全耳廓再造术与听力重建术同步进行

为使先天性小耳畸形外耳道骨性闭锁患者同步取得增进听力并改善耳廓外形一举两得的双重效果，本组１５８例同步完成听力重建及耳廓再造术。结果：听力增进率１３２例。占８３．１％。全耳廓再造成活率１５５例，占９８．２％，耳廓外形优良１３７耳。认为在严格选择病例的情况下可获增进听力及良好外耳形态的效果。     

全耳廓再造术与听力重建术同步进行

为使先天性小耳畸形外耳道骨性闭锁患者同步取得增进听力并改善耳廓外形一举两得的双重效果，本组１５８例（１６０耳）同步完成听力重建及耳廓再造术。结果：听力增进率（２０～４５ｄＢ）１３２例（１３３耳），占８３．１％。全耳廓再造成活率１５５例（１５７耳），占９８．２％，耳廓外形优良（解剖轮廓清楚）１３７耳（８５．６％）。认为在严格选择病例的情况下可获增进听力及良好外耳形态的效果。     

耳廓再造及听力重建同期手术在小耳畸形治疗中的分析

目的:探讨先天性小耳畸形的诊断及手术方法,分析并总结其临床特点及手术治疗中及术后存在的一些问题。方法:回顾性分析我科2000年1月～2010年1月中手术治疗先天性小耳畸形患者30例(36耳),22耳行自体肋软骨耳廓再造及听力重建术,另5耳只行外耳道、鼓室成形术。结果:就诊患者中听力损失为中度以上及畸形程度较重的占大多数,对不同程度外耳道、中耳畸形内语频听阈的差异分析有统计学差异(P<0.05),畸形越重,听力损失越重。术后耳廓支架外露2耳(9.09%),外耳道再次狭窄5耳(18.52%),感音神经性耳聋1耳(3.70%);结论:耳廓再造及听力重建同期进行即可保证美观又可提高听力,术前需进行综合评估、注意手术适应证的选择,注意手术操作细节及术后护理可降低并发症出现。     

先天性外中耳畸形患者听力重建与同步MEDPOR耳廓再造术的护理

目的 探讨同步进行外耳道、鼓室成形与应用高密度聚乙烯（MEDPOR）再造耳廓治疗先天性外中耳畸形患者的护理方法。方法 对25例先天性外中耳畸形患者采用Ⅰ期外耳道、鼓室成形加耳后皮下皮肤扩张器埋置术，Ⅱ期应用MEDPOR作支架行耳廓再造术。术前术后做好心理护理，密切观察病情，尤其是术耳局部皮肤、血运的观察护理。结果 术后1个月语频听力提高15dB以上者21例（占84．0％），其中听力改善30dB以上者10例，占40．0％。随访1～5年，听力保持稳定者17例（占68．0％）。MEDPOR耳廓再造18例一期愈合，外形良好；7例支架外露，再次手术修复，效果满意。结论 听力重建与MEDPOR耳廓再造同步进行可获得较满意的听力和耳廓外形，加强手术前后护理，是手术成功的重要保障。     

全耳廓Ⅰ期再造术及外耳道鼓室成形术(附6例报告)

报道6例先天性小耳症,用肋软骨和加成形硅橡胶耳廓模型作支架,一次再造耳廓,并同时行外耳道及鼓室成形术,改善了外形,增强了听力,随访1—3年,效果满意。     

Medpor支架行耳廓再造术后效果及患者满意度观察

目的:探讨肋软骨已经发生钙化的耳缺损或先天性小耳患者应用Medpor支架行耳廓再造术的方法及效果。方法:选取2009年3月-2015年5月于本院行耳廓再造术治疗的102例(102耳)患者为研究对象,其中53例(53耳)采用MEDPOR支架实施耳廓再造术为研究组,49例(49耳)采用自身肋软骨实施耳廓再造术为对照组,对比两种手术方法的效果及术后外观满意度。结果:研究组患者有1例出现皮瓣坏死,皮瓣存活率为98.11%,对照组未出现皮瓣坏死及支架外露,皮瓣存活率100.00%,组间比较差异无统计学意义(P0.05);两组患者耳廓外形术后效果评价结果比较,差异亦无统计学意义(P0.05);研究组患者术后满意率为86.79%低于对照组的93.88%,但组间比较差异无统计学意义(P0.05)。结论:肋软骨已经发生钙化的耳缺损或先天性小耳患者采用Medpor支架行耳廓再造术,疗效确切,可应用于临床。     

耳矫治器无创矫正先天性耳廓形态畸形疗效观察

目的:探讨耳矫治器无创矫正先天性耳廓形态畸形的疗效。方法:选取2019年5月-2020年6月笔者医院收治的先天性耳廓形态畸形患儿204例(204耳)作为研究对象。根据患儿矫正初始年龄将其分为以下两组:小龄组(≤42d)132例,大龄组(42d)72例,所有患儿均给予耳矫治器治疗。治疗后随访3个月,根据患儿耳廓形态进行疗效评价,并记录其矫正时间和并发症情况。结果:小龄组有效率(93.94%)高于大龄组(83.33%),矫正时间低于大龄组,差异有统计学意义(P0.05)。随访期间,小龄组出现4例皮损,1例皮疹,1例感染;大龄组出现5例皮损,2例皮疹,3例感染;小龄组并发症总发生率(4.55%)低于大龄组(13.89%),差异有统计学意义(P0.05)。耳矫治器治疗垂耳、招风耳、耳轮畸形、杯状耳、Stahl's耳、隐耳的有效率分别为95.65%、84.62%、96.67%、86.11%、86.36%、94.44%,以垂耳、耳轮畸形、隐耳有效率最高。结论:耳矫治器无创矫正先天性耳廓形态畸形疗效好,且患儿越早接受治疗,效果越好,矫正时间越短,并发症越少。其中以垂耳、耳轮畸形、隐耳的患儿矫正效果更佳。     

先天性小耳畸形皮肤定量扩张耳廓再造和颞筋膜瓣听力重建序列治疗的围手术期护理

目的:总结先天性小耳畸形皮肤定量扩张耳廓再造和颞筋膜瓣听力重建序列治疗的围手术期护理经验,提高其治疗效果。方法:2010年1月～2011年12月对38例接受耳皮肤定量扩张耳廓再造和颞筋膜瓣听力重建序列治疗的先天性小耳畸形的患者进行围手术期护理观察。结果:38例患者术后再造耳廓形态逼真、立体感强;术后听力均有不同程度提高,未出现面瘫、眩晕、耳鸣等并发症,近期及远期随访患者无明显外耳道狭窄及远期听力下降。结论:皮肤定量扩张耳廓再造和颞筋膜瓣听力重建序列治疗是先天性小耳畸形的良好方法,加强围手术期护理对提高手术疗效具有重要作用。     

耳畸形整形术

目的探讨和评价不同耳畸形的手术方法、效果及其影响因素.方法根据耳畸形的不同情况,利用自体肋软骨,对379例（401耳）采用双叶皮瓣法、29例（29耳）采用耳后沟皮瓣行耳廓再造及耳道成形术.对84例（84耳）气化型乳突患者同时行耳道成形术和鼓室成形术.结果335例（82%）术后随访3个月以上,其中273例（67%）随访0.5～5年,手术效果满意,再造耳形态逼真,颅耳角满意;358例（380耳）先天性小耳畸形术后复查听力,335耳术后听力有不同程度提高,其中84耳同时行耳道成形术和鼓室成形术,听力改善更明显;45耳术后听力无明显改善（＜10 dB）.结论自体肋软骨是耳再造的理想材料,双叶皮瓣及耳后沟皮瓣行耳再造效果满意,听力有所提高.     

先天性耳廓畸形的自愈性及耳廓矫正器治疗效果分析

目的探讨先天性耳廓畸形(CAD)患儿的自愈性及采用耳廓矫正器进行治疗的效果。方法以2020年1至12月在南通大学附属妇幼保健院出生的CAD患儿为研究对象, 根据患儿家长意愿进行分组:不同意采用耳廓矫正器进行治疗但愿意接受随访者纳入观察组, 在出生后1个月和1年通过电话或微信进行随访, 统计患儿耳廓自愈比例(痊愈和有效耳数占该组患耳总数的比例);同意采用耳廓矫正器进行治疗者纳入无创矫正组, 并根据患儿初始矫正年龄分为≤7 d、8～28 d和>28 d 3个亚组, 该组患儿采用国产耳廓矫正器进行治疗, 在治疗结束后1个月和1年通过电话或微信进行随访, 统计耳廓治疗有效比例(痊愈和有效耳数占该组患耳总数的比例), 并对初始矫正年龄≤7 d、8～28 d、>28 d 3个亚组的耳廓矫正器佩戴时间进行统计分析, 3组间总体比较采用方差分析, 组间两两比较采用LSD-t检验, P<0.05为差异有统计学意义。结果观察组共纳入43例患儿(71只耳), 男21例, 女22例, 出生后(2.1±0.3) d, 左侧34只, 右侧37只。无创矫正组纳入24例患儿(41只耳), 男8例, ...     

Thermosensitivity in a reconstructed microtic ear

The aim of this study was to evaluate thermo-thresholds in autologous reconstructed microtic ears. Nineteen patients with unilateral microtia were investigated no less than two years after the last operation (3.6+/-1.7 years). Their normal corresponding ear acted as controls. Eight healthy children were also investigated to illustrate technical differences between measuring the two sides. Thermal sensitivity was tested quantitatively using a SENSELab MSA Thermotest. The skin temperature was also tested. Three different areas of the ear were examined: the lobe, the antihelix, and the helix. The reconstructed ear had a significantly higher skin temperature for all investigated areas compared with the normal ear (reconstructed ear 30.2+/-1.2 degrees C, normal ear 28.6+/-0.9 degrees C). For the controls there were no significant differences in any area. For the patients there were small differences in perception of cold between the reconstructed and the normal ear. There were significant differences in the antihelix region and the helix in heat perception in the reconstructed ear compared with the normal one (helix reconstructed ear 43.9+/-3.8 degrees C, helix normal ear 38.3+/-3.0 degrees C, antihelix reconstructed ear 39.9+/-3.0 degrees C, antihelix normal ear 36.4+/-1.7 degrees C). The reconstructed ear had a changed thermosensitivity, but there did not seem to be any clinical disadvantages.     

Thermosensitivity in a reconstructed microtic ear

The aim of this study was to evaluate thermo-thresholds in autologous reconstructed microtic ears. Nineteen patients with unilateral microtia were investigated no less than two years after the last operation (3.6±1.7 years). Their normal corresponding ear acted as controls. Eight healthy children were also investigated to illustrate technical differences between measuring the two sides. Thermal sensitivity was tested quantitatively using a SENSELab MSA Thermotest. The skin temperature was also tested. Three different areas of the ear were examined: the lobe, the antihelix, and the helix. The reconstructed ear had a significantly higher skin temperature for all investigated areas compared with the normal ear (reconstructed ear 30.2±1.2°C, normal ear 28.6±0.9°C). For the controls there were no significant differences in any area. For the patients there were small differences in perception of cold between the reconstructed and the normal ear. There were significant differences in the antihelix region and the helix in heat perception in the reconstructed ear compared with the normal one (helix reconstructed ear 43.9±3.8°C, helix normal ear 38.3±3.0°C, antihelix reconstructed ear 39.9±3.0°C, antihelix normal ear 36.4±1.7°C). The reconstructed ear had a changed thermosensitivity, but there did not seem to be any clinical disadvantages.     

软壁外耳道重建鼓室成形术在胆脂瘤性中耳炎听力重建中的应用效果

目的 观察软壁外耳道重建鼓室成形术治疗胆脂瘤性中耳炎的效果,探究其对听力重建的影响。方法 选取我院2019年1月-2021年1月收治的100例胆脂瘤性中耳炎患者为研究对象,按照奇偶数法分为对照组和观察组,各50例。对照组行开放式乳突根治术,观察组行软壁外耳道重建鼓室成形术,比较两组治疗效果、术后气骨导差、气导听阈及预后情况。结果 观察组总有效率为94.00%,高于对照组的80.00%,差异有统计学意义（P＜0.05）;两组气骨导差、气导听阈均低于术前,且观察组气骨导差、气导听阈低于对照组,差异有统计学意义（P＜0.05）;观察组术后干耳率为84.00%,高于对照组的32.00%,观察组术后结痂率、复发率分别为10.00%、2.00%,低于对照组的64.00%、18.00%（P＜0.05）。结论 软壁外耳道重建鼓室成形术治疗胆脂瘤性中耳炎疗效确切,可改善患者听力水平,且预后良好,复发率低,是一种安全性较高的治疗方案。     

Clinical outcome of neurofibromatosis type 2-related vestibular schwannoma: treatment strategies and challenges

To discuss the appropriate treatment strategy for NF2-related vestibular schwannoma (VS) according to our experiences, we analyzed long-term clinical and radiological data focusing on NF2-related VS patients. Seventeen NF2-related VS patients were included. Based on their first management modality for VS, we classified these patients into the following four groups: microsurgery (MS), fractionated gamma knife radiosurgery (f-GKS), single session gamma knife radiosurgery (s-GKS), and conservative management (CM). Each patient was assessed for each separate ear. Changes of tumor volume and hearing status for 32 ears in 17 patients according to their first treatment modality were evaluated. The mean follow-up duration and tumor volume of the MS (4 ears, 4 patients), f-GKS (12 ears, 10 patients), s-GKS (8 ears, 7 patients), and CM (8 ears, 7 patients) groups were 3.9 years and 1.6 mL; 5.1 years and 11.1 mL; 8.4 years and 5.6 mL; and 6.1 years and 1.6 mL, respectively. Relatively lower local control rates were observed in the MS and the CM group (0 and 12.5 %, respectively). On the other hand, better local control rates for follow-up periods of 5.1 and 8.4 years were achieved in the f-GKS and the s-GKS groups (75 and 50 %, respectively). However, hearing preservation in all treatment modalities could not be achieved effectively. Long-term preservation of hearing in at least one serviceable ear as well as tumor control should be considered for each patient. Therefore, a proper treatment option should be selected at the appropriate time according to clinical characteristics of individual patients.     

鼓膜修补术经耳内镜下选择耳垂脂肪压片治疗的临床分析

目的：探讨经耳内镜下选择耳垂脂肪压片法进行鼓膜修补手术的临床疗效及安全性。方法随机将我院耳鼻喉科收治的100例需进行鼓膜修补术的患者分成观察组（52例）和对照组（48例）,观察组进行耳内镜下鼓膜修补术、对照组行显微镜下鼓膜修补术,比较两组患者手术出血量、手术时间、听力恢复、伤口愈合情况。结果观察组手术时间、术中出血量分别为（11.5±3.5）min、（8.2±2.2）mL,均明显低于对照组的（44.3±3.8）min、（18.5±1.8）mL,两组两种观察组指标比较差异均有统计学意义（P＜0.05）;观察组术后3个月复查,有效率达94.23%,对照组有效率达93.75%,差异无统计学意义（P＞0.05）;两组听阈值在手术前比较差异无统计学（P＞0.05）,两组治疗后与治疗前分别进行组内比较,听力均明显加强且差异有统计学意义（P＜0.05）;治疗后两组比较,治疗组的听力恢复要优于对照组且差异有统计学意义（P＜0.05）。结论经耳内镜下选择耳垂脂肪压片法进行鼓膜修补手术具有较好的疗效,同时听力恢复更好、手术时间及出血量更少。     

Loss of auditory function in microvascular decompression for hemifacial spasm. Results in 143 consecutive cases

Auditory function was studied before and after surgery in 143 consecutive patients who were operated on for hemifacial spasm by microvascular decompression of the intracranial portion of the facial nerve. The acoustic middle ear reflex was abnormal preoperatively in 41% of the patients, indicating that the vascular abnormalities that caused the hemifacial spasm also affected the auditory nerve. Three patients suffered a profound hearing loss in the ear on the operated side, and one lost hearing function totally. In addition, 24 patients had a moderate elevation in the pure-tone threshold at one or more octave frequencies. Of these, 16 patients experienced a hearing loss at only one frequency (8000 Hz), while eight had a threshold evaluation of no more than 20 dB in the speech frequency range (500, 1000, and 2000 Hz). Two patients were deaf on the side of the spasm before the operation. Three patients were not tested postoperatively, and one patient was tested only after surgery. Thus, in this series of 143 patients, only 2.8% suffered a significant hearing loss as a complication of facial nerve decompression to relieve hemifacial spasm.     

Audiometric assessment of pediatric patients with cystic fibrosis

Background

The purpose of this study was to evaluate hearing impairment in pediatric patients with cystic fibrosis (CF).

残耳组织在小耳畸形外耳再造中的应用

目的 总结外耳再造术中对残耳进行的不同处理,探讨合理应用残耳的方法. 方法 2005年9月-2006年7月,对128例单侧小耳畸形患者采用分期手术进行矫治.男79例,女49例;年龄5～21岁,平均11岁.左耳44例,右耳84例.残耳呈花生状56例,腊肠状35例,舟状27例,贝壳状10例.外耳道正常存在5例,狭窄11例,闭锁112例.患耳按耳廓发育情况分为Ⅰ度17例,Ⅱ度98例,Ⅲ度13例.一期手术时植入50 mL肾形扩张器1枚.对于残耳上端距发际线较近者,同期将残耳中上部纵行切开,去除多余的残耳软骨,切口直接缝合.二期手术时利用残耳中上部覆盖软骨支架下部,根据残耳的具体位置,应用"V-Y"推进、"Z"成形术和残耳向上逆转等方法矫正残耳位置.三期手术时利用保留的残耳再造耳轮脚或覆盖再造耳修整时形成的创面. 结果 患者残耳经改形或移位后血运良好,全部成活.切口Ⅰ期愈合.患者均获8～15个月随访.以残耳形成的耳垂外形丰满自然,再造耳与健侧耳基本对称.再造耳耳垂存活良好,无破溃.再造的耳轮脚清晰可见,耳轮、对耳轮及三角窝结构清晰,患者及家属均满意. 结论 合理应用残耳是成功施行外耳再造术、保证再造耳与健侧耳对称的重要环节.     

利用Ⅲ度小耳畸形残耳组织行再造耳耳屏及耳甲腔成形

目的探讨采用全扩张法对残耳组织量较少的Ⅲ度小耳畸形患者行全耳再造术,合理利用残耳组织行耳屏及耳甲腔成形。方法新方法组对36例组织量较少的Ⅲ度小耳畸形患者,一期采用经残耳切口,在耳后无发区浅筋膜深面及有发区浅筋膜浅层双平面埋置大容量扩张器(150 ml);二期行自体肋软骨支架无需植皮的全扩张法全耳再造术;三期时将残耳垂皮肤进行合理设计,用于再造耳屏并覆盖部分耳甲腔创面,残耳软骨用于作为耳屏的内支撑或垫于支架深面以增加支架的高度。传统扩张组46例,三期时将残耳垂转移以再造耳垂,采用M形皮瓣法再造耳屏,耳甲腔区游离植皮。三期再造耳修整后6~12个月随访,对耳屏和耳甲腔的大小及患者的满意度进行评价。结果新方法组患者术后耳郭表面均无明显切口瘢痕,仅1例患者残耳垂皮瓣远端覆盖耳甲腔部位存在约0.6 cm×0.4 cm大小皮瓣表皮水泡,经换药10 d后愈合。传统扩张组中可见5例患者耳甲腔移植皮片表面出现水泡,经换药后愈合。与传统扩张组相比,新方法组耳屏挛缩变形轻,耳甲腔回缩率小。新方法组患者满意率明显高于传统扩张组(P<0.05)。耳垂丰满度与正常耳相比略差。结论采用全扩张法可以扩张足够的皮肤,用于完全覆盖整个软骨支架的表面,无需行耳垂转位,再造耳支架表面无手术瘢痕,且残耳组织可以得到充分利用,再造的耳屏及耳甲腔外形良好。