伴有面神经异常的前庭窗闭锁患者内耳开窗术式的选择及疗效分析  

Selection of inner ear fenestration strategy and surgical effect of patients with oval window atresia accompanied by facial nerve aberration

作　　者：陈钟壡 汤若薇 谢静[1,2] 郭婧滢 赵鹏飞[3] 杨紫荆 王国鹏[1,2] 龚树生 Chen Zhongrui;Tang Ruowei;Xie Jing;Guo Jingying;Zhao Pengfei;Yang Zijing;Wang Guopeng;Gong Shusheng(Otolaryngology Head and Neck Surgery Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Clinical Center for Hearing Loss,Capital Medical University,Beijing 100050,China;Department of Radiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院耳鼻咽喉头颈外科中心,北京100050 [2]首都医科大学耳聋疾病临床诊治与研究中心,北京100050 [3]首都医科大学附属北京友谊医院放射科,北京100050

出　　处：《中华耳鼻咽喉头颈外科杂志》2024年第9期902-908,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的总结伴有面神经异常的前庭窗闭锁患者内耳开窗术式的选择, 并分析疗效。方法回顾性分析2015年1月至2023年3月首都医科大学附属北京友谊医院就诊的先天性中耳畸形患者的临床资料97例(132耳), 其中随访资料完整的患者39例(44耳), 男27例, 女12例;年龄7~48岁, 平均17.8岁;伴有面神经异常者且前庭窗闭锁患者14例(16耳), 不伴面神经异常者25例(28耳)。总结分析影像学表现、纯音测听结果、内耳开窗术式的选择、术中发现及术后听力改善情况, 使用Prism 9软件对手术前后患者的平均骨导及气骨导差进行统计学分析。结果 14例(16耳)伴有面神经异常且前庭窗闭锁的中耳畸形患者均表现为自幼听力差, 无面神经麻痹。术前行颞骨高分辨率CT(HRCT)检查及纯音测听、盖莱试验检查。记录统计患者锤骨、砧骨、镫骨、前庭窗及面神经5个部位的畸形情况。HRCT检查发现4个部位及以上畸形者12耳(75.0%)。术前纯音测听(0.5、1、2、4 kHz)骨导听阈为(15.3±10.4)dB HL, 气骨导差为(46.3±10.6)dB。根据面神经、听小骨畸形程度的不同, 对伴有面神经异常的14例(16耳)前庭窗闭锁患者实施了3种不同的内耳开窗手术, 其中砧骨-前庭窗开窗术7例, 锤骨-前庭窗开窗术7例, 鼓岬耳蜗开窗术2例。术后随访3~18个月, 患者无面神经麻痹。术后骨导听阈为(15.7±7.9)dB HL, 气骨导差为(19.8±8.5)dB。气骨导差在手术前后的差异有统计学意义(t=7.766, P<0.05), 手术前后骨导听阈差异无统计学意义(t=0.225, P=0.824)。伴与不伴面神经异常患者气骨导差缩小值之间差异无统计学意义(t=1.412, P=0.165)。3种术式之间疗效不存在明显差异。10 μm级耳科专用CT评估人工镫骨植入位置无明显移位。结论对于面神经不完全遮盖前庭窗的前庭窗闭锁患者可以依据听小骨畸形具体情况选择砧骨-前庭窗开窗术或锤骨-前庭窗开窗术, 对于面Objective:To summarize the clinical features and postoperative efficacy of patients with oval window atresia accompanied by facial nerve aberration.Methods:The clinical data of patients with congenital middle ear malformation with facial nerve aberration admitted to our hospital from January 2015 to March 2023 were retrospectively analyzed.There were 97 cases(133 ears)in total.Among them,39 patients(44 ears)had complete follow-up data,including 27 male patients and 12 females,aged 7-48 years old,with an average age of 17.8 years old.Of these,14 cases(16 ears)were patients combined with facial nerve aberration,and 25 cases(28 ears)were without facial nerve aberration.The results of imaging examination,pure-tone audiometry,selection of surgical strategy,intraoperative findings and postoperative hearing improvement were summarized and analyzed.The malformations of malleus,incus,stapes,oval window and facial nerve were recorded.Prism 9 software was used to statistically analyze the mean bone conductance and air-bone gap of patients before and after surgery.Results:All the 14 patients(16 ears)with middle ear malformation accompanied by facial nerve aberration and oval window atresia showed poor hearing and no facial palsy since childhood.High resolution CT(HRCT)examination of temporal bone,pure tone audiometry and Gelle test were performed before surgery.The malformations of malleus,incus,stapes,oval window and facial nerve were recorded.Preoperative high-resolution CT(HRCT)examination of temporal bone found 12 ears with 4 or more deformities,accounting for 75.00%,in the group of patients with facial nerve malformation.The preoperative average bone conductive threshold was(15.3±10.4)dB and the average air-bone gap was(46.3±10.6)dB in pure-tone audiometry(0.5,1,2,4kHz).According to the different degrees of facial nerve and ossicle malformation,we performed three different hearing reconstruction strategies for the 14 patients(16 ears)with facial nerve aberration and oval window atresia,including 7 ears of incus bypass

关 键 词：前庭窗闭锁 面神经异常 镫骨手术 耳科专用CT 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]