中耳粘连的临床特点及治疗  

Clinical features and management of middle ear adhesion

作　　者：陈晓华[1] 卢伟[1] 秦兆冰[1] 李素娟[1] 贾代杰[1] 

机构地区：[1]郑州大学第一附属医院耳鼻咽喉头颈外科,河南郑州450052

出　　处：《中国耳鼻咽喉头颈外科》2008年第9期509-511,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的研究中耳粘连的临床特点及其治疗效果。方法回顾分析2002年1月～2007年1月间术者经治的诊断为中耳粘连且术后随访资料完整者40例患者的临床资料。结果Siegle耳镜检查发现,所有患者的鼓膜均有程度不同的内陷、粘连、活动差(可部分或全部不活动);术中发现,鼓室黏膜水肿、增厚,鼓室内有不同程度纤维组织粘连和膨胀不全,可累及中耳各部分结构,甚至蜗窗和前庭窗,以中、下鼓室及听骨链周围粘连严重;术前纯音听力测试(0.5、1、2、4 kHz)平均气骨导差(35.34±6.99)dB,术后6个月纯音听力测试(0.5、1、2、4 kHz)平均气骨差(18.47±5.76)dB;术后随访观察及部分患者复查颞骨CT显示鼓膜及鼓室腔形成良好。结论①中耳粘连的临床特点主要表现为鼓室内不同程度的纤维组织粘连,以中、下鼓室及听骨链周围粘连严重;②中耳粘连可以进行手术治疗,术中尽量保留正常的鼓室黏膜,通畅咽鼓管,形成大的鼓室腔,用外侧带有软骨膜的削薄的耳甲腔软骨重建鼓膜,是手术成功的关键。OBJECTIVE To study the clinical features and therapeutic efficacy of middle ear adhesion. METHODS The clinical data of 40 cases of middle ear adhesion collected during 5 years from 2002 to 2007 were studied retrospectively. RESULTS Part or all of the tympanic membrane of the patients did not move under Siegle otoscopy. The lesions of middle ear adhesion were extensive and invaded all middle ear structures including round and oval windows. The lesions were severe, especially in narrow anatomical spaces such as mesotympanum, hypotympanum and interossicular spaces. Pure tone audiometry showed that average air-bone gap （A-B gap） were （35.34±6.99） dB preoperatively. The average A-B gap were （18.47 ±5.76） dB 6 months after operation. Follow-up observations and postoperative CT scan showed that tympanic membranes and middle ear cavity recovered well. CONCLUSION There are various degrees of tympanic fibrous adhesion and atelectatic tympanum in middle ear adhesion, especially in mesotympanum, hypotympanum and interossicular spaces. The middle ear adhesion can be treated with operation. The key points for a successful operation include preserving normal tympanum mucosa, opening eustachian tubes, making a bigger middle ear cavity, and performing tympanoplasty with perichondrium-cartilage plates.

关 键 词：中耳 粘连 外科手术 

分 类 号：R764[医药卫生—耳鼻咽喉科]