中耳胆脂瘤患者生活质量调查及听力图聚类分析  

A Survey of Quality of Life in Patients with Middle Ear Cholesteatoma and Cluster Analysis of Their Audiograms

作　　者：韩静 于文永[2] 王斌全[2] HAN Jing;YU Wenyong;WANG Binquan(School of Nursing,Shanxi Medical University;Department of Otorhinolaryngology Head and Neck Surgery,First Hospital of Shanxi Medical University)

机构地区：[1]山西医科大学护理学院,太原030001 [2]山西医科大学第一医院耳鼻咽喉头颈外科,太原030001

出　　处：《中华耳科学杂志》2021年第6期894-902,共9页Chinese Journal of Otology

摘　　要：目的采用问卷调查中耳胆脂瘤患者手术前后生活质量并分析其影响因素,对患者术前听力图形态进行聚类分析,为临床治疗护理提供依据;方法通过对2018年1月至2019年12月符合纳入排除标准的109例中耳胆脂瘤患者进行回顾性研究,采用中文版《慢性耳病调查量表》以及《慢性中耳炎评估量表》比较患者手术前后不同临床资料的生活质量,并采用多因素logistic回归分析患者手术前后生活质量的影响因素;对研究对象术前各频率的听力阈值进行分层聚类分析;结果(1)CCES结果示术后各个维度及总评分均高于术前(P<0.05);CCOMOT-15结果示除听觉功能维度较术前没有变化外,其他维度及总评分均低于术前(P<0.05);(2)CCES量表结果示:耳溢液是影响COME患者术前术后的独立危险因素(P<0.05);(3)CCES症状分量表中的S1条目、CCOMOT中的听觉功能维度与术前患耳语频听力平均值(500-4000Hz)具有显著相关性(P<0.05);CCOMOT中的听觉功能维度(P<0.001)、心理健康维度(P<0.05)、量表总分(P<0.05)与术前健耳语频听力平均值(500-4000Hz)具有显著相关性;(4)患耳术前听力图的形状可分为全频率下降型和高频渐降型;结论手术可改善患者的生活质量,问卷调查为患者术前、术后生活质量评估提供了补充信息;对患者术前听力图进行分类,以期为术者评估听骨链状态提供一定参考。Objective We used questionnaires to survey quality of life and influencing factors in patients with middle ear cholesteatoma before and after surgery, and performed a cluster analysis to classify their pre-operative audiograms for relations to clinical treatment. Methods The Chinese version of the Chronic Otitis Survey Scale and the Chronic Otitis Media Evaluation Scale were used to retrospectively study 109 patients who met the inclusion and exclusion criteria and were treated during a period of from 2018 to 2019. Factors potentially affecting the quality of life of patients before and after surgery were evaluated by analyzing clinical variables using multi-factor logistic regression. Hierarchical cluster analysis was performed on pre-operative hearing threshold at different frequencies. Results(1) CCES showed that all dimensions and total scores were higher after surgery than before surgery(P<0.05). CCOMOT-15 results showed that, all dimensions and total scores were lower after surgery than before surgery(P<0.05) except auditory function which was unchanged;(2)The CCES scale indicated ear discharge as an independent risk factor affecting quality of life both before and after surgery(P<0.05);(3)The S1 item in the CCES symptom subscale, the auditory function dimension in CCOMOT and the average preoperative thresholds over whispering frequencies showed significant correlation. The auditory function dimension, mental health dimension and CCOMOT-15 total score showed a significant correlation with the average preoperative thresholds over whisper frequencies;(4) Preoperative audiograms of the affected ear could show full frequency falling or high frequency gradually falling patterns. Conclusion Surgery can improve quality of life in patients with middle ear cholesteatoma. Questionnaire surveys can provides supplementary information on quality of life before and after surgery. Cluster analysis can help classify audiogram morphology and provide a useful information for evaluating status of the ossicular chain.

关 键 词：中耳胆脂瘤 生活质量 聚类分析 

分 类 号：R764[医药卫生—耳鼻咽喉科]