影响鼓膜成形术鼓膜移植成活率的相关因素

采用联合切口径路全翻内置法鼓膜成形术，对不同程度干湿耳和不同大小鼓膜穿孔的慢性化脓性中耳炎进行治疗，取得良好效果，表明鼓膜移植物的成活率与术前鼓室干湿度和鼓膜穿孔大小无明显关系，而与手术方式的选择和手术操作的技巧有密切关系，其中，尤以彻底清除鼓室病灶最为重要。     

影响鼓膜成形术鼓膜移植物成活率的相关因素

采用联合切口径路全翻内置法鼓膜成形术，对不同程度干湿耳和不同大小鼓膜穿孔的慢性化脓性中耳炎进行治疗，取得良好效果。表明鼓膜移植物的成活率与术前鼓室干湿度和鼓膜穿孔大小无明显关系，而与手术方式的选择和手术操作的技巧有密切关系，其中，尤以彻底清除鼓室病灶最为重要。     

鼓室成形术影响听力疗效相关因素分析

目的 探讨鼓室成形术听力疗效的相关影响因素.方法 报告118例（126耳）鼓室成形术,对可能影响听力疗效的16项因素进行分析.结果 病程短、病变轻、术前有较大骨气导间距、咽鼓管通畅、术中保留锤骨柄、选取适当术式以及术后完好鼓膜状态则听力效果较好,10项单因素经统计学分析均有显著性意义（P＜0.05）.结论 鼓室成形术听力疗效受多种因素影响,主要与病变程度及手术方法有关.     

鼓室干湿程度和鼓膜穿孔大小对鼓膜成形术后听力的影响

报告对各种不同程度干湿的鼓室和不同大小的鼓膜穿孔的慢性化脓性中耳炎１１８例采用联合切口径路全翻内置法行鼓膜成形术，观察对术后听力的影响，结果提示术前鼓室干燥和“干耳”时间越久，术后纯音气导测听的听力改善越明显，而鼓膜穿孔大小与术后听力改善的程度并无绝对关系。     

夹层法鼓膜成形术远期疗效的相关因素探讨

目的 探讨夹层法鼓膜成形术远期疗效的相关影响因素.方法回顾性研究1999年1月至2003年12月北京同仁医院住院行颞肌筋膜夹层法修补鼓膜穿孔的205例(223耳)患者的临床资料,年龄12～65岁,平均34.3岁;病程1个月～25年,平均16.1个月.观察指标包括年龄、性别、病因、病程、干耳时间、手术径路、穿孔部位、穿孔大小、鼓室状况、鼓膜是否有硬化斑.术后随访2年以上用SPSS 12.0软件包进行数据管理、统计方法为Logistic回归.结果 随访2～5年鼓膜愈合212耳,远期鼓膜愈合率为95.1%.其中,鼓膜色泽与形态正常、无其他并发症者186耳,远期手术成功率为83.4%.经多因素Logistic回归分析,依据OR值显示可能影响手术成功的相关因素依次为:穿孔大小(OR=1.900)、病程(OR=1.003)、干耳时间(OR=0.908).对术前纯音测听检查为传导性聋175耳分析显示:术后气骨导差(听力级)的平均值较术前降低7.0dB.结论 鼓膜穿孔越小、病程越短、在一定时间范围内干耳越久,远期发生并发症的可能性越小,对手术成功越有利.鼓膜内陷钙化常为晚期并发症,也是造成修补失败的重要原因之一.     

鼓膜成形术研究进展

鼓膜成形术（myringoplasty）又称鼓膜修补术,是通过组织移植技术修复穿孔,重建一个完整而活动的鼓膜,其目的是提高听力及防止经鼓膜穿孔所致的中耳感染。鼓膜成形术始于1878年,最早由Berthold提出,迄今临床应用已有百年。至上世纪50年代,随着手术显微镜的应用,移植技术的提高和各种新型抗生素的问世,鼓膜成形术的技术逐渐成熟,鼓膜穿孔的愈合率得到提高,     

儿童鼓膜成形术的疗效评估

儿童鼓膜成形术的疗效受许多因素的影响 ,如患儿年龄、鼓膜穿孔大小、部位、中耳病变情况以及手术方法等。由于纳入标准或排除标准不同 ,鼓膜成形术的成功率差异较大 ,文献报道为 35 %～ 92 %。关于手术时间的选择亦存在较大分歧。有学者认为应尽早手术 ,以防止病变的进一步发展 (听骨链破坏、胆脂瘤形成 ) ,避免在语言发育阶段有听力障碍。而另有学者则建议推迟手术 ,其原因是在儿童期有较高的上呼吸道感染发生率、咽鼓管功能不良、免疫功能发育尚未成熟 ,且鼓膜穿孔有自愈倾向。此外 ,在咽鼓管发育尚未完成之前 ,通过穿孔的鼓膜引流中耳分…     

James Sheehy鼓膜成形术

目的 应用James Sheehy鼓膜成形术对无残边鼓膜大穿孔行鼓膜成形术并观察其疗效。方法2001年1月至2003年6月，共有60名无残边鼓膜大穿孔的患者接受．James Sheehy鼓膜成形术治疗，男36名，女24名，年龄16～64岁，平均45．23岁。术前气骨导差5—45dB，平均28．5dB。其中54名患者随访超过6个月。技术关键：①做耳道后壁带血管蒂皮瓣，切除耳道前壁皮肤；②行耳道成形术至一个显微镜视野下能够看到整个鼓环；③必要时探查听骨链；④颞肌筋膜外植修补鼓膜，上方置于残余锤骨柄下方；⑤耳道前壁游离皮肤及耳道后壁带血管蒂皮肤复位。结果52名患者一期愈合，2名患者术后3个月修补鼓膜中心部位出现2处针眼样穿孔，经明胶海绵贴补二期愈合，鼓膜形态如常；6名患者术后出现轻微颞颌关节症状，3天后消失；2名患者出现修补鼓膜外侧愈合。结论．James Sheehy鼓膜成形术为无残边鼓膜大穿孔治疗的可靠技术，鼓膜修补成功率高，术后反应轻微，新生鼓膜形态好。     

内镜下鼓膜成形术

目的评价内镜下修补干性鼓膜中、小穿孔的效果并与传统的烧灼法作对照。方法按完全随机法将鼓膜干性中央性中、小穿孔130耳分为两组,第一组100耳接受内镜下同种异体颞肌筋膜鼓膜成形术(内镜组),另30耳采用传统的40%三氯醋酸烧灼法进行修补(对照组)。比较两组间术后3个月鼓膜穿孔完全愈合的耳数以及术后6个月的语言频率纯音听阈的差异。结果术后3个月,内镜组鼓膜穿孔完全愈合率为91/100,较对照组的20/30高(P<0.01),术后6个月,两组鼓膜穿孔完全愈合者的骨-气导差在10dB以内的占90.1%。结论使用内镜修补鼓膜穿孔具有明显的优势,可代替手术显微镜且更容易通过狭窄或弯曲的外耳道,该手术是一种简单易行、安全有效的方法。     

Hearing loss related to zinc deficiency in rats

Summary Based on the observation that the zinc concentration in the cochlea of guinea pigs is very high, Shambaugh in North America has suggested that zinc plays an important role in hearing. Zinc deficiency is not infrequently present in growing children and elderly people, and thus might result in a hearing loss, which should be treated with zinc supplementation. The present experiment examined the effects of a zinc-deficient diet on hearing in 7-week-old rats. The auditory brainstem response threshold was measured in four rats before, during and after a zinc-deficient diet. Concentrations of zinc in the brain and in several other organs were measured, and the cochleas were examined microscopically. No hearing loss or morphological change in the cochlea of these animals was detected, although a clear zinc-deficient status was reached.     

Hearing impairment among adults: The impact of cardiovascular diseases and cardiovascular risk factors

Objective: To investigate the influence of cardiovascular diseases on hearing impairment (HI) among adults. Furthermore, to seek other potential risk factors for HI, such as smoking, obesity, and socioeconomic class. Design: A cross-sectional, unscreened, population-based, epidemiological study among adults. Study sample: The subjects (n = 850), aged 54–66 years, were randomly sampled from the population register. A questionnaire survey, an otological examination, and pure-tone audiometry were performed. Results: Cardiovascular diseases did not increase the risk for HI in a propensity-score adjusted logistic regression model: OR 1.24, 95% CI 0.79 to 1.96 for HI defined by better ear hearing level (BEHL), and OR 1.48, 95% CI 0.96 to 2.28 for HI defined by worse ear hearing level (WEHL), in the 0.5–4 kHz frequency range. Heavy smoking is a risk factor for HI among men (BEHL: OR 1.96, WEHL: OR 1.88) and women (WEHL: OR 2.4). Among men, obesity (BEHL, OR 1.85) and lower socioeconomic class (BEHL: OR 2.79, WEHL: OR 2.28) are also risk factors for HI. Conclusion: No significant association between cardiovascular disease and HI was found.     

Hearing results of the total middle ear reconstruction

Objective:To evaluate the success of hearing results in total middle ear reconstruction with cartilage ossiculoplasty for the patients with old open- mastoidectomy cavities. Method: A retrospective review of 69 patients who underwent total middle ear reconstruction with cartilage ossiculoplasty was performed. Results: In this series, the successful hearing results were obtained in 61 % of the patients after operation, but 93% of the ears were dry. For patients with stapes, the successful rate was 65%; for patients without stapes,it was 58 %. The mean hearing gain was 10.7dB. Conclusion: Total middle ear reconstruction offers an effective treatment algorithia of hearing reconstruction for patients with old mastoidectomy cavities. 1. Stapes is important for hearing improvement; 2. Staged operation is good for hearing restoration; 3. For a large number of patients with a problematic cavitites, hearing restoration is possible by total middle ear reconstruction.     

早产儿听力筛查结果及其听力障碍危险因素

目的 分析新生儿重症监护中心(NICU)中早产儿的听力筛查结果, 探讨导致早产儿听力障碍的高危因素。方法 回顾性分析821 例不同胎龄早产儿的一般资料及听力筛查数据, 对听力筛查未通过的危险因素加以总结。结果 821 例中听力初筛未通过率61.0%, 复筛未通过率为 16.0%, 出生后 3 个月自动听性脑干反应(AABR)总未通过率为 9.4%。初筛、复筛及AABR检查未通过率及听力障碍程度随胎龄的增大呈依次降低的趋势。多因素Logistic 回归分析表明, 极低出生体质量、高胆红素血症、感染和窒息是听力初筛和复筛听力障碍的危险因素, 胎龄 > 32 周为听力初筛听力障碍的保护因素(OR=0.499, P=0.022), 极低出生体质量为听力复筛听力障碍独立危险因素(OR=2.385, P=0.038)。结论 早产儿由于机体各组织器官发育不成熟, 听力障碍高发, 胎龄越小听力损伤发生危险性越高, 听力障碍与出生体质量、高胆红素血症、感染和窒息有关, 应该对早产儿听力进行早期监测并及时随访。     

《中国听力语言康复科学杂志》2003～2008年载文、作者群及影响因子分析

目的通过分析《中国听力语言康复科学杂志》6年的载文量．作者群及总被引频次．影响因子等指标,了解我国听力语言康复学科发展现状。方法采用文献计量学方法对2003～2008年该刊载文及作者群进行统计分析。结果该刊载文量逐年上升,栏目设置稳定,论文的高产作者和高产单位相对集中,已形成核心作者群,科研合作率高。结论该刊是我国听力语言康复工作者学术交流和信息传递的重要平台,起到了传递国内外最新科研成果和临床信息的良好作用,为学科建设和事业发展做出了积极贡献。     

Hearing results of stapedotomy and malleo-vestibulopexy in congenital hearing loss

Aims

To analyze hearing results of surgical treatment of hearing loss associated with the congenital stapes ankylosis with or without malformations of ossicular chain.

Study design

Retrospective chart review.

Methods

The charts of 1369 stapedotomies performed by senior author (JH) from 1991 to 2006 were reviewed. In 40 cases operative findings were consistent with isolated congenital stapes fixation or associated with middle ear malformations. The modified stapedotomy technique was employed in 33 cases and malleo-vestibulopexy was used in 7 cases. Operative findings were standardized according to Cremers’ classification. The outcomes of 40 surgeries were analyzed according to the 1995 AAO-HNS Committee on Hearing and Equilibrium guidelines. High frequency hearing results on 4, 8 and 12 kHz were reported in addition to standard frequencies. Results of stapedotomies and malleo-vestibulopexies were calculated separately. Surgical complications were described.

Results

The mean post-operative air conduction (AC) was 33 dB, bone conduction (BC) 22 dB and speech reception thresholds (SRT) 31 dB. Closure of the air-bone gap (ABG) to within 10 dB was achieved in 24/40 (60%) of cases. Lack of improvement was observed in 3/40 (8%) patients. In 26/32 (81%) of cases with potential for bilaterally serviceable hearing it was achieved. In 24/40 (60%) of cases symmetrical hearing with interaural difference of less than 10 dB was demonstrated.

Conclusion

Significant hearing gain in patients with congenital stapes ankylosis makes surgical treatment a valuable adjunct or an alternative to hearing aids in selected cases.     

Sensorineural Hearing Loss after Vibration: an Animal Model for Evaluating Prevention and Treatment of Inner Ear Hearing Loss

Sensorineural hearing loss following a variety of acoustic trauma, including middle ear surgery, is well known. Current literature, which points to the deleterious influence of noise on the inner ear during surgery, has yet to assess the influence of vibration generated by the burr. The purpose of the study reported here was to establish an animal model that mimics drilling and can be used to explore methods of hearing loss prevention and treatment. A specially developed electromagnetic vibrator was calibrated and used in 59 guinea pigs to induce hearing loss. Both young and old guinea pigs were used. The bony external ear canal of guinea pigs were exposed to vibration or sound of varying duration and intensity. The vibration of the temporal bone and noise level in the middle ear were measured. Electrocochleography was recorded to evaluate the hearing loss. Among the young animals, 90% developed a significant threshold shift (TS &gt;20 dB), when vibrated with 250 Hz at an intensity of 6.2 m/s² for 15 min. An average of 42 dB TS was observed. With 10 min exposure 63% showed a TS. The older animals vibrated for 5 min developed the same TS (mean TS 34 dB) as the young animals when vibrated for 10 min. The vibration-induced TS showed no recovery within 3 days of observation. In the contralateral ear 4 out of 5 animals showed TS&gt;20 dB. When exposed to sound levels exceeding the vibration-generated sound in the middle ear (119 dB at 250 Hz) only 2 out of 11 animals (18%) showed TS. The frequency of TS and level of TS were significantly greater in the vibrated animals than in sound-only exposed animals (p&lt;0.01). The degree of vibration-induced TS in the present animal model could be controlled by vibration intensity and duration. The older animals were more susceptible to vibration-induced inner-ear damage than younger animals. This model will be used in further studies to find methods for prevention and treatment of hearing loss during ear surgery.     

西安市中学生听力现况调查

目的了解目前中学生听力状况,为制定中学生人群听力损失的防治策略提供科学依据。方法用分层随机整群抽样法对西安市中学生行问卷调查、耳科查体、纯音测听及声导抗测试,数据用SPSS15．0统计软件处理。结果1．共调查1567人,男生793人（50．61％）,女生774人（49.39％）。2．听力情况：听力减退患病率2．30％（36／1567）,听力残疾患病率0．13％（2／1567）。传导性听力减退13人,感音神经性听力减退20人,混合性听力减退3人。3．噪声性听力减退、中耳炎,耵聍栓塞等是引起中学生听力减退常见疾病。4．Logistic回归结果显示,性别、MP3／MP4使用时间、睡眠、耳聋家族史,耳毒性药物史等因素均与听力减退相关;MP3／MP4是听力损伤的独立危险因素。5．“耳科正常中学生”各频率听力受损的可能性随着MP3／MP4使用时间的延长而增大。6．“耳科正常中学生”声导抗检测鼓室图绝大多数为A型,无B型图。结论目前中学生人群中听力减退患病率较高。长时间、高音量使用MP3,MP4是中学生听力减退重要原因。失眠、耳聋家族史、耳毒性药物史等是中学生听力减退的危险因素。     

鸡卡那霉素耳中毒后听功能恢复不全的形态基础

目的　探讨鸡卡那霉素耳中毒后听功能恢复不全的形态基础。方法　将 3天龄罗曼鸡按 2 0 0mg·kg-1·d-1连续肌注卡那霉素 10天 ,分别于施药第 8天、停药后 1、7、15、30、6 0天时处死 ,对照组动物不给予任何药物。动物处死前先用半正弦波 (40 0 0Hz)刺激行ABR检查 ,完毕后取颞骨 ,行扫描电镜标本制作及观察。结果　鸡ABR阈移于施药完毕时达到极限 ,停药后即开始恢复 ,停药后 7天时 ,ABR阈值有明显恢复 ,停药后 15天时 ,其ABR阈值已接近正常 ,但直至停药后 2个月时 ,ABR阈值仍有 15dBSPL未能完全恢复。扫描电镜所见 ,施药完毕时 ,鸡基底乳头近端 4 0 %区域内毛细胞完全破坏消失 ,并见毛细胞再生修复现象 ,停药后 7天时 ,毛细胞形态有成熟 ,其表皮板增大 ,表面静纤毛丛排列成阶梯样 ,停药后 15天时 ,基底乳头损伤区域已基本修复 ,大多数再生毛细胞已基本成熟 ,但直至停药后 2月时其静纤毛丛极向仍未完全恢复正常。结论　鸡卡那霉素耳中毒后 ,基底乳头再生毛细胞静纤毛丛的极向未完全恢复可能是其听功能恢复不全的重要形态学基础