民航飞行员耳硬化症二例的诊治及航空医学鉴定  

Diagnosis and treatment of 2 civil pilots with otosclerosis and aeromedical assessment

作　　者：马峰杰[1] 胡墨绳[1] 秦彩虹[1] 

机构地区：[1]中国民用航空局民用航空医学中心航空人员体检鉴定所,北京100123

出　　处：《中华航空航天医学杂志》2016年第3期212-217,共6页Chinese Journal of Aerospace Medicine

摘　　要：目的：分析民航飞行员耳硬化症的临床特征和航空医学鉴定，以加强对该病的认识，提高航空医学鉴定水平。方法通过回顾分析民航飞行员耳硬化症1例及疑似病例1例的临床资料并进行文献复习，总结耳硬化症的临床特征、诊断、治疗及航空医学鉴定。结果病例1患者于2011年发现左耳听力损失，因未做骨导导致漏诊。2013年8月体检做骨导，显示左耳传导性听力损失，骨导2000 Hz阈值升高，连续3 d盖莱试验阴性，声导抗As型曲线，确诊为耳硬化症（左）、Ⅲ度听力损失（左）。考虑到其空中听力实测和背离试验结果正常，结论：飞行合格，建议每年复查纯音测听1次，密切监测听力。病例2患者双耳渐进性听力下降3年余，纯音测听显示双耳传导性听力损失，左耳出现典型“卡哈切迹”，高度怀疑为耳硬化症，进一步检查结果显示声导抗双耳C型曲线，颞骨CT及盖莱试验均正常，排除耳硬化症。临床会诊认为传导性听力损失和卡哈切迹可能与中耳负压状态相关，诊断为Ⅲ度听力损失（左）、Ⅱ度听力损失（右）。要求进行地面观察，待鼓室压力恢复正常后重新鉴定。结论耳硬化症的诊断应结合病史、临床查体以及辅助检查结果（听力学及影像学）综合判断。鉴定时应依据听力损失程度、前庭功能以及手术情况区别评定。Objective To strengthen the awareness of the otosclerosis and improve aeromedical assessment level by disease analysis and related literatures review . Methods Clinical data of a civil pilot′s otosclerosis case and a suspected case , as well as related literature were retrospectively reviewed .The clinical characteristics ,diagnosis ,treatment of otosclerosis and aeromedical assessment were summarized . Results Case 1 ：the pilot was found left ear hearing loss in annual physical examination of 2011 .He missed diagnosis due to the absence of osteoacusis check and was qualified . In August 2013 ,he was received osteoacusis check that indicated the conductive hearing loss of his left ear and the threshold of 2 000 Hz bone conduction was increased .The iterative Gelle tests of the left＆amp;nbsp;ear in 3 d were negative and the tympanometry showed type curve . The pilot was finally diagnosed as otosclerosis （left ） and grade Ⅲ hearing loss . Due to his normal results in the air conversation test and the audition deviation test , he was qualified but had to receive pure tone audiometry annually .Case 2 ：the pilot was found binaural progressive hearing loss for more than 3 years and the pure tone audiometry showed bilateral conductive hearing loss . His left ear characterized with typical ＆quot;Carhart notch＆quot; so he was highly suspected with otosclerosis .For further diagnosis ,he received acoustic immittance test （binaural C curve result） ,temporal CT check and Gelle test and got all normal results .He was excluded the suspicion of otosclerosis .The clinical consultation speculated that his conductive hearing loss with Carhart notch might be related to middle ear negative pressure state .The pilot′s hearing loss was respectively diagnosed as grade III （left） and II （right） . He was assessed as temporary grounding and required to have other assessment as the tympanic cavity pressure recovered to normal . Conclusions The diagnosis of otosclerosis should be based on comprehensive asses

关 键 词：耳硬化病 听力损失 听阈 合格鉴定 民航飞行员 

分 类 号：R856[医药卫生—航空、航天与航海医学]