开放式鼓室成形术对慢性中耳炎患者听力重建效果的影响

Influence of hearing reconstruction outcomes of open tympanoplasty in patients with chronic otitis media

摘要:

目的 分析行开放式鼓室成形术对慢性中耳炎患者听力的影响。方法 回顾性收集诊治的86例(共93耳)慢性中耳炎患者(慢性化脓性中耳炎44耳，中耳胆脂瘤49耳)的基本信息及接受开放式鼓室成形术术前和术后6个月骨导和气导阈值，分析开放式鼓室成形术对慢性中耳炎患者听力的影响。结果 对93耳行开放式鼓室成形术的慢性中耳炎患者术前、术后不同频率纯音测听下的骨导和气导听力阈值变化的分析显示，术后气导听力在中低频区域获得显著改善。在0.5、1 kHz频率，气导听力阈值较术前分别平均降低了5.4 dB 和5.5 dB ，差异均具有统计学意义(P均<0.05)。术后骨导听力阈值在各测试频率(0.5、1、2、4 kHz)均与术前水平相当，均无统计学意义(P均>0.05)。经比较两类疾病之间、不同病程、部分型听骨重建和完全型听骨重建之间听力改善程度均无统计学差异(P均>0.05)。结论 接受开放式鼓室成形术可以显著改善气导，维持骨导，且重建效果不受术前病程长短、疾病分型和术中植入听小骨类型影响。开放式鼓室成形术可有效改善慢性中耳炎患者的气导听力，是慢性中耳炎听力重建的一种可靠外科手段。

Abstract:

Objective To analyze the impact of open tympanoplasty on hearing of patients with chronic otitis media. Methods It was retrospectively collected for basic data of 86 patients (a total of 93 ears) with chronic otitis media (44 chronic suppurative otitis media; 49 cholesteatoma) in the Third Affiliated Hospital of Chongqing Medical University. And the bone conduction and air conduction thresholds before and 6 months after open tympanoplasty were analyzed to explore the impact of open tympanoplasty on the hearing of patients with chronic otitis media. Results Based on the analysis of the changes in bone conduction and air conduction hearing thresholds under pure tone audiometry at different frequencies before and after surgery in 93 ears of patients with chronic otitis media who underwent open tympanoplasty, post-operative AC hearing improved significantly in the low-to-mid frequency range. At 0.5 kHz and 1 kHz, the post-operative AC thresholds decreased by an average of 5.4 dB and 5.5 dB, respectively, compared to pre-operative levels, with both differences being statistically significant (all P<0.05). Post-operative BC thresholds remained comparable to pre-operative levels across all tested frequencies (0.5, 1, 2, 4 kHz), with no statistically significant differences (all P>0.05). No statistically significant differences were found in the degree of hearing improvement between the two disease types, among different disease durations, or between partial and total ossicular chain reconstruction (all P>0.05). Conclusions Open tympanoplasty could significantly improve air conduction while preserving bone conduction. And the reconstruction effect was not affected by the preoperative disease course, disease classification, or the type of ossicles implanted.Open tympanoplasty is effective in improving air conduction hearing of patients with chronic otitis media, which is a reliable surgical approach for hearing reconstruction in chronic otitis media.