耳硬化症镫骨小窗技术后短期与中期听力效果的关系探讨  

Relationship between Short-term Hearing Results and Mid-term Hearing Outcomes after Stapedotomy in Patients with Otosclerosis

作　　者：方延青 陈兵[1] FANG Yanqing;CHEN Bing(TENT Institute and Department of Otorhinolaryngology,Eye&ENT Hospital,NHC Key Laboratory of Hearing Medicine,Fudan University,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院国家卫生健康委员会听觉医学重点实验室,上海200031

出　　处：《中华耳科学杂志》2022年第2期271-276,共6页Chinese Journal of Otology

基　　金：国家自然科学基金面上项目(82071048);优秀医师-优秀临床研究者计划(双优计划)(SYA202005 and SYB202005)~~。

摘　　要：目的 探讨临床耳硬化症患者镫骨小窗技术后短期与中期听力效果的关系。方法 回顾性分析我院45例耳硬化症并进行镫骨小窗技术的患者,所有患者均在术前1月内、术后1月内(Time-1)及术后1年内(Time-2)进行纯音测听,分析比较三次听力学资料。结果 患者在Time-1及Time-2的气导(AC)阈值、骨导(BC)阈值与术前听力水平有显著相关性(Time-1:AC:P=0.002, BC:P=0.003;Time-2:AC:P=0.012,BC:P=0.0001)。术后Time-1及Time-2两次听力结果之间亦有显著相关性(AC:P=0.001, BC:P=0.001)。AC、BC、气骨导差(ABG)阈值在术后1月显著改善(AC:P<0.001, BC:P<0.001, ABG:P<0.001),在术后1年内仍继续改善(AC:P<0.001, BC:P=0.01, ABG:P=0.04),差异均具有统计学意义。手术成功率从术后1月内84.4%,提高到术后1年内的93.3%。对于单频,术后AC在Time-1及Time-2时改善均以低频优于高频,术后BC改善在2kHz最显著(Time-1改善7dBHL, Time-2改善10.87dBHL)。约1/3患者在Time-1出现了轻微的BC听阈升高,大部分在Time-2改善良好。BC在高频(4kHz)的恢复迟于低频。结论镫骨小窗技术后1年内听力结果有持续改善的趋势,手术成功率亦随时间的延长而继续提高。患者在术后1月内听阈改善值分别为术后1年内的3倍(AC),1.3倍(BC)及4.3倍(ABG)。患者术后1月内的纯音测听结果能预估1年内的听力结果,约1/3患者Time-1时出现了轻微的BC听阈升高,但大部分在Time-2时改善良好。Objective To investigate the relationship between short-term hearing results and mid-term hearing outcomes after stapedotomy in patients with clinical otosclerosis. Methods Pure tone audiometry data collected within 1month before, 1 month(Time-1) and 1 year(Time-2) after stapedotomy in 45 patients with clinical otosclerosis were retrospectively analyzed and compared. Results Both air conduction(AC) and bone conduction(BC) thresholds at Time-1and Time-2 were significantly correlated with preoperative levels(P=0.002 and P=0.003 for Time-1, and P=0.012 and P=0.0001 for Time-2, respectively). AC and BC hearing results at Time-1 were also correlated with those at Time-2(P=0.001). AC and BC thresholds improved and air bone gap(ABG) was reduced at both Time-1(P<0.001), and Time-2(P<0.001, P=0.01 and P=0.04, respectively). Surgery was rated as successful at 84.4% at Time-1 and 93.3% at Time-2. AC threshold improvement at low frequencies was better than that at high frequencies at both Time-1 and Time-2. The greatest postoperative BC threshold improvement was at 2 kHz(7 dB at Time-1 and 10.87 dB at Time-2). About 1/3 of the patients showed mild BC threshold deterioration at Time-1, whereas most showed improvement at Time-2. Improvement of BC threshold at 4 kHz appeared later than that at low frequencies. Conclusion After stapedotomy, hearing shows a trend of continuous improvement within 1 year, with the rate of surgery success also increasing along with time. Compared to outcomes at one year, AC thresholds were better by 3 folds, BC thresholds by 1.3 folds and ABG by 4.3 folds,respectively, at 1 month after surgery, which may be used to predict hearing outcomes at one year. About 1/3 of these patients may experience early mild BC threshold deterioration with recovery at a later time.

关 键 词：纯音测听 镫骨小窗技术 随访时间 

分 类 号：R764[医药卫生—耳鼻咽喉科]