中耳手术中电钻噪声对耳蜗功能的影响

目的 探讨中耳手术中电钻噪声对耳蜗功能的影响.方法 对32例单侧慢性化脓性中耳炎患者行乳突根治及鼓室成形术,术中采用TES-1351声级计检测使用不同规格电钻钻头对手术产生的噪声,比较手术耳及非手术耳手术前、术后2周及3个月时1、2、4、6、8 kHz各频率的平均骨导听阈.结果 术中不同规格电钻钻头发出的噪声强度为93~112 dB SPL,手术耳术后2周1、2、4、6、8 kHz骨导平均听阈较术前升高(P<0.05),而在术后3个月时1、2 kHz平均骨导听阈与术前差异无统计学意义(P>0.05),但4、6、8 kHz平均骨导听阈仍高于术前水平(P<0.05).非手术耳术后2周及3个月时1、2 kHz骨导平均听阈与术前相比有所提高,但其差异无统计学意义(P>0.05);而4、6和8 kHz骨导平均听阈仍较术前升高(P<0.05).结论 中耳手术中电钻噪声对耳蜗功能有一定损伤,以高频区明显.     

鼓室成形术中电钻及吸引噪声的安全性评估

目的 :探讨耳显微外科手术中电钻及吸引的噪声 ,对术耳和非术耳的耳蜗功能所产生的影响。方法 :采用ND10型声级计 ,对鼓室成形术中不同规格和不同种类的钻头及吸引所产生的噪声进行检测 ,并分别比较术耳术前和术后 1个月的纯音骨导阈值以及非术耳术前和术后 1个月的骨导阈值。结果 :术中电钻钻头与吸引所致噪声强度分别为 82～ 10 6dB(A)和 71～ 84dB(A) ,术前与术后 1个月左右双耳纯音骨导阈值变化差异无统计学意义 (P >0 .0 5 )。结论 :鼓室成形术中电钻及吸引器的使用是安全的 ,对双侧耳蜗功能无明显不良影响     

手术中电钻噪声对耳蜗的影响

本文介绍了电钻噪声在耳外科手术中对内耳影响及噪声对听觉器官和机体作用的影响因素新进展。     

耳外科手术中吸引器产生噪声的评估

目的探讨耳显微外科中电钻产生噪声的大小及其影响因素，以及耳蜗开窗术时噪声的特点。方法采用ER-7c型声级计，对耳显微手术中不同种类和不同规格的电钻在9具尸头的12侧颞骨中产生的噪声进行测量.并分别对噪声的等效声压级的峰值（MAX）和RMS（均方根）值进行统计学分析。结果在9具尸头的12侧颞骨中测量噪声值如下：（1）不同直径的切割钻在乳突骨皮质产生噪声峰值的均值为120.4dBSPL-121.7dBSPL，RMS值为108.3dBSPL-110.6dBSPL；（2）在乳突腔，不同直径的切割钻和金刚钻产生噪声峰值为116.8dBSPL-121.5dBSPL，RMS为105.4dBSPL-110.1dBSPL，其差别无统计学意义：（3）耳蜗开窗术记录噪声峰值在116.0dBSPL-131.5dBSPL，噪声RMS值为108.6dBSPL-124.9dBSPL，并且在3具尸头的3侧颞骨中记录到转动的金刚钻接触鼓阶内骨膜时噪声值超过130dBSPL。结论耳显微手术中电钻转动所产生的噪声值较大，尤其在耳蜗开窗时转动的金刚钻接触鼓阶内骨膜时噪声值更大，足以引起噪声性耳聋。因此改进耳显微手术的技术、缩短内耳受噪声暴露的时间对降低噪声性耳聋的发生率至关重要。     

耳外科手术中电钻产生噪声的评估

目的 探讨耳显微外科中电钻产生噪声的大小及其影响因素,以及耳蜗开窗术时噪声的特点.方法 采用ER-7c型声级计,对耳显微手术中不同种类和不同规格的电钻在9具尸头的12侧颞骨中产生的噪声进行测量,并分别对噪声的等效声压级的峰值(MAX)和RMS(均方根)值进行统计学分析.结果 在9具尸头的12侧颞骨中测量噪声值如下:(1)不同直径的切割钻在乳突骨皮质产生噪声峰值的均值为120.4 dB SPL～121.7 dB SPL,RMS值为108.3 dB SPL～110.6 dB SPL;(2)在乳突腔,不同直径的切割钻和金刚钻产生噪声峰值为116.8 dB SPL～121.5 dB SPL,RMS为105.4 dB SPL～110.1 dB SPL,其差别无统计学意义;(3)耳蜗开窗术记录噪声峰值在116.0dB SPL～131.5 dB SPL,噪声RMS值为108.6 dB SPL～124.9 dB SPL,并且在3具尸头的3侧颞骨中记录到转动的金刚钻接触鼓阶内骨膜时噪声值超过130 dB SPL.结论 耳显微手术中电钻转动所产生的噪声值较大,尤其在耳蜗开窗时转动的金刚钻接触鼓阶内骨膜时噪声值更大,足以引起噪声性耳聋.因此改进耳显微手术的技术、缩短内耳受噪声暴露的时间对降低噪声性耳聋的发生率至关重要.     

电钻噪声对豚鼠听功能的影响

目的 观察耳科电钻噪声对豚鼠听功能的影响。方法 将48只豚鼠耳后切口置于电钻噪声连续暴露30分钟和60分钟,应用听性脑干反应（ABR）记录技术评价电钻噪声暴露前后不同时间豚鼠听功能的变化。结果 电钻噪声暴露后各组动物ABR阈值、潜伏期和波间期较暴露前略有升高,但无明显差异（P＞0.05）。结论 耳科电钻就当前临床应用的强度、时间及范围内来看,其噪声强度尚不会影响豚鼠的听功能。     

耳科手术中电钻噪声所致内耳声损伤的防治

目的观察电钻性能的改善、缩短电钻噪声暴露时间和药物干预对电钻噪声所致内耳声损伤的防护作用.方法总结1995年前病例24例,1995年后92例.1995年后的患者随机分组,对照组44例,术后常规治疗;治疗组48例,术后除常规治疗外,同时给予ATP 80mg/d和辅酶A 100u/d静脉滴注,阿米三嗪30mg、萝巴新10mg(都可喜1片)2次/d口服,持续一周.将对照组分别与1995年前病例和1995年后同期病例中的治疗组比较.结果1995年前和1995年后的对照组4kHz平均骨导听力损失分别为18.96±3.22dB和16.02±4.62dB,差异显著;平均骨导听力损失大于15dB的发生率分别为33.3%(8/24例)和11.4%(5/44例),差异显著.1995年后病例的对照组和治疗组间的比较表明,2、4kHz和平均骨导听力下降程度对照组明显重于治疗组;2、4kHz和平均骨导听力下降大于15dB的例数在对照组显著多于治疗组.结论选用性能良好的电钻、尽量使用高转速、缩短电钻使用时间以及电钻噪声暴露后及时给予药物干预治疗可以显著的减轻术后感音神经性聋发生的可能性和严重程度.     

水杨酸钠对噪声性听力损失影响的实验

目的 观察水杨酸钠能否减轻噪声引起的听力损失。方法 将３６只健康且耳廓反射正常的花色豚鼠随机分为水杨酸钠实验组、生理盐水对照组、水杨酸钠对照组和噪声暴露组。噪声暴露采用１０５ｄＢ ＳＰＬ的４ＫＨｚ窄带噪声下暴露２ｈ,连续５ｄ。水杨酸钠给药为每天０．５ｇ／ｋｇ体重连续１０ｄ。由短声诱发听性脑干反应（ａｕｄｉｔｏｒｙ ｂｒａｉｎｓｔｅｍ ｒｅｓｐｏｎｓｅ,ＡＢＲ）,连续测试其阈值;而后取动物双侧耳蜗荧     

噪声对作业工人听觉影响的动态观察

目的　通过动态观察噪声环境作业工人的听力变化情况,进一步了解噪声性听力损害的发生发展规律。方法　对2012年1月～2014年12月在本院进行健康检查和听力测试的噪声作业工人的听力学资料,进行统计学分析。结果　随访的120例作业工人中,接触噪声时间2年22例,3～5年43例,6～10年55例。噪声作业2～10年工人中,6 kHz处出现听阈提高分别有15耳、49耳和81耳;4 kHz处出现听阈提高分别有19耳、71耳和89耳;3 kHz处出现听阈提高分别有3耳、31耳和75耳。6、4和3 kHz 3个频率处,接触噪声时 间长,听阈提高发生率多,差异有统计学意义。6、4和3 kHz3个频率处,发生噪声性聋例数比较,P 均＜0.05,差异有统计学意义;4 kHz与6 kHz,4 kHz与3 kHz,6 kHz与3 kHz两两比较,P 均＜0.01,差异有统计学意义。结论　噪声环境作业工人,接触噪声时间越长,越容易发生听力损害,听力损害程度越严重;各频率中4 kHz处最易出现噪声性聋,其次为6 kHz处。     

分泌性中耳炎骨导听阈改变的临床观察

目的 证实分泌性中耳炎可导致感音神经性聋,为临床干预分泌性中耳为,尤其是顽固的分泌性中耳炎提供依据。方法 115例（164耳）分泌性中耳炎患者治愈后或未愈患者病程中复查的纯音测听检查结果,记录0．5、1、2、4kHz频率骨导听阈,计算骨导听力损失dB数。分为单侧组66例,双侧组49例,将66例单耳患者的健耳作为对照组。结果 在164耳中,出现骨导听阈提高的共94耳（57．3％）。双侧组与单侧组骨导听力损失程度差异均无显著性（P＞0．05）;单侧组和双侧组患耳在同一频率的骨导听力损失程度相似,且平均的骨导听力损失程度也相似;同频率之间的骨导听力损失不同,4kHz的骨导听力损失为最大。结论 半数以上分泌性中耳为可以导致感音神经性耳聋。在不同频率间的骨导听力损失不同,以高频损失为主,并有向语言频率区过渡的趋势。     

伴有骨导下降的中耳疾病手术效果分析

目的探讨慢性中耳炎（胆脂瘤）伴有骨导下降患者经手术治疗后骨导听力的改善及其生理基础，并与耳硬化症术后“卡哈氏”切迹的变化进行对比分析。方法病例分二组，一是本院耳硬化症手术有一年以上完整听力随访资料的42例（57耳），平均年龄46．74岁（15～71岁），男8例（12耳），女34例（45耳）。二是同期中耳炎（含鼓室硬化、胆脂瘤、粘连性中耳炎）行听力重建并有一年以上随访资料者182例（200耳），平均年龄43．92岁（15～72岁），男79例（83耳），女103例（117耳）。统计二组术后骨导听力改善（至少一个频率减少10dB以上）的耳数和百分比，进行卡方统计分析。结果镫骨手术组57耳术后有13耳（22％）、中耳炎组200耳中有51耳（25．5％）符合条件。卡方检验，x^2=0．172〈x^2 0.005=3．8416，故P〉0．05，2组差异没有显示显著性意义。2个典型病例术后骨导明显改善。结论耳病变由于改变了振动频率，或增加了质量负荷，都可以影响骨导；中耳炎毒素也可以使内耳水肿，细胞变性甚至坏死。前者随着中耳病变解除，骨导可以恢复；后者需要尽早治疗，部分可能挽救。     

以听力突然下降为特征的分泌性中耳炎（附24例报告）

目的：提高对以听力突然下降为特征的分泌性中耳炎的确诊率。方法：回顾性分析24例（28耳）以听力突然下降为特征的分泌性中耳炎的临床资料,结果：11例患者被误诊或漏诊,各频率的平均气导阈值在60．2－66．5dBHL,平均骨导阈值在40．5－58．6dBHL,听力图示感音神经性聋9耳,混合性聋19耳,鼓室压图为B型,治疗后听力明显改善,结论,鼓室积液影响圆窗及卵圆窗间的相位差,导致听力突下降,它们的听力图无特征,并对产生误诊的原因进行了讨论。     

儿童分泌性中耳炎致骨导听力下降的临床特征分析

目的 探讨儿童分泌性中耳炎致骨导听力下降的特点、病因和预后.方法 回顾性分析75例(82耳)分泌性中耳炎患儿骨导听力下降的临床资料,并对其发病年龄、病程、积液性质和积液量与骨导听阈的关系进行观察.结果 75例患儿(82耳)骨导听力下降,平均骨导阈值在2.0 kHz和4.0kHz处增高最明显.骨导听阈与病程和积液性质显著相关(P＜0.01或P＜0.05),与年龄、积液量无关.75例患儿均采取鼓膜切开置管术和(或)腺样体切除术,术后给予药物治疗.随访6月,听力恢复正常者76耳,气导听阈下降但骨导听阈无改善者6耳.结论 分泌性中耳炎可导致儿童骨导阈值增高,是导致儿童耳聋的危险因素之一,及早干预可避免病情发展.     

分泌性中耳炎骨导听阈改变的临床观察

目的证实分泌性中耳炎可导致感音神经性聋,为临床干预分泌性中耳炎,尤其是顽固的分泌性中耳炎提供依据.方法115例(164耳)分泌性中耳炎患者治愈后或未愈患者病程中复查的纯音测听检查结果,记录0.5、1、2、4kHz频率骨导听阈,计算骨导听力损失dB数.分为单侧组66例,双侧组49例,将66例单耳患者的健耳作为对照组.结果在164耳中,出现骨导听阈提高的共94耳(57.3%).双侧组与单侧组骨导听力损失程度差异均无显著性(P>0.05);单侧组和双侧组患耳在同一频率的骨导听力损失程度相似,且平均的骨导听力损失程度也相似;不同频率之间的骨导听力损失不同,4kHz的骨导听力损失为最大.结论半数以上分泌性中耳炎可以导致感音神经性聋.在不同频率间的骨导听力损失不同,以高频损失为主,并有向语言频率区过渡的趋势.     

Surgical and audiological results of bone-anchored hearing aids: comparison of two surgical techniques

IntroductionThe bone-anchored hearing system has become the most viable treatment option for subjects with conductive or mixed hearing loss, who are unable to benefit from conventional hearing aids or middle ear surgery.ObjectiveTo compare the surgical and audiological outcomes between the minimally-invasive Ponto surgery and a linear incision with soft tissue preservation techniques in bone-anchored hearing system recipients.MethodsA retrospective study was carried out from January 2017 to June 2018. Forty-two adult patients eligible for unilateral bone-anchored hearing system surgery with the Ponto system were included in the study. The implant and abutment lengths used varied from 3 to 4 mm and from 6 to 14 mm, according to the bone and skin thickness of the participants, respectively.ResultsTwenty-two surgeries were performed using the minimally invasive Ponto surgery technique (52.4%) and 20 (47.6%) using the linear incision. The mean age of the subjects implanted with minimally invasive Ponto surgery and linear incision techniques were 42.0 and 33.3 years old, respectively. Ten male (45,5%) and 14 (70%) female patients were implanted using minimally invasive Ponto surgery and the linear incision techniques, respectively. There were no differences between pure tone audiometric thresholds and monosyllabic word recognition scores of the subjects, when comparing both surgical techniques. The minimally invasive Ponto surgery technique significantly reduced the surgical time compared to the linear incision technique. There were no differences between both surgical techniques for skin-related complications; (Holgers 3 and 4) which occurred in 18.8% for MIPS and in 25% for linear incision. Subjects included in the minimally invasive Ponto surgery technique group showed a superior cosmetic outcome, with no surgical scar or additional sutures.ConclusionThe surgical and audiological outcomes were satisfactory and were not correlated to the surgical technique selected in all subjects. When compared to the linear incision, the minimally invasive Ponto surgery technique showed reduced surgical time and superior esthetic outcomes in the postoperative follow-up.     

Magnesium levels in middle ear fluids and sera in otitis media with effusion

Summary Middle ear fluids (MEE) and matched sera (S) were obtained from 50 patients with serous otitis media and magnesium levels were measured to determine if magnesium concentration was distinctly varied in otitis media with effusion (OME). The MEE/S ratio was considerably raised along with transient sensory hearing loss in chronic OME when compared with acute OME. The higher magnesium level found in the MEE implies that it is probably produced locally by the middle ear mucosa and may contribute to the hearing loss found. We also regard the MEE/S ratio as a prognostic factor in OME. Correspondence to: W. L. Yue     

Hearing screening and middle ear measures in American Indian infants and toddlers

American Indian children have three times the rate of otitis media compared to the general population, yet prospective cohort studies of OME and hearing loss have not been previously reported in American Indian infants. Between 1997 and 2003, a cohort of 421 infants was enrolled at birth from Minnesota American Indian reservations and an urban clinic and followed to age 2 years. This study reports OAE hearing screening results related to OME diagnoses, as well as risk for recurrent hearing screening failure and OME in American Indian infants and children. METHODS: Infants were prospectively assessed at regular intervals with pneumatic otoscopy, distortion product otoacoustic emissions, and tympanometry by nurses who were trained in all procedures and validated on pneumatic otoscopy. RESULTS: In the newborn period, 23.5% of infants failed hearing screening in at least one ear. Hearing screening failures increased to 29.9% from 2 to 5 months of age. Technical fail results due to excessive noise occurred frequently in infants 6-24 months of age, making interpretation of true pass and fail rates questionable in older infants. OAE test result was associated with OM diagnosis, and this relationship strengthened with age, with the strongest association above 6 months of age. CONCLUSIONS: A high rate of hearing screening failures occurred among American Indian infants in the first 5 months of age, and was significantly associated with a correspondingly high rate of otitis media. Only one infant out of 366 was identified with sensorineural hearing loss, thus essentially all of the hearing screening failures reflected either a middle ear origin or other temporary problems. OAE screening provided a valuable hearing screening measure in this population at high risk for recurrent otitis media, but due to excessive noise in infants 6 months and older, practical use of OAE screening is limited. Use of behavioral assessment is needed after 6 months of age, when high rates of OME persist in this population. Increased efforts to develop public and medical education, as well as screening, diagnosis and treatment programs are needed to detect and decrease recurrent OME in American Indian infants and children.     

Hearing loss among prison inmates in India — a pilot study

Aims  This study was done to assess the pattern of hearing loss and the types of ear diseases causing hearing loss among prisoners in an Indian prison. Materials and methods  A total of 102 inmates were studied by subjecting them to a complete ENT evaluation and pure tone audiometry. Results  Seventy inmates had normal bilateral peripheral hearing sensitivity while 32 had some degree of hearing impairment. Almost 50% of the hearing loss among the inmates was found to be sensorineural. Conclusion  This study supports earlier reports of high incidence of hearing loss among prison inmates. The majority with sensorineural hearing loss were in the younger age group but since this study was not designed to determine the cause or risk factors, this cannot be commented upon. Infective ear diseases were found to be a significant etiological factor for conductive hearing loss.     

高位颈静脉球及术中出血的处理

目的：研究慢性中耳炎行鼓室成形术的患者高位颈静脉球（HJB）的发生率及HJB裸露并发术中破裂出血的处理。方法：对2005年1月～2006年8月287例慢性中耳炎行鼓室成形术的患者进行回顾性研究,结合高分辨率CT（HRCT）所见及术中处理加以分析。结果：287例慢性中耳炎患者中,HRCT检查发现HJB65例,左侧14例,右侧31例,双侧20例。术中发现颈静脉球顶部骨壁缺损5例,其中1例发生颈静脉球出血,占0．35％（1／287）。以胶原蛋白海绵片封闭静脉裂口,再以合适大小颞肌肌瓣填压后出血控制效果好。发生颈静脉球出血者经止血后,顺利完成了清除病灶、听骨链重建等全部手术步骤。结论：鼓室成形术术前需注意颈静脉球情况,手术中遇到HJB,尤其在颈静脉球与下鼓室间骨壁缺损时易发生颈静脉破裂出血时,颞肌肌瓣及胶原蛋白海绵片是较好的止血材料,同时短暂控制性低血压及术中冷静、及时、恰当的处理也是减少出血、保证安全的重要措施,并可继续完成既定手术。