座舱压力调节器（CTQ-11）的医学分析

座舱压力调节器(CTQ-11)是在运输机(运-八)上调节座舱压力的一种控制机构。当飞机起降达到一定的高度时，座舱压力调节出现的一种超调的压力变化。为此，本文通过模拟凹线压力进一步阐明这种压力对中耳的影响。本研究模拟了四种压力变化事(0．25kPa/s、0．40kPa／s、0．49kPa／s和0.62kPa／s)及六种总压值(7．41kPa／28．8s、9．70kPa／37．0s、15．06kPa／57．5s、19．06kPa/47．0s、20．39kPa／41．3s和21．06kPa／33．7s)。凹线压力处于增压过程。中耳压差大约达到3．99kPa以上的压力时，多数受试者出现压耳。随着压力不断增加，压耳加重。积累压力达到15.06kPa时，鼓膜充血所占的比例可以达到80％，但鼓膜充血程度并不严重。听阈功能下降，最多可以降低15dB。听力下降均属传导性的。随着增压的解除或症状的消失，听力恢复正常。本研究结果对于分析与评定有关座舱压力调节机构，有一定的实际意义。     

歼击机座舱噪声对飞行员听力的影响

为定量地描述飞机噪声对飞行员听力损伤程度,测量了歼击机座舱内的噪声,均在１１０ｄＢＡ左右,研究了飞机噪声引起的暂时性听力阈移（ＴＴＳ）,发现ＴＴＳ２下降明显,有的频率高达１３ｄＢ。其恢复过程的特点是低频和语频部分较快,而高频部分较慢,检查了１６６名歼击机飞行员的听力,有轻度以上高频听力损失者达５３．６％,而且是随着飞行时间增加而加重的。由此说明飞机座舱噪声可以引起飞行员的永久性听力阈值,其损伤特点     

810nm和650nm半导体激光治疗仪治疗急性化脓性中耳炎215例

目的:观察810 nm和650 nm半导体激光治疗仪治疗急性中耳炎的效果。方法 :急性化脓性中耳炎患者215例,耳痛患者198例,无耳痛患者17例;耳闷胀感58例,无耳闷胀感157例;听力下降23例,无听力下降192例。采用810 nm和650 nm半导体激光连续治疗7～10 d为一个疗程,治疗1～2个疗程,对耳部疼痛程度,耳闷胀感程度,听力下降情况进行观察。结果:经治疗后耳痛167例全部消失,缓解31例;耳闷胀感消失55例,无效3例;听力恢复20例,听力无恢复但稳定3例。结论:810 nm和650 nm半导体激光治疗仪治疗急性中耳炎有效,能迅速减轻疼痛。     

高压氧治疗并发中耳气压伤98例的临床特征及对策

目的探讨高压氧治疗过程中并发中耳气压伤的临床特征及护理策略。方法对98例高压氧治疗过程中并发中耳气压伤患者的临床表现、发生时机及原因、治疗和预后进行回顾性分析,总结护理干预要点。结果 98例患者主要表现为耳堵48例（49.0%）、耳痛22例（22.4%）、耳鸣16例（16.3%）、耳胀8例（8.2%）,头晕、头痛4例（4.1%）。其中听力暂时性减退56例（57.1%）,消失6例（6.1%）。耳镜检查发现鼓膜充血66例（67.3%）,鼓室内有积液或积血12例（12.3%）,鼓膜破裂或穿孔6例（6.2%）。发生于升压过程中90例（91.8%）,减压过程中8例（8.2%）。发病原因主要包括咽鼓管不畅或堵塞68例（69.4%）,调压不当22例（22.4%）,高压氧舱操作不当8例（6.2%）。结论高压氧治疗过程中并发中耳气压伤主要表现为耳堵、耳痛、耳鸣、鼓膜充血等;91.8%的发生于升压过程中,69.4%的发病原因是咽鼓管不畅或堵塞,其他为操作失误引起。因此,高压氧治疗过程应严格操作规范,严密观察,预防和减少中耳气压伤的发生。     

飞机座舱噪声与飞行学员听力的关系

为了弄清教练机座舱噪声与飞行学员听力的关系，笔者对初教-6和歼教-5飞机飞行中座舱内的噪声和飞行学员飞行前的基础听力，以及在这两种飞机上各飞行一年后的听力进行了测定。结果表明，这两种飞机座舱噪声都在98dB(A)左右，学员在其中各飞行一年后，听力无明显变化。原有轻度甚至中度高额听力损失的学员，飞行两年后高频听力未见恶亿。这项结果为“空军招收飞行学员听力标准”中放宽高频部分的听力值提供了科学依据。     

爆震时豚鼠听器损伤的病理变化

动物试验证明,火炮发射后,爆震在近距离内可引起较重的中耳及耳蜗损伤。30只豚鼠60耳中,鼓膜破裂者57耳;听骨链破坏者32耳;中耳积血或有渗出液者47耳;轻度耳蜗病变者3耳,中度者41耳,重度者16耳。耳蜗的损伤主要在耳蜗的第1、2周,其中21耳病变波及第3、4周。上述结果与临床检查炮震后听力损伤者的听力曲线相符合。     

先天性中耳畸形的临床听力学研究

目的:探讨先天性中耳畸形的临床听力学特征。方法:对经手术证实为单纯先天性中耳畸形104例(140耳)进行回顾性分析。术前听力评估依患者的配合情况择用纯音测听、声阻抗或听觉脑干反应测试。分别统计各组的语言频率(0.5、1、2kHz)和高频(>2kHz)的听力结果,分析组间差异。结果:先天性中耳畸形在语言频率上听力损失无明显差异,而在高频听力损失上存在显著差异(P<0.05),且先天性中耳畸形累及耳蜗结构时可存在骨导下降及混合性耳聋。结论:先天性中耳畸形依累及范围和程度,表现为不同程度的传导性或混合性耳聋。     

高压氧治疗合并中耳气压伤20例临床分析及护理

中耳气压伤是高压氧治疗中的常见并发症。1994年1月～12月在我科做高压氧治疗者557人,发生中耳气压伤者36人,占6.46％。36例中资料较完整的20例,现报告如下。1 临床资料 本组男16例、女4例,年龄18～60岁。气压伤双耳14例,单耳6例。原因:感冒、慢性鼻咽炎11例、咽鼓管调压不当6例、陈旧性中耳炎2例、外伤性鼓膜穿孔（已愈合）1例。20例均有耳痛、耳呜。经耳科检查鼓膜腔积液8例、鼓膜充血鼓膜内陷7例、鼓室内少量出血2例、鼓膜破裂3例。2 发生中耳气压伤的原因 加压时中耳腔内处于负压状态,当中耳内外压力差超过12.0kPa,肌肉将无力使咽鼓管开放。如咽鼓管调压不当可出现耳痛、耳鸣、耳聋、眩晕、恶心,甚至鼓膜破裂。咽鼓管调压不当的原因是:①不能正确做咽鼓管调压动作,如吞咽、咀嚼、闭嘴捏鼻鼓气等使咽鼓管肌肉收缩的方法;②意识不清或昏迷;③咽鼓管通气障碍,如上呼吸道感染、鼻窦炎、鼻甲肥大、息肉、肿瘤、咽鼓管肌张力不良、咽鼓管炎症、水肿等。     

中耳气压伤对听力的影响及其预防

在航空、潜水、高压氧治疗、快速上浮脱险等过程中均会经历中耳内外气压的变化,严重时会导致中耳气压伤,对从业者听力及相关军事、民用项目产生严重影响。笔者就中耳气压伤的发生机制、对听力的影响及其预防等方面的研究进行综述,为预防中耳气压伤提供参考及新的思路。     

直升机飞行员热负荷防护研究现状及前景

直升机座舱一般不密封,其内部微小气候直接受外界环境的影响波动较大,会使机组人员遇到各种不同温度的冷热负荷。我国南方处于热带和亚热带气候,常年平均气温高,日照时间长。夏季停放在地面的飞机座舱温度高达56℃;此外座舱的温度还受太阳辐射的影响,阳光通过舱盖大面积的透明有机玻璃直射到座舱内,可产生温室效应;随着各种机载设备的增加,电子设备工作时产生的大量热能也     

Middle ear pressure and symptoms after skydiving

OBJECTIVES: Altitude-related otic barotrauma and its symptoms have been identified from air-travel, scuba diving, and hyperbaric chambers, but not in skydiving. It is not known whether skydiving-related otic barotrauma could cause symptoms severe enough for medical attention or be implicated in skydiving-related accidents. This study assessed the effect of altitude change on middle ear pressures in skydivers by comparing changes in pressure before and after a skydive, pressure changes in those who developed middle ear symptoms vs. those who did not, and pressures in those who attempted equalization vs. not. METHODS: This prospective observational cohort enrolled skydivers on random days in Deland, FL. A tympanometer was used to measure middle ear pressures in decapascals (daPa) on the ground before and after skydiving. RESULTS: Average middle ear pressures in 69 subjects were significantly different before (-23.5 daPa) and after (-70.5 daPa) the skydive. There were 13 subjects (18.8%) who had middle ear symptoms after descent, but there were no statistically significant differences in ear pressure changes in those with (-57.5 daPa) and without (-44.2 daPa) symptoms after their jump. There was, however, a significant difference in pressure in those jumpers who did (-32.7 daPa) and did not (-75.7 daPa) equalize successfully after their jump. CONCLUSIONS: Rapid skydiving descent from high altitudes causes negative middle ear pressure changes. The ability to equalize ear pressures after a jump had a large impact on the change in ear pressure. However, the change in middle ear pressure was not associated with the presence of middle ear symptoms.     

中耳胆脂瘤开放式乳突切开鼓室成形术并发症分析

目的 分析中耳胆脂瘤开放式乳突切开鼓室成形术并发症发生情况,探讨发生原因.方法 回顾分析2007-02至2017-02随访的438例行开放式乳突切开鼓室成形术的中耳胆脂瘤患者术后并发症发生情况.结果 438例中耳胆脂瘤手术患者,常见的10种手术并发症为术后听力下降(15.8％)、外耳道狭窄(9.6％)、患侧味觉下降(7...     

鼓室置管治疗腭裂患者听力障碍的临床观察

目的　探讨伴分泌性中耳炎腭裂患者 ,采用鼓室置管术对中耳功能及听力损失的影响。方法　对 12 0例 ( 2 19耳 )患有分泌性中耳炎的腭裂患者 ,随机分为观察组 :腭裂修复 +鼓室置管术组 ;对照组 :单纯腭裂修复组。术后 6个月进行鼓室图 ,脑干听觉诱发电位检查。结果　中耳置管组术前术后V波反应阈值及轻中度听力损失有显著差异 (t =11 3 2 ,P <0 .0 1;χ2 =3 8 2 8,P <0 .0 0 1)。对照组术前术后V波反应阈值及轻中度听力损失均无显著差异 (t=1 2 4,P >0 .0 5 ;χ2 =2 46,P >0 .0 5 )。术前两组V波反应阈值及轻中度听力损失差异无显著性 (P>0 .0 5 ) ,术后两组V波反应阈值及轻中度听力损失差异有显著性 (t =12 86,P <0 .0 1;χ2 =10 12 ,P <0 .0 0 1)。中耳置管组术前术后鼓室图有显著差异 ( χ2 =40 75 ,P <0 .0 0 1) ;对照组术前术后鼓室图差异无显著性 ( χ2 =1 45 ,P >0 .0 5 )。术前两组鼓室图差异无显著性 ,术后两组鼓室图有显著差异 ( χ2 =2 0 76,P <0 .0 0 1)。结论　腭裂修复同时行鼓室置管有利于伴有分泌性中耳炎腭裂患者中耳功能改善 ,提高患者听力。     

中耳涎腺迷芽瘤1例并文献复习

目的总结中耳涎腺迷芽瘤的发病机制、临床特征、诊断及治疗。方法报道1例中耳涎腺迷芽瘤患者,并结合国内外相关文献进行分析。结果中耳涎腺迷芽瘤多考虑为先天发育异常所致;临床上多以单侧传导性耳聋为特征,伴有听骨链或面神经的异常或畸形;诊断需病理证实中耳内有正常涎腺组织存在;需手术治疗。结论中耳涎腺迷芽瘤较为罕见,为良性病变,术前诊断较为困难,术后病理检查可明确诊断。手术治疗应在保证不损伤面神经的前提下尽量完整切除,有条件的患者可行听力重建。     

CT of the temporal bone in achondroplasia

In an attempt to better define the changes affecting the temporal bone that might predispose achondroplastic dwarfs to otitis media, nine achondroplastic subjects who were evaluated for hearing loss underwent high-resolution CT scanning of the temporal bone. Comparisons were made with 10 nonachondroplastic subjects. A number of morphologic changes were seen, including (1) poor development of mastoid air cells, (2) foreshortening of the carotid canals, (3) narrowing of the skull base, (4) "towering" petrous ridges, and (5) relative "rotation" of the cochlea and other temporal bone structures. The most significant change was the rotational effect, which was more pronounced medially, resulting in an abnormal orientation of inner ear structures relative to middle ear structures and of middle ear structures relative to the external auditory canal. There was a notable lack of evidence for otitis media or its sequelae in any of the achondroplastic subjects. Audiograms were obtained in six of the nine achondroplastic subjects (two adults and four children). There was evidence of mixed hearing loss in the four children, but only of sensorineural hearing loss in the adults. We believe that the persistent hearing loss in achondroplasia is not due to sequelae of otitis media as some authors have suggested. Intrinsic vestibulocochlear changes below the limits of resolution of high-resolution CT scanning may be responsible.     

模拟轻潜水耳气压伤与内耳减压病实验研究

为研究６０ｍ轻潜水对内耳的影响,本实验以豚鼠为研究对象,开放左耳听泡,模拟６０ｍ潜水正常及快速减压,应用听生理学,形态学,活体微循环的研究方法证明：开放听泡避免耳气压伤后,中耳,内耳未见病理生理学改变,亦未见内耳微循环的血液流变学改变,提示在６０ｍ轻潜水的减压过程中,耳蜗,前庭功能的损害以耳气压伤为主,较少发生内耳减压病。     

不同气压变化速率对豚鼠耳气压伤的影响

为了解不同气压变化速率对中、内耳的影响，利用低压舱对40只豚鼠施以10种不同升、降速率（上升率／下降车为：20／20、20／100、50／20、50／100、100／20、100／100、150／20、150／100、200／20、200／100，m／s）的损伤实验。实验结果表明：前庭躯体反应的出现是因中耳腔的正压，而不是负压影响。咽鼓管机能不良和上升速率过快是本病的主要原因。下降速率增快可使鼓膜破裂数量增加，鼓膜的穿孔对避免内耳进一步损伤有积极作用，并且可因此减少发病率。圆窗膜和卵圆窗的损伤在本病中是较少发生的。变压性眩晕是一种伴随前庭终器明确病理改变的气压伤，并非一过性前庭功能失衡。     

Anomalous vessel in the middle ear: the role of CT and MR angiography

An 8-year-old child was examined because of conductive hearing loss with a retrotympanic mass on otoscopy. CT and MR angiography showed a large inferior tympanic artery traversing the hypotympanum and joining a thin, irregular internal carotid artery with a normal middle meningeal artery. These investigations, coupled with knowledge of the embryological development allowed a diagnosis of a complex vascular anomaly in the middle ear and avoided potential surgical complications. Received: 23 February 1998 Accepted: 7 March 1998     

原发性结外淋巴瘤在耳鼻及咽部的临床特点

目的 总结原发性结外淋巴瘤在耳、鼻及咽部的临床表现,以提高及时确诊率。方法 回顾性分析16例原发性结外淋巴瘤在耳、鼻及咽部的临床表现特点,特别是罕见的中耳淋巴瘤和少见的副鼻窦淋巴瘤的临床表现。结果 中耳淋巴瘤1例,以伴有疼痛的慢性分泌性中耳炎(传导性聋)、轻度面瘫为特点;扁桃体淋巴瘤7例,以咽异物感及单侧扁桃体肿大为特点;鼻及副鼻窦淋巴瘤2例,以血涕、鼻臭、下鼻甲黏膜粗糙,增厚为特点;鼻咽部淋巴瘤以血涕、头痛为特点;口咽部淋巴瘤以咽痛、发热、软腭溃疡、口臭为特点。结论 在发现耳、鼻及咽部病变时,掌握原发性结外淋巴瘤在耳、鼻及咽部的临床表现特点,及时行病理检查,是及时确诊的关键。     

The association of cleidocranial dysostosis with hearing loss.

Three new cases of cleidocranial dysostosis with hearing loss are reported in this paper. The significant points concerning this association are: (1) the hearing deficit is predominantly a middle ear conduction problem secondary to structural abnormalities of the ossicles; (2) there is sometimes a small bone conduction deficit indicating either a cochlear or an eighth nerve problem; (3) the middle ear hearing loss was corrected surgically in one reported case; (4) there is dense sclerosis of the temporal bone which makes a middle ear operation technically difficult; and (5) hearing loss with cleidocranial dysostosis may be more common than the number of cases in the literature suggests.