儿童非炎症性传导性聋的病因分析与诊治  

Etiology analysis and diagnosis of noninflammatory conductive hearing loss in children

作　　者：许信达[1] 李蕊叶 周晓莉 李文妍[1] XU Xinda;LI Ruiye;ZHOU Xiaoli;LI Wenyan(Department of Pediatric Otolaryngology,Eye&ENT Hospital,Fudan University,Shanghai Auditory Medical Center,NHC Key Laboratory of Hearing Medicine Research,Shanghai,200031,China;Department of Otolaryngology of Traditional Chinese Medicine Hospital,Linwei District,Weinan City,Shaanxi Province)

机构地区：[1]复旦大学附属眼耳鼻喉科医院小儿耳鼻喉科、上海市听觉医学临床中心、卫生部听觉医学重点实验室,上海200031 [2]陕西省渭南市临渭区中医医院耳鼻喉科

出　　处：《临床耳鼻咽喉头颈外科杂志》2023年第3期206-212,共7页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家自然科学基金(No:81922018,82271170,81700915);上海市“医苑新星”青年医学人才培养资助计划(2020[No.87])。

摘　　要：目的:探讨非炎症性传导性聋患儿的病因组成,诊疗特点及疗效。方法:回顾分析2019年1月—2022年11月于复旦大学附属眼耳鼻喉科医院住院并接受手术治疗的非炎症性传导性聋患儿资料。结果:共纳入179例(189耳)患儿。患耳主症状分布频率由高到低依次为耳闷、听力下降、耳痛、面瘫。听力下降程度分布为:轻度34耳(19.5%),中度70耳(40.2%),中重度52耳(29.9%),重度18耳(10.3%)。耳硬化症的平均听阈相对最高,为(63.5±7.8)dB HL,听骨链畸形的平均气骨导差最大,为(35.4±9.8)dB HL。全组患耳平均气导听阈为(50.4±14.5)dB HL,气骨导差为(30.3±10.4)dB HL;术后分别恢复至(36.1±14.5)dB HL和(20.0±8.6)dB HL,效果显著。听骨链重建手术方式分布:TORP 88耳(46.6%)、PORP 49耳(25.9%)、人工镫骨8耳(4.2%)、自体听骨重建9耳(4.8%)、听骨链松解35耳(18.5%)。在病因诊断上,CT对先天性中耳胆脂瘤的诊断率最高;在听小骨异常的诊断上,CT对锤骨和砧骨的诊断率更高。从家长代诉的症状出现时间到手术探查的时间,平均历时(2.2±2.9)年,先天性中耳胆脂瘤、听骨链畸形、耳硬化症、鼓室硬化分别为(1.3±1.7)年、(5.2±4.2)年、(4.4±4.1)年和(5.4±0.9)年,听骨链畸形、耳硬化症、鼓室硬化的诊断需要更长时间。结论:在儿童非炎症性传导性聋疾病诊疗中,结合详细病史、专科检查和影像学检查,能够最大程度提高诊断准确率,达到个性化综合治疗的目的。时机合适的手术介入是清除病灶和提高听力的重要方法。Objective: To investigate the etiology, diagnosis and treatment of noninflammatory conductive hearing loss in children. Methods: The clinical data of children patients admitted to the Eye & ENT Hospital of Fudan University from January 2019 to November 2022 were retrospectively analyzed. Results: A total of 179 cases(189 ears) were analyzed. The main symptoms from high to low were: ear tightness, hearing loss, earache, and facial paralysis. The degree of hearing loss was mild in 34 ears(19.5%), moderate in 70 ears(40.2%), moderate-severe in 52 ears(29.9%), severe in 18 ears(10.3%). The mean hearing threshold of otosclerosis was the highest(63.5±7.8) dB HL, and the mean air-bone gap of ossicular chain malformation was the largest(35.4±9.8) dB HL. The mean hearing threshold of the affected ear was(50.4±14.5) dB HL, and the mean air bone gap was(30.3±10.4) dB HL. After operation, the results were(36.1± 14.5) dB HL and(20.0±8.6) dB HL, respectively. Distribution of surgical methods for ossicular chain reconstruction: 88 ears(46.6%) of TORP, 49 ears(25.9%) of PORP, 8(4.2%) ears of Piston, 9 ears(4.8%) of autogenous ossicular reconstruction, and 35 ears(18.5%) of ossicular chain relaxation. CT diagnostic rate showed more sensitivity to malleus and incus abnormalities, the diagnosis rate of congenital middle ear cholesteatoma was the highest. The mean duration time of diagnosis was(2.2±2.9) years, while the diagnosis of ossicular chain malformation([5.2±4.2]years), otosclerosis([4.4±4.1]years), tympanosclerosis([5.4±0.9]years) took longer. Conclusion: In the diagnosis and treatment of noninflammatory conductive hearing loss in children, the combination of detailed medical history, specialized examination and imaging examination can maximize the accuracy of diagnosis and achieve the purpose of personalized comprehensive treatment. Surgical intervention with appropriate timing is important to remove lesions and improve hearing.

关 键 词：儿童 传导性聋 计算机断层扫描 先天性中耳胆脂瘤 耳硬化症 听骨链畸形 治疗 

分 类 号：R764.43[医药卫生—耳鼻咽喉科]