95例镫骨畸形及耳硬化症的手术体会

目的:探讨鼓膜完整、咽鼓管通畅的传导性聋患者之镫骨手术的疗效。方法:回顾性分析95例鼓膜 完整、咽鼓管通畅的传导性聋的镫骨手术资料,比较耳硬化症、单纯中耳畸形、外耳道狭窄畸形之镫骨 卵圆窗外 科治疗的效果。结果:术后4周听阈均值显示:利用砧骨的卵圆窗开窗术优于砧骨 镫骨底板连接术(P<0.05); 3组中外耳道狭窄畸形优于耳硬化症及单纯中耳畸形组(P<0.05);生理性镫骨底板切除术与利用砧骨的卵圆 窗开窗术差异无统计学意义。随访1～3年,除镫骨撼动术(8/14)的听阈均值又同于术前水平外,其余均保持术 后近期听力水平。结论:镫骨手术应用于镫骨 卵圆窗畸形病例时有别于耳硬化症而有其特殊性     

晚期耳硬化症CO2激光辅助镫骨开窗术疗效的初步观察

目的　探讨CO2激光辅助镫骨开窗人工镫骨植入术治疗晚期耳硬化症的效果。方法　2010年1月~2014年1月间15例（16耳）临床确诊为晚期耳硬化症的患者在我科接受了CO2激光辅助镫骨开窗人工镫骨植入术,术前言语频率平均气导听阈70.21 dB HL,平均骨导听阈38.49 dB HL,平均气骨导差（air conduction-bone conduction gap,ABG）31.72 dB HL,所有病例术后随访超过半年。结果　术后半年言语频率平均气导听阈 43.7 dB HL,平均骨导听阈28.95 dB HL,平均气骨导差14.75 dB HL,ABG≤20 dB者9耳,占比56.3%,ABG闭合≤10 dB者6耳,占比37.5%。无一例术后出现顽固性眩晕、感音神经性聋及面瘫等严重并发症。结论  CO2激光辅助技术降低了镫骨开窗手术严重并发症的几率,多数患者术后听力明显提高,是一种安全、实用、相对经济的选择。     

镫骨切除术和镫骨钻孔术250例比较

33年的镫骨切除术和镫骨钻孔术250例比较,其中152例为镫骨足板切除,脂肪及金属丝赝复物重建;98例为镫骨钻孔特氟隆活塞重建,镫骨钻孔采用小开窗法,用人工或低速钻在足板后上方钻直径为5～6mm的小孔,安放直径为4mm的特氟隆活塞,再用脂肪封闭卵圆窗。250例手术中有33个患者为双耳手术。局麻、大多数用耳内切口,少数为耳前切口。术后3～6个月听力检查,并随访1年。经术前术后气骨导差距、气传导及语言接受率检查发现:术后气骨导差距在10dB以内者脂肪金属丝组占95%,其余5%在11～20dB;特氟隆活     

外中耳畸形与传导性耳聋的相关性

目的 探求不同类型的外中耳畸形与传导性耳聋的相关性,以利于术前术式的选择。 方法 180例外中耳畸形通过手术证实分为3组听骨异常,并与术前纯音听阈均值(dB HL)经t检验以观其相关性。 结果 1.外耳道狭窄组中的上鼓室狭窄(锤砧骨活动不良)与镫骨卵圆窗畸形有统计学差异(P<0.05);2.外耳道狭窄组与外耳道骨性闭锁组间有微弱差异,根据术前外中耳畸形的听阈均值尚不能准确预估其听骨畸形之类型,但对外耳道狭窄组的听阈均值则有参考意义。结论 外中耳畸形其听力损失关键不仅在于听骨链完整与否而更应强调中耳畸形所涉及部位如镫骨固定或缺如,卵圆窗封闭等。     

鼓室成形的内耳开窗术:恢复听力的一种辅助方法

本文研究单侧或双侧多次分期鼓室成形术失败的病例,包括鼓室成形术后听力检查仍然不好,缺少听骨链支持的前庭窗手术,前庭窗有纤维性或硬化性病灶,以及严重中耳炎前庭窗、圆窗、后鼓室、鼓隐窝及咽鼓管口感染者。唯一方法是先施行乳突鼓室凿开术,彻底清除病灶,然后为了重建有效听力,分期施行Lempert的水平半规管的迷路开窗术。乳突鼓室凿开术:第一期手术即作者1960年改良的Lempert乳突鼓室凿开术与外耳道耳甲软骨成形术。经耳内或耳后径路的自身闭塞的无移植物乳突根治术腔,可以达到永久性干耳。和Lempert 1949年所描述相同,所有感染病灶均应除去。本手术将颞骨气房结构的内容物彻底清除,使水平半规管轮廓露出,将外耳道底削低至下鼓室底平面,使圆窗、前庭窗区彻底暴露,从鼓膜张肌管部切去感染的鼓膜张肌腱。这种无移植物自行缩小的乳突腔,自行堵塞咽鼓管口。因此手术后术腔变成充满蹼样纤维组     

单纯先天性听骨链畸形的临床诊断及治疗

目的:探讨单纯先天性听骨链畸形的诊断及治疗方法.方法:回顾性分析2005-06-2009-08诊治的4例单纯先天性听骨链畸形病例,并进行疗效分析.4例患者均行鼓室探查及听骨链重建术,术后随访1~4年不等,通过检测语言频率(0.5、1.0、2.0 kHz),语言频率气导听阈提高15 dB以上为手术成功标准.结果:术中发现 3例为砧骨畸形,其中2例伴有镫骨底板上结构缺如,镫骨底板固定,1例砧骨缺如.听力重建后3例患者听力明显提高,术后随访期间言语频率气导听阈平均提高47 dB,骨导听阈无明显改变,1例听力无提高.所有病例均无耳鸣、眩晕、面瘫等并发症发生.结论:对不伴有外耳畸形的先天性传导性聋患者,应高度怀疑先天性听骨链畸形,鼓室探查术可确诊,听骨链重建术可提高听力.     

CO_2激光辅助MVP技术治疗先天性听骨链畸形结果分析

目的应用CO_2激光辅助Malleovestibulopexy(MVP)技术治疗先天性听骨链畸形并观察其疗效。方法10例(14耳)先天性听骨链畸形患者,其中6例为单侧传导性聋,4例为双侧传导性聋。14耳均行CO_2激光辅助下MVP技术重建听力。通过术前、术后气骨导差比较疗效。手术关键:(1)术中保留锤骨柄完整;(2)以CO_2激光行镫骨底板或卵圆窗开窗,直径约为0.6mm;(3)人工听骨置入小窗,并固定于锤骨柄靠近锤骨颈处。结果 14耳先天性听骨链畸形患者中,13例均为镫骨底板固定,1例为前庭窗封闭;其中6耳为砧骨长脚缺失,镫骨上部结构缺失;1耳为砧骨豆状突缺失、镫骨上部结构缺失;1耳为听骨链完整、连接,锤砧关节不活动,砧骨、固定;1耳为听骨链完整、连接,锤砧关节活动,砧骨长脚倾斜度增大;1耳为砧骨缺如,镫骨上结构缺失;2耳为砧骨后倾,长脚压于面神经表面,镫骨上部结构缺失1耳为砧骨长脚缺失,砧骨与镫骨间膜性连接,镫骨上结构存在,镫骨底板固定;还有1耳为砧骨长脚缺失、镫骨上结构畸形伴先天性鼓室胆脂瘤,镫骨底板固定。术前言语频率平均气骨导差为46.5dB,术后言语频率气骨导差平均值为9.71dB,较术前缩小36.79dB(P<0.01);术后患者无恶心、呕吐及明显眩晕。结论镫骨底板固定或封闭伴砧骨缺如或病变的先天性听骨链畸形,采用CO_2激光辅助MVP技术可以提高听力,其疗效显著、安全系数高、术后反应轻微。     

CO2激光辅助Fisch人工镫骨技术治疗耳硬化症疗效观察

目的探讨CO2激光辅助Fisch人工镫骨技术治疗耳硬化症的疗效。方法2001年10月至2003年12月间,30名临床确诊为耳硬化症的患者在上海交通大学附属第六人民医院接受CO2激光辅助Fisch人工镫骨技术治疗,术前言语频率平均气导听阈为63.33dB HL,气骨导差为24.5~50.25dB,平均为36dB。全部病例随访12个月以上,平均随访18个月。结果24例患者于术后6个月复查听力,言语频率平均气导听阈为26.82dB HL,气骨导差≤15dB者23例,占95.83%;气骨导差≤10dB者21例,占87.5%;平均气骨导差为8.50dB。30例患者术后12个月时复查听力,言语频率平均气导听阈为27.52dB HL,气骨导差≤15dB者28例,占93.33%;气骨导差≤10dB者25例,占83.33%;平均气骨导差为8.60dB。术后半年与一年复查听力结果相比,差异无统计学意义(P>0.05)。结论CO2激光辅助Fisch人工镫骨技术治疗耳硬化症疗效显著,术后反应轻,远期疗效稳定,是治疗耳硬化症的可靠技术。     

先天性镫骨畸形手术治疗的临床分析

目的分析先天性镫骨畸形的诊断和听骨链重建的方法和疗效。方法2000年1月—2005年10月间住院治疗的19例(21耳)先天性镫骨畸形病人,术前检查语言频率(0.5～2kHz)气导听力平均为62.9±16.6dBHL,气骨导差平均为46.4±15.9dBHL。依术中镫骨畸形的类型和足板情况采用相应的听骨链重建术:10耳足板固定或卵圆窗闭锁作钻孔活塞术,2耳行镫骨撼动、提高术;4耳镫骨上结构全缺如但足板活动,用自体骨片尖枪柱立于足板,并用鼓索神经或鼓膜紧张部弹压固定;5耳足弓部分或全部缺失伴或不伴砧骨长脚部分缺失的病例,用自体骨片作成“Y”叉形,置于砧骨长脚及底板之间。结果参照Teunissen(1993)分型,其中I型8耳,II型4耳,III型8耳,IV型1耳。术后语言频率气骨导差缩小大于15dB或气导听阈小于40dBHL为手术有效标准,计有18耳,有效率为85.7%(18/21),术后语言频率听力与术前相比在统计学上差异有极显著意义。四种不同手术技术的疗效无明显差别。结论根据镫骨畸形的类型和足板是否活动采取相应的听骨链重建术,既安全又可取得良好的效果。     

第二耳镫骨切除术并发症

第一耳镫骨切除术后听力良好,第二耳是否要手术,意见不一。Schuknecht(1971)认为双耳听力有利而须手术,Ludman与Grant(1973)等认为双耳镫骨切除术缺乏长期疗效的基础,而Smyth等(1975)发现术后前庭损伤可致残废。本文报告50例双耳耳硬化症均先后在2年左右间隔时间因患者要求作了第二耳镫骨切除术。其中男37,女13,年龄20～40岁者33例;两卵圆窗病变对称者20例,均采用特氟隆活塞(0.8mm)法。30例随访一年以上,有5例达五年。全部100耳以术后语音频率(0.5～2KHz)气骨导差距在15dB以内者为成功,计81耳,15dB以上者为失败,计19耳,其中有5耳为感音神经聋。属第二     

先天性双耳镫骨及卵圆窗缺如的诊断和治疗

OBJECTIVE: To date, bilateral congenital absence of stapes and oval window in two members (elder brother and younger sister) of a family has not been reported previously in the literature to our knowledge. The etiology, diagnosis and management are hereby introduced and discussed. METHODS: The diagnosis was based on history, audiological examinations, high resolution CT scanning and/or the operation. The modified Lempert's fenestration operation of the horizontal semicircular canal was performed on one ear each of the elder brother and the younger sister. RESULTS: Postoperative hearing threshold was 25 dB for speech frequencies with a gain of 47dB for the elder brother, and hearing threshold of 28 dB with a gain of 52 dB for the younger sister. Following up one to eight years individually showed that their hearing gains were steady. CONCLUSION: Patients' parents are relatives of first cousin and have two sons and one daughter. However, there are two family members suffered from bilateral congenital absence of stapes and oval window, and these malformations might be related to inheritance. Good bone conduction and Carhart's notches revealed bilaterally in the patients' audiograms. These are the important indications for diagnosis of this disease. The modified Lempert's fenestration operation of the horizontal semicircular canal is a safe and good choice for treatment.     

Facial nerve and stapes anomaly: a case report

A 17-year-old white female presented with a unilateral conductive hearing loss which had been present since birth. The external auditory canal and tympanic membrane appeared to be normal, and the manubrium was mobile. Exploratory tympanotomy revealed the horizontal segment of the facial nerve to be dehiscent and displaced inferiorly, thus occupying the oval window niche. The nerve was interposed between a rudimentary crural arch and a fixed stapes footplate. The malleus and incus were normal. A burr hole was made into the vestibule at the superior edge of the oval window; however the utricular macula was encountered, and further attempts at reconstruction were discarded. Other procedures, such as rerouting the facial nerve in association with stapedectomy or fenestration of the lateral semicircular canal, were considered to be inappropriate for this case of unilateral deafness.     

Bifenestration--a hearing-improving operation in severe ear malformations

Bifenestration as an operation for hearing improvement is described in a case of congenital absence of the oval and round window. Besides the classical fenestration of the horizontal semicircular duct, an artificial round window was performed in the middle ear. Due to the acoustic resonance of the mastoid cavity, the resulting conductive loss in the higher frequencies was only 20-30 dB.     

Isolated congenital stapes ankylosis: surgical results in 32 ears and a review of the literature

Isolated congenital stapes ankylosis is described in 32 operated ears from 28 patients. In 27 ears, a regular stapedectomy was performed. In the remaining 5 ears, 2 had stapes gushers, 2 had bony stapedial tendons, and 1 had an aberrant facial nerve crossing the oval window. The average individual hearing gain was 20 dB. The mean hearing gain for the 24 successful stapedectomies was 29 dB. In 24 of 32 ears (75%), an essential hearing gain of at least 15 dB Fletcher's index hearing threshold could be achieved. A Fletcher's index not exceeding 30 dB could be achieved in 19 of 32 ears (60%), in spite of several cases with a sensorineural component in the hearing loss. A review of the literature and overview of longer series with isolated congenital stapes ankylosis is presented.     

Selective resection of the semicircular canals of rabbits with preservation of hearing.

The goal of this investigation was to develop a method of surgical removal of the semicircular canals of the rabbit without induction of auditory impairment. Four different surgical techniques were utilized: i) fenestration of the lateral semicircular canal; ii) fibrin glue perfusion of the canal following fenestration; iii) removal of the lateral semicircular canal by drilling after fenestration and fibrin glue perfusion, and iv) removal of all three canals after fenestration and fibrin gluing. Brainstem auditory potentials were recorded repeatedly for up to 3 months after operation and demonstrated preservation of hearing in all rabbits in the first group and in 78% of the second group. In the third group the potentials could be recorded in 67% of the animals and showed a 20 dB deterioration of hearing. After removal of all three semicircular canals residual hearing could be recorded in 50% of the rabbits. These animals regularly showed a 30-40 dB deterioration of hearing. A precise microsurgical technique using fibrin glue and bone chips for interruption of the peri- and endolymph flow proved crucial for hearing preservation.     

Two cases of Tullio phenomenon in which oval and round window reinforcement surgery was effective

AimTo report the effect of oval and round window reinforcement surgery performed in two patients with the Tullio phenomenon. Case 1: A male with bilateral superior canal dehiscence syndrome. Downbeat nystagmus with leftward horizontal eye movement was recorded in an electronystagmogram using a pure-tone sound of 110 dB at 2000 or 4000 Hz in the right ear. Case 2: A female who had undergone stapes surgery. Computed tomography revealed an ossicular prosthesis in the vestibule. An audiogram indicated mild to moderate hearing impairment in the right ear. Leftward horizontal nystagmus was recorded in an electronystagmogram using a pure-tone sound of 110 dB at 500 or 1000 Hz in the right ear. Surgical findings indicated that the prosthesis was inserted deep into the oval window, which was closed with thin connective tissue.OutcomesAfter oval and round window reinforcement surgery was performed in the right ear, and loud, pure-tone sounds elicited neither nystagmus nor dizziness in either patient.     

Congenital aural atresia A new subclassification and surgical management

The four surgical methods currently in use to improve hearing in patients with congenital aural atresia are (i) fenestration of the lateral semicircular canal, (ii) type III tympanoplasty, (iii) canal plasty and (iv) canal plasty with homograft tympanoplasty. Because the surgery is difficult and the functional results are not always good, the criteria for surgery are also influenced as to whether the anomaly is unilateral or bilateral and what the cosmetic goal is. When aural rehablitation and cosmetic surgery are contemplated, co-ordinated planning by the otological and plastic surgeon is necessary to attain the best end result. Of the 36 ears with a type II anomaly operated on at the University of Nijmegen between 1972 and 1983 by the technique of canal plasty, the average hearing gain was 20 db, with 18 patients having a 35 dB or better air conduction threshold. The functional results seem to be related to the degree of malformation involved. Classification of the malformations has proved to be useful in discussing the surgical results.     

Congenital aural atresia. A new subclassification and surgical management

The four surgical methods currently in use to improve hearing in patients with congenital aural atresia are (i) fenestration of the lateral semicircular canal, (ii) type III tympanoplasty, (iii) canal plasty and (iv) canal plasty with homograft tympanoplasty. Because the surgery is difficult and the functional results are not always good, the criteria for surgery are also influenced as to whether the anomaly is unilateral or bilateral and what the cosmetic goal is. When aural rehabilitation and cosmetic surgery are contemplated, co-ordinated planning by the otological and plastic surgeon is necessary to attain the best end result. Of the 36 ears with a type II anomaly operated on at the University of Nijmegen between 1972 and 1983 by the technique of canal plasty, the average hearing gain was 20 db, with 18 patients having a 35 dB or better air conduction threshold. The functional results seem to be related to the degree of malformation involved. Classification of the malformations has proved to be useful in discussing the surgical results.     

The active middle ear implant for the rehabilitation of sensorineural, mixed and conductive hearing losses

Active middle ear implants, such as the Vibrant Soundbridge, are used as an important part in the rehabilitation of sensorineural, conductive hearing, or mixed hearing loss. The attachment of the Vibrant Soundbridge at the round window and the usage of the Vibroplasty couplers strongly expanded the application of the Vibrant Soundbridge.The Vibrant Soundbridge is developed for patients who have an intolerance to hearing aids and a moderate to profound sensorineural hearing loss. The VSB also provides an optimal solution for patients with failed middle ear reconstructions or patients with atresia. To capture the improvement with the VSB Implant with different hearing losses a literature analysis was conducted. The functional gain was analyzed for 107 patients with conductive hearing loss and for 214 patients with sensorineural hearing loss out of 14 studies.Patients with conductive and mixed hearing loss resulted in a functional gain from 30 to 58?dB with the VSB. Patients with a pure sensorineural hearing loss showed a functional gain of 23-30?dB. The VSB bone conduction threshold shift was analyzed for all studies conducted in the years between 2000 and 2009. In 11 of the 16 studies there was no significant (p=0.05) change found. In 5 studies, the pre- to post-surgical bone conduction threshold shift was less than 10?dB. None of these studies measured a threshold shift of more than 10?dB.The flexible attachment at either the long process of the incus with sensorineural hearing loss, with an conductive hearing loss at the round window or the use of Vibroplasty couplers at the oval window, head of the stapes or round window makes the VSB an extremely versatile instrument. If patients can't wear conventional hearing aids, had failed middle ear reconstructions or atresia the VSB presents, due to the significant hearing improvement in any type of hearing loss, an ideal solution.     

Fenestration of the horizontal semicircular canal in congenital conductive deafness

Fenestration of the horizontal semicircular canal enables the otologic surgeon to restore hearing in those patients with congenital conductive deafness who are not candidates for stapedectomy, ossicular reconstruction, or tympanoplasty. Since the development of stapedectomy, much of the finesse technique of fenestration surgery has been lost, and many otologic surgeons today are unfamiliar with the fenestration operation. The surgical technique for creating a permanently patent fenestra in the horizontal semicircular canal is described. The causes of failure in fenestration surgery are reviewed. Thirty-three patients who have undergone fenestration for congenital conductive deafness over a 30-year period, and 100 patients who underwent fenestration for otosclerosis in 1950, are reviewed to demonstrate patient selection and the efficacy of this operation in establishing long-term hearing improvement.