耳内镜下手术治疗单纯先天性中耳畸形疗效分析

目的：探讨单用耳内镜手术治疗单纯先天性中耳畸形的疗效。方法：回顾性分析2017年1月至2021年6月在温州医科大学附属第一医院收治的27例单纯先天性中耳畸形患者的临床资料，对术前高分辨率计算机断层扫描结果、术中所见、手术方式及术前后听力学资料进行分析。结果：27例患者均为单耳发病，24例患者为传导性聋，3例混合性聋且以传导性为主。Teunissen-Cremers分型I型5例，II型6例，III型15例，IV型1例。术中分别使用PORP 8例、TORP 7例和Piston 11例行听骨链重建术。1例IV型患者系前庭窗闭锁，听骨及面神经严重畸形，行加长的7.0 mm Piston锤骨前庭桥接术。27例患者术前平均气导为（62.1±8.3）dB HL，术后6个月平均气导为（30.6±7.4）dB HL（t=19.47，P＜0.001）。15例（55.6%）气导听力提高超过30 dB HL。术前平均气骨导差为（43.1±9.3）dB HL，术后6个月为（13.4±5.2）dB HL（t=16.75，P＜0.001）。结论：单纯先天性中耳畸形主要表现为听骨链畸形，单用耳内镜诊治先天性中耳畸形具有视野清晰、操作准确、无需外耳道或耳后切口、创伤小、并发症少、术后听力恢复好的优点。

Clinical analysis of transcanal endoscopic ear surgery for single congenital middle ear malformations

Objective: To describe the operative findings and analyze the surgical effect of endoscopic ear surgery for congenital middle ear malformations. Methods: From January 2017 to June 2021, a retrospective study was performed on 27 patients with congenital middle ear malformations who underwent endoscopic surgery. Demographic data, high-resolution computed tomography findings, intraoperative findings, surgical management and audiometric data were recorded. Results: Altogether 27 patients with congenital middle ear malformations were included, consisting of 3 cases unilateral mixed hearing loss with significant conductive hearing loss and 24 cases unilateral conductive hearing loss. Anomalies were categorized according to the Teunissen and Cremers classification system: 5 ears were categorized as class I, 6 ears as class II, 15 ears as class III and 1 ear as class IV. Prostheses used in surgery included 8 PORPs, 7 TORPs and 11 Pistons. One patient was type IV, with vestibular window atresia, facial nerve malformation, and malleostapedotomy was performed with lengthened 7mm Piston to reconstruct ossicular chain. The air conduction pure tone average was (62.1±8.3) dB HL preoperatively and (30.6±7.4) dB HL postoperatively (t=19.47, P<0.001). Fifteen cases (55.6%) acquired an air conduction hearing gain exceeding 30 dB HL. Mean air-bone gap (ABG) was (43.1±9.3) dB HL preoperatively and (13.4±5.2) dB HL postoperatively (t=16.75, P<0.001). Twenty-five cases (93%) showed a postoperative ABG of less than 20 dB after operation. Conclusion: Simple congenital middle ear deformity is mainly manifested as a listening bone chain deformity. The ear endoscopy alone for the diagnosis and treatment of congenital middle ear malformation has the advantages of a clear field of vision, accurate manipulation, no need for external ear canal or posterior ear incision, small wound, few complications, good postoperative hearing recovery.