossicular mobility was found to be normal in 71.1% of the cases.     

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.     

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.     

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.     

耳内镜下鼓耳道后径路行鼓膜修补术的疗效观察

目的探讨耳内镜下鼓耳道后径路行鼓膜修补术疗效观察。方法采用回顾性分析,对我科21例耳内镜下行鼓耳道后径路鼓膜修补患者,随访半年,针对术后鼓膜愈合率以及听力情况进行分析。结果20例患者,21耳,20例鼓膜愈合,成功率为95.2%,术后无味觉损伤,无移植物内陷及外移,无耳鸣或耳鸣加重,无听力损伤,无胆脂瘤形成;术前平均气导听阈为(49.4±8.6)dB HL,骨气导差为(31.9±4.9)dB HL,术后平均气导听阈为(24.2±5.9)dB HL,骨气导差为(12.7±6.5)dB HL,听力较术前明显提高(P<0.01)。17例(81%)骨气导差小于20db HL。结论耳内镜下利用耳屏软骨-软骨膜经鼓耳道后径路行鼓膜修补术,对不同部位鼓膜穿孔愈合率及听力恢复均获得良好疗效,临床上值得推广应用。     

The value of exploratory anterior tympanotomy in differentiating causes of conductive hearing loss and assessment of their treatment results

The aim of examination was value of exploratory anterior tympanotomy in differentiation causes of conductives hearing loss and assessment of results treatment. Materials of examinations determined 34 patients aged 15-66 years, treated in 1995-2000 years, who qualified to exploratory anterior tympanotomy in aim decision of cause of conductives hearing loss. Among of examined were 14 patients with suspicion of otosclerosis (41.2%), 12 patients with unclear etiology of hypoacusis (35.3) and 8 patients with deterioration of hearing after stapedectomy (23.5%). Preoperative diagnostic embraced: a history, otolaryngologic examination, full audiologic examination and chosen cases of radiologic assessment of temporal bone by computer tomography. After perioperative decision cause of conductive hypoacousis were performed of operations of improved hearing and comprised of average hearing loss by CPT and PTA pre- and postoperative treatment. After performed of exploratory tympanotomy there vere stated following causes of conductive hypoacusis: otosclerosis (61.8%), separated of prosthesis after stapedectomy (14.7%) synechia of prosthesis with tympanic membrane (8.8%) and in singles causes of ossicular synechia in tympanic cavum (5.9%), tympanosclerosis (5.9%) and vitium of middle ear (2.9%). The best of hearing improvement after repairment operations of conductive system were obtained in cases of stapedectomy, exchange of prosthesis after stapedectomy, reconstruction of system by TORP prosthesis, however smaller improvement after operations of synechias of stapes prosthesis with surroundings and postoperation of tympanosclerosis.     

Comparison of incus interpositioning technique versus glass ionomer cement application in type 2 tympanoplasty

Objective of this study is to compare glass ionomer cement application and incus interpositioning techniques in patients who have chronic otitis media, conductive hearing loss with intact tympanic membrane and who undergo hearing reconstruction of staged surgery using a retrospective chart review in the setting of Ministry of Health Ankara Training and Research Hospital ENT Clinic, Turkey. We retrospectively evaluated patients who underwent otological surgery and hearing reconstruction with auto graft incus during 2005–2008 or glass ionomer cement during 2008–2010. Patients who had cholesteatoma, stapes fixation and tympanosclerosis were excluded. Postoperative mean follow-up time of 107 patients was 9.8 months (6–38 months, 83.2 % of them was ≤9 months). Postoperative pure tone hearing thresholds, graft status, gain scores and air bone gaps were recorded. Intact graft, dry ear on the operated side and ABG scores less than 20 dB were accepted as surgical success. Preoperative ABG score was 30.6 ± 7.93 dB in glass ionomer (group I) and 33.6 ± 11.99 dB in incus interpositioning (group II). Postoperative ABG scores were 13.6 ± 10.40 and 22.6 ± 12.39 dB, respectively, in group I and II. Success of closure in ABG scores was obtained in both groups (p < 0.001). Gain scores in group I were better (p = 0.035). Graft success (p = 0.020) correlated with gain score. Results showed that the glass ionomer cement application is a good, cost-effective technique, easy to perform and yields better hearing scores and lower complication rates compared to incus interpositioning technique.     

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。     

Analysis of long-term hearing after tympanosclerosis with total/partial stapedectomy and prosthesis used

Conclusion. Long-term hearing gain results are good after prosthetic reconstruction of the stapes in the tympanosclerotic ear. The type of stapedectomy, whether partial or total, does not affect the result of the surgery very much. Objectives. Comparative evaluation of the hearing results of total/partial stapedectomy technique and the prosthesis used within a 10-year follow-up period after stapedectomy in cases with dense tympanosclerosis and completely fixed stapes. Patients and methods. Twenty-five cases with completely fixed stapes due to generalized tympanosclerosis were included in this retrospective study between 1995 and 2005. Two-stage canal wall up procedure was planned for all cases, and stapedectomy was performed at the second stage. After the second stage, 25 ears in the sixth month, 18 ears in the first year, 14 ears in the second year, and 7 ears in the tenth year were available for follow-up. Preoperative and postoperative air–bone gap values of the patients and their hearing gain were compared. Total stapedectomy was carried out in 17 of the patients and partial stapedectomy in 8 of them. For ossiculoplasty, a plastipore total ossicular replacement prosthesis was used in 17 patients, homograft ossicle in 2 patients, and Teflon piston in 6 patients. Results. In 17 cases in which we used total stapedectomy, the average preoperative air–bone gap value improved from 40.23 to 18.47 in the sixth month, and from 38.4 dB to 9.6 dB in the tenth year. In eight cases in which we used partial stapedectomy, the average preoperative air–bone gap improved from 38.63 dB to 24.38 dB and from 35 dB to 17 dB, respectively. The average postoperative hearing gain with total stapedectomy was 21.76 dB in the sixth month and 28.8 dB in the tenth year. Hearing gain with partial stapedectomy was successively 14.25 dB and 18 dB. When we compared the results of total prosthesis and Teflon pistons among the materials used in ossiculoplasty, although hearing gain with total prostheses was better, the results were not statistically significant.     

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.     

Fully implantable hearing aids in patients with congenital auricular atresia

INTRODUCTION: Patients with congenital auricular atresia suffer from a conductive hearing loss (HL) with an air-bone gap of 50 to 60 dB. Conventional bone conducting or bone anchored hearing aids are treatment options with several disadvantages and a biophysical limitation of almost no sound attenuation in the skull bone. Surgical construction of the sound conducting apparatus has been performed by others and modified by us into a three-step procedure with in vivo prefabrication of the external ear canal and the tympanic membrane. Although the results improved after inauguration of our modifications, there still remains an air-bone gap that makes air conducting hearing aids necessary in many patients. Implantable hearing aids have been developed for patients with perceptional HL and normal middle ear function but not for patients with middle ear disease or malformation. OBJECTIVES: Our objectives were to improve the hearing results of auricular atresia. STUDY DESIGN: Prospective. METHODS: The surgical instruments, the transducer, and the operative technique of the only fully implantable hearing aid (Otologics Fully Implantable Middle Ear Transducer) clinically available were modified. They were implanted in five patients with congenital auricular atresia and their audiologic outcome evaluated. RESULTS: After activation and fitting of the devices, patients experienced an improvement of sound-field thresholds up to 50 dB HL. The mean functional gain in a three frequency pure-tone average was approximately 35 dB HL. CONCLUSIONS: This technique appears to provide a completely new dimension for the audiologic rehabilitation of patients with severe malformation of the middle ear.     

保留听骨链的低位完桥鼓室成形术

目的 探讨保留听骨链的完桥式鼓室成形术对上鼓室有阻塞性病变的慢性化脓性中耳炎的效果.方法 对23例上鼓室肉芽包裹听骨链阻塞鼓窦入口、影响上鼓室引流的慢性化脓性中耳炎患者采用低位完桥鼓室成形术(鼓窦入口及上鼓室外侧壁保留更加狭窄的低位"骨桥"样结构),彻底清除病变组织,松解活动受限的听骨链,疏通中、上鼓室的引流,术后随访0.5~3年,观察疗效.结果 23例患者术前平均纯音听阈(0.5~2 kHz)为43.91±9.90 dB HL,气骨导差为24.04±5.10 dB,术后随访期内平均纯音听阈稳定,为33.17±7.63 dB HL,气骨导差为14.70±4.52 dB;所有患者3月内获得干耳;无复发或再次鼓膜穿孔病例;1例术后6月后出现鼓室积液(分泌性中耳炎),行鼓膜置管(T型管),6个月后拔管,随访1年,未再复发.结论 对上鼓室有阻塞性病变的慢性化脓性中耳炎患者进行保留听骨链的低位完桥鼓室成形术,复发率低,提高听力效果好.     

Type I Tympanoplasty: surgical success and prognostic factors

ObjectivesTo evaluate success rate of type I tympanoplasty in adults and to investigate the importance of selected prognostic factors on graft uptake.Material and methodsRetrospective medical chart review of 155 patients who underwent Type I Tympanoplasty, in our department, from January 2013 to December 2017. Graft uptake rate was evaluated and the effects of prognostic factors on surgical outcome such as sex, smoking and otological surgery history, status of the contralateral ear, size and location of the perforation, middle ear mucosa status, surgical approach and graft material. Preoperative and postoperative audiometric data were collected, and the functional success was determined.ResultsThe overall surgical anatomical success rate was 75%. Analysis of the selected variables, identified as independent prognostic factors of anatomical unsuccess (95% CI): smoking (OR = 3.29, p < .01), middle ear tympanosclerosis (OR = 2.96; p = .04). Perforations above 50% of the tympanic membrane area had a borderline effect on graft uptake (p = .05). There was a significative improvement in the average air conduction thresholds of 7.44 dB and an ABG closure rate at 10 dB and 20 dB was achieved in 47% and 84.5%, respectively. Patients who received temporalis fascia graft had similar hearing gain compared to patients who underwent cartilage tympanoplasty (7.7 vs. 7.3 dB, p = .79).ConclusionType I tympanoplasty is an effective and safe procedure with a high anatomical success rate in the treatment of mucosal COM. Poorer outcomes were found in patients with smoking habits, in those with tympanosclerosis of middle ear mucosa and in larger perforations. These prognostic factors should be considered in surgical planning and patients should be advised to quit smoking. Tympanoplasty with cartilage graft had a hearing outcome comparable to temporalis fascia graft and should be considered in high-risk patients.     

A study of inflammatory mediators in the human tympanosclerotic middle ear

OBJECTIVE: To analyze immunocompetent cells as well as 2 factors involved in inflammation and also thought to be involved in bone remodeling-interleukin 6 (IL-6) and inducible nitric oxide synthase in the human middle ear, including the tympanic membrane. DESIGN: Biopsy specimens were obtained from the human middle ear and tympanic membrane during surgery. Using an immunohistochemical technique, the expression of macrophages, T cells, B cells, IL-6, and inducible nitric oxide synthase were analyzed. MATERIALS: Nine biopsy specimens from tympanic membranes in children having a transtympanic ventilation tube inserted as a treatment for secretory otitis media and 11 biopsy specimens from tympanosclerotic plaques from patients with chronic otitis media and tympanosclerosis. RESULTS: More positively stained specimens showing macrophages, B cells, and IL-6 were seen in the biopsy specimens from children with secretory otitis media compared with the biopsy specimens from patients with chronic otitis media and tympanosclerosis. The biopsy specimens from patients with chronic otitis media and tympanosclerosis more often showed positive stainings for inducible nitric oxide synthase than the biopsy specimens from children with secretory otitis media. The presence of IL-6 and inducible nitric oxide synthase was shown by staining to be mostly in the surface cells, while macrophages and B cells were stained deeper in the tissues, in connective tissue, or around sclerotic lesions. CONCLUSIONS: The 2 patient groups differed in antigen presentation so that macrophages, B cells, and IL-6 were labeled more frequently in patients with secretory otitis media, that is, an early phase of the disease. Inducible nitric oxide synthase was seen more frequently in the patients with already established tympanosclerosis in a later phase of the disease.     

Ossiculoplasty using incus interposition: hearing results and analysis of the middle ear risk index.

OBJECTIVE: To determine the immediate hearing result and the long-term stability of sculpted incus interposition in ossiculoplasty and evaluate the utility of the middle ear risk index in predicting hearing outcome in these cases. PATIENTS: One hundred thirty-seven surgical patients. STUDY DESIGN: Review of 137 patients who underwent ossiculoplasty using autologous or homologous sculpted incus interposition. INTERVENTIONS: Ossiculoplasty using autologous or homologous sculpted incus interposition. METHODS: Retrospective chart review, using the guidelines delineated by the Committee on Hearing and Equilibrium of the Academy of Otolaryngology-Head and Neck Surgery for the evaluation of results for the treatment of conductive hearing loss. RESULTS: The mean preoperative air bone gap was 26.8 dB, and the mean postoperative gap was 18.6 dB. Twenty-seven percent of patients were closed to within 10 dB, and 66.4% were brought to within 20 dB of the postoperative bone conduction line. Average time to the last postoperative audiometric testing was 15.8 months, with a range of 2 to 62 months. A mean air bone gap change of -0.2 dB was noted. Four patients had more than a 10 dB deterioration in conductive hearing loss. There were no cases of graft extrusion. Each ear operated upon in our series was fully scored using the middle ear risk index, and an index total was calculated. No statistical associations could be demonstrated in any group between the postoperative air bone gap and the middle ear risk index subcategories or total. CONCLUSIONS: Sculpted autologous or homologous incus interposition provides hearing success comparable with current allograft prosthesis studies, has a very low extrusion rate, and remains stable over time. We were not able to demonstrate an association between the middle ear risk index and hearing results in this subset of patients.     

A new grafting technique for tympanoplasty: tympanoplasty with a boomerang-shaped chondroperichondrial graft (TwBSCPG)

The aim of this study was to introduce a new grafting technique in tympanoplasty that involves use of a boomerang-shaped chondroperichondrial graft (BSCPG). The anatomical and functional results were evaluated. A new tympanoplasty with boomerang-shaped chondroperichondrial graft (TwBSCPG) technique was used in 99 chronic otitis media patients with central or marginal perforation of the tympanic membrane and a normal middle ear mucosa. All 99 patients received chondroperichondrial cartilage grafts with a boomerang-shaped cartilage island left at the anterior and inferior parts. Postoperative follow-ups were conducted at months 1, 6, and 12. Preoperative and postoperative audiological examinations were performed and air–bone gaps were calculated according to the pure-tone averages (PTAs) of the patients. In the preoperative period, most (83.8 %) air–bone gaps were ≥16 dB; after operating using the TwBSCPG technique, the air–bone gaps decreased to 0–10 dB in most patients (77.8 %). In the TwBSCPG patients, the mean preoperative air–bone gap was 22.02 ± 6.74 dB SPL. Postoperatively, the mean postoperative air–bone gap was 8.70 ± 5.74 dB SPL. The TwBSCPG technique therefore decreased the postoperative air–bone gap compared to that preoperatively (p = 0.000, z = ?8.645). At the 1-month follow-up, there were six graft perforations and one graft retraction. At the 6-month follow-up, there were nine graft perforations and three graft retractions. At 12 months, there were seven graft perforations and four graft retractions. During the first year after the boomerang tympanoplasty surgery, graft lateralization was not detected in any patient. Retractions were grade 1 according to the Sade classification and were localized to the postero-superior quadrant of the tympanic membrane. The TwBSCPG technique has benefits with respect to postoperative anatomical and audiological results. It prevents perforation of the tympanic membrane at the anterior quadrant and avoids graft lateralization due to placement of the graft under the manubrium mallei. Given these benefits, the TwBSCPG technique seems to be a good alternative for grafting in tympanoplasties.     

持续灌流模式耳内镜下Ⅲ、Ⅳ型鼓室硬化症手术疗效分析

目的 探讨采用持续灌流耳内镜手术模式(CIM-EES)一期鼓室成形术治疗Ⅲ、Ⅳ型鼓室硬化症的临床疗效.方法 2019.3-2020.9对17例(21耳)Ⅲ、Ⅳ型鼓室硬化症患者,在持续灌流模式耳内镜下采用外嵌法,一期行Ⅱ型鼓室成形术,观察分析手术时间,鼓膜愈合成功率,并比较术前及术后6个月平均气、骨导听阈(PTA)及气骨...     

不同类型先天性中耳畸形的手术治疗

探讨先天性中耳畸形的临床分型及其手术策略。方法选取2016年6月—2019年12月收治的23例（33耳）先天性中耳畸形患者进行中耳畸形临床分型及不同的手术策略进行回顾分析，观察术后疗效和听力的恢复情况。术前对23例（33耳）中耳畸形患者均行耳内镜检查、听力学检查及颞骨CT并听骨链三维重建检查。结果23例患者中18例为术前明确畸形，5例为术中探查发现畸形。其中15例为锤、砧骨畸形，选择人工听骨赝复物（TORP或PORP）或自体听骨植入修复；6例为镫骨畸形，选择人工镫骨赝复物（Piston）植入；1例为鼓膜穿孔伴有先天性中耳畸形，先行鼓膜成形术，二期行听骨链重建手术；1例畸形程度比较复杂，面神经走形异常，在前庭窗处分叉，遮挡前庭窗，未能行进一步治疗。术后气导阈值提高至正常的有15例（65.2%）；骨气导差（ABG）恢复至30 dB以内的有16例（69.6%），ABG术后仍超过30 dB的有5例（21.7%），1例听力未改善（4.3%），1例无法行听骨重建（4.3%）。结论先天性中耳畸形术前诊断比较困难，CT检查很难精确评估，手术探查为最有说服力的诊断标准，明确中耳畸形临床分型后选择最佳的手术方式，是治愈疾病并提高患者术后听力最佳选择。     

Bone conduction improvement after surgery for conductive hearing loss

The objective is to evaluate change in post-operative bone conduction in patients who underwent surgery for conductive/mixed hearing loss due to various reasons. The study design is of retrospective case review and tertiary referral center setting. Five-hundred patients with unilateral conductive/mixed hearing loss were divided into five equal groups (each representing different causes for pre-operative hearing loss), who underwent appropriate surgical correction and had a follow-up audiogram available. The intervention comprises surgery (like myringoplasty and ossiculoplasty with closed or open cavity mastoidectomy for chronic otitis media, stapes mobilization for tympanosclerosis and stapedotomy for otosclerosis) for conductive/mixed hearing loss. Significant improvement or worsening in bone conduction was defined as 15?dB or more improvement or worsening of bone conduction threshold at least in two frequencies between 500 and 4000?Hz. All the other groups also showed a consistent pre-operative bone conduction reduction with an equally consistent improvement in post-operative bone conduction improvement to a varying degree with otosclerosis group having maximum percentage of patients with post-operative bone conduction improvement (60%). The measurement of bone conduction is not necessarily a true reflection of the function of the inner ear. Middle ear makes a contribution to bone conduction and correction of a middle ear conductive lesion causes an apparent improvement in inner ear function. The apparent inner ear hearing loss caused in this way may be reversible to some extent.