不同分型鼓室硬化的听力学特点与术后疗效分析

Analysis on audiological characteristics and surgical effect of tympanosclerosis of different types

摘要:

目的 分析不同分型鼓室硬化患者的听力学特点，探讨其手术治疗效果，为术前评估提供参考。方法 回顾性分析135例(135耳)鼓室硬化手术患者，对比手术前后听力学资料。结果 Ⅰ、Ⅱ型鼓室硬化患者多表现为传导性耳聋(分别为71.4%、68.8%)，Ⅳ型鼓室硬化患者中混合性耳聋出现的比例更高(66.7%)。各型鼓室硬化的听力曲线以平坦型为主。卡哈切迹出现率为13.3%(18/135)，Ⅳ型鼓室硬化患者中38.9%患者听力图出现了卡哈切迹。各型鼓室硬化患者(除Ⅲ型鼓室硬化外)术后气骨导差(ABG)和气导平均听阈(PTA)均较术前降低。Ⅰ型鼓室硬化的手术成功率最高(79.0%)，Ⅳ型鼓室硬化的手术成功率最低(63.9%)。结论 各型鼓室硬化患者听力图多呈现平坦型曲线，混合性耳聋最多见于Ⅳ型鼓室硬化，卡哈切迹的出现可提示镫骨的固定。手术清除鼓室内硬化灶是主要的治疗方式，Ⅰ型鼓室硬化术后成功率最高，Ⅳ型鼓室硬化最低。

关键词:鼓室硬化;纯音测听;术后疗效

Abstract:

Objective To analyze the audiological characteristics and discuss the surgical effect of patients with tympanosclerosis of different types, so as to provide reference for preoperative evaluation.Methods Clinical data of 135 tympanosclerosis patients (135 ears) surgically treated were retrospectively analyzed, and their audiological data before and after operation were compared.Results Conduction deafness was common in type Ⅰ and Ⅱ tympanosclerosis patients (71.4% and 68.8%, respectively), and mixed deafness was frequent in type Ⅳ tympanosclerosis patients (66.7%). The auditory curve of tympanosclerosis was mainly flat. The incidence of Carhart notch was 13.3% (18/135) in all the patients, and 38.9% in those with type Ⅳ tympanosclerosis on audiogram. The postoperative values of air-bone gap (ABG) and pure tone average (PTA) were lower than the preoperative ones in all types of tympanosclerosis except type Ⅲ. The success rate of operation was the highest in type Ⅰ tympanosclerosis (79.0%), and the lowest in type Ⅳ (63.9%).Conclusions The audiogram of patients with tympanosclerosis is mostly flat, and mixed deafness is most common in type Ⅳ tympanosclerosis. The appearance of Carhart notch may indicate fixation of the stapes. Surgical removal of the sclerotic lesions is the main treatment modality with the highest success rate for type Ⅰ and the lowest for type Ⅳ tympanosclerosis.

Key words:Tympanosclerosis;Pure tone audiometry;Postoperative effect