镫骨小窗技术对耳硬化症患者频率特异性骨导超闭合的影响  

Effects of Stapedotomy on Frequency-Specific Bone Conduction Overclosure in Patients With Otosclerosis

作　　者：张坤 陈兵[1] 方延青 ZHANG Kun;CHEN Bing;FANG Yanqing(ENT institute and Department of Otorhinolaryngology,Eye&ENT Hospital,NHC Key Laboratory of Hearing Medicine,Fudan University,Shanghai,200031,China;Department of Otorhinolaryngology,Qilu Hospital,Shandong University,Jinan,Shandong,250012,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻喉科,上海200031 [2]山东大学齐鲁医院耳鼻咽喉科,济南250012

出　　处：《中华耳科学杂志》2022年第1期88-92,共5页Chinese Journal of Otology

基　　金：国家自然科学基金:81700925;复旦大学附属眼耳鼻喉科医院“优秀医师-优秀临床研究者”项目:SYB202005。

摘　　要：目的评估镫骨小窗技术对耳硬化症患者频率特异性骨导超闭合的影响。方法回顾性分析我院130例诊断为耳硬化症并进行镫骨小窗技术的患者。收集患者术前及术后的纯音测听资料,按照术前骨导(BC)是否≤25 dB HL,把患者分为骨导正常组(normal BC,N-BC)及骨导阈值升高组(increased threshold BC,IT-BC);并根据各频率是否有骨导阈值升高分为亚组。比较术后各频率亚组之间,骨导的超闭合率(Overclosure rate,OR),显著超闭合率(Significant overclosure rate,SOR),骨导恶化率(Deterioration rate,DR),显著恶化率(Significant deterioration rate,SDR)以及相应的阈值的差异是否有统计学意义。结果5例缺乏随访资料被剔除,共纳入125例病人,其中76例为N-BC组,49例为IT-BC组。所有IT-BC亚组的OR、SOR、超闭合阈值、显著超闭合阈值(除外1kHz)优于N-BC亚组(P<0.05)。DR,SDR及相应的阈值在平均(PTA)水平差异无统计学意义。术后成功率差异在PTA水平及各频率亚组水平无统计学意义(P>0.05)。结论小窗技术对于术前骨导阈值升高的临床耳硬化患者仍具有同样的手术效果。在频率相关性听力结果中,骨导超闭合在所有频率的IT-BC亚组均显著优于N-BC亚组;在术前具有骨导阈值升高患者的言语频率,约50%以上的术后骨导改善超过10 dB。Objective To determine effects of stapedotomy on overclosure of frequency-specific bone conduction(BC)in patients with otosclerosis.Methods We conducted a retrospective analysis of 130 cases of otosclerosis treated with stapedotomy in our hospital.Pre-and postoperative audiometry were collected and preoperative BC threshold was classified as“normal”if≤25 dB HL(N-BC group)or otherwise as“increased”(IT-BC group).Cases were further subgrouped based on preoperative BC levels at specific frequencies.The rate of overclosure(OR),significant overclosure(SOR),deterioration(DR)and significant deterioration(SDR)were compared among the sub-groups to access frequency-specific outcomes.Results A total of 125 patients were included,of which 76 were in the N-BC group and 49 in the IT-BC group,after excluding 5 cases for incomplete data.In all IT-BC sub-groups,the OR,SOR and frequency-specific thresholds were significantly better than those in the corresponding N-BC sub-group(P<0.05),except for SOR at 1 kHz.As measured by the pure tone average(PTA),DR,SDR and their corresponding thresholds were not significantly different between the N-BC and IT-BC groups or among different subgroups(P>0.05).Conclusion Stapedotomy was efficient and safe in patients with otosclerosis with or without preoperative increase of BC thresholds.Frequency-specific overclosure was more obvious in IT-BC sub-groups than in N-BC subgroups.In about 50%of patients with preoperatively increased BC thresholds,BC thresholds at speech frequencies showed significant overclosure(i.e.≥10 dB improvement)postoperatively.

关 键 词：超闭合 骨导 镫骨小窗技术 

分 类 号：R764[医药卫生—耳鼻咽喉科]