不同气骨导差混合性听力损失耳硬化症患者手术疗效分析  

Comparative study of surgical effects on patients with mixed deafness and otosclerosis with different air bone conduction differences

作　　者：张帅[1] 贺楚峰[1] 蔡鑫章[1] 蒋璐[1] 吴学文[1] 金毅[1] 梅凌云[1] Zhang Shuai;He Chufeng;Cai Xinzhang;Jiang Lu;Wu Xuewen;Jin Yi;Mei Lingyun(Department of Otorhinolaryngology Head and Neck Surgery,Xiangya Hospital,Central SouthUniversity,Key Laboratory of Otorhinolaryngology,Hunan Province,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院耳鼻咽喉头颈外科耳鼻咽喉重大疾病研究所湖南省重点实验室,长沙410008

出　　处：《中华耳鼻咽喉头颈外科杂志》2023年第7期666-671,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金(81873705,82171154)。

摘　　要：目的分析术前不同气骨导差(air-bone gap,ABG)混合性听力损失耳硬化症患者的手术疗效,为耳硬化症手术的预后评估提供参考。方法收集2013年11月至2020年5月在中南大学湘雅医院接受镫骨小窗技术人工镫骨植入手术、术前表现为混合性听力损失的耳硬化症患者的临床资料,共108例(116耳),其中女性71例(76耳),男性37例(40耳),平均年龄38.5岁。根据术前纯音测听ABG将其分为三组:S组,15 dB≤ABG<31 dB,共39耳;M组,31 dB≤ABG<46 dB,共58耳;L组,ABG≥46 dB,共19耳。采用SPSS 24.0统计软件比较分析三组患者术后6~12个月时的听力结果。结果术后有3耳(S组2耳,L组1耳)出现严重的感音神经性听力损失,未纳入统计分析。各组耳硬化症患者术后纯音听阈较术前均有明显改善,平均气导阈值改善(21.6±13.4)dB,术前、术后比较,差异具有统计学意义(t=17.13,P<0.01);平均骨导阈值改善(3.7±7.6)dB,术前、术后比较,差异具有统计学意义(t=5.20,P<0.01);术后ABG为(18.3±9.3)dB,较术前(36.2±8.6)dB明显缩小。三组患者中L组气导阈值改善量最大[(29.9±10.8)dB],S组的改善量最小[(15.7±11.4)dB]。术后气导和骨导纯音听阈三组间比较,差异均无统计学意义(P值均>0.05)。S组术后ABG最小[(16.5±9.0)dB],L组术后ABG最大[(20.5±10.0)dB]。与S组相比,M组和L组术后在2000 Hz处仍遗留较大的ABG。S组和M组术后骨导阈值较术前均有一定改善(P值均<0.01)。结论手术能使不同术前ABG的混合性听力损失耳硬化症患者获益:术前ABG小的患者手术效果较好,术后各频率ABG闭合理想;术前ABG大的患者手术能明显提升气导阈值,但某些频率术后仍可能遗留一定的ABG。手术对骨导阈值的改善效果不明显。应结合患者实际情况,告知其助听器等治疗方法以供患者选择。Objective To analyze the surgical efficacy of patients with mixed hearing loss and otosclerosis with different air bone gap(ABG)before surgery,and to provide reference for the prognosis evaluation of otosclerosis surgery.MethodsThe clinical data of 108 cases(116 ears)of otosclerosis who had undergone stapes fenestration technique artificial stapes implantation in Xiangya Hospital of Central South University from November 2013 to May 2020 and had mixed hearing loss before surgery were collected,including 71 women(76 ears)and 37 men(40 ears),with an average age of 38.5 years.According to preoperative pure tone audiometry ABG,they were divided into three groups:group S,15 dB≤ABG<31 dB,a total of 39 ears;group M,31 dB≤ABG<46 dB,a total of 58 ears;and group L,ABG≥46 dB,19 ears in total.The hearing outcomes of three groups of patients at 6-12 months after surgery were compared and analyzed using SPSS 24.0 statistical software.ResultsA total of 3 patients(group S:2 cases;group L:1 case)experienced severe sensorineural hearing loss after surgery and were not included in the statistical analysis.After surgery,the pure tone hearing threshold of patients with otosclerosis in each group was significantly improved compared to before surgery,with an average air conduction threshold improvement of(21.6±13.4)dB.The difference between before and after surgery was statistically significant(t=17.13,P<0.01).The average bone conduction threshold improved by(3.7±7.6)dB,and the difference was statistically significant before and after surgery(t=5.20,P<0.01).The postoperative ABG was(18.3±9.3)dB,which was significantly reduced compared to preoperative(36.2±8.6)dB.Among the three groups of patients,the L group had the highest improvement in air conduction threshold[(29.9±10.8)dB],while the S group had the lowest improvement[(15.7±11.4)dB].There was no statistically significant difference in post operative pure tone hearing thresholds between the three groups(P>0.05).The postoperative ABG in group S was the smallest[(16.5±9.0

关 键 词：耳硬化病 听觉丧失 混合传导感音神经性 测听法 纯音 气骨导差 镫骨外科手术 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]