慢性化脓性中耳炎患者的术前术后听力分析  

Pre-and post-operative hearing in patients with chronic suppurative otitis media

作　　者：刘雯宇 李光启[1] LIU Wenyu;LI Guangqi(Otorhinolaryngology Hospital,First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院耳鼻咽喉科医院,广州510080

出　　处：《中华耳科学杂志》2024年第4期557-561,共5页Chinese Journal of Otology

摘　　要：目的通过收集慢性化脓性中耳炎患者的术前术后的纯音测听数据,分析其听力在术后不同时期不同频率的恢复情况。方法回顾性分析2019年1月至2022年8月在中山大学附属第一医院耳鼻咽喉科医院收治的慢性化脓性中耳炎患者54例,共56耳,所有患者术前均接受了乳突CT、耳内镜检查和纯音测听检查及术后定期门诊观察鼓膜愈合情况和进行纯音测听,并分析其术后不同时期的气导(AC)、骨导(BC)及气骨导差(ABG)的变化情况。结果患者各频率的ABG在术前及术后均有差异性(P<0.05);比较术后不同时期气导均值,差异有统计学意义(P<0.05);比较500 Hz和1000 Hz的ABG在术后不同时期的差异有统计学意义(P<0.05);2000 Hz的ABG在术后不同时期的差异无统计学意义(P>0.05)。进一步按术中是否置入人工听骨分组,比较术前500 Hz、1000 Hz和4000 Hz的ABG差异有统计学意义(P<0.05);比较术前术后各频率各时期的气导均值差异均有统计学意义(P<0.05)。结论慢性化脓性中耳炎各个频率的听力损失及术后听力恢复是有差异的,有人工听骨置入者术前听力较差,且500 Hz、1000 Hz和4000 Hz的ABG大于无人工听骨置入者;术后各频率的恢复的时间也有差异,患者的听力总体上会在术后3~6个月内得到提高并维持稳定;其中,2000 Hz的听力在术后1~2月稳定,500 Hz、1000 Hz听力提高的时间需要延长至术后3~6个月。Objective To report hearing recovery at different frequencies and at different periods by review of tone audiometry data before and after surgery in patients with chronic suppurative otitis media.Methods Data from patients with chronic suppurative otitis media(n=54,56 ears)admitted to the Department of Otolaryngology,First Affiliated Hospital of Sun Yat-sen University,from January 2019 to August 2022,were retrospectively analyzed.All patients received mastoid CT,otoendoscopy and pure tone audiometry before surgery,and regular outpatient observation of tympanic membrane healing and pure tone audiometry after surgery.Changes of air conduction(AC)and bone conduction(BC)thresholds and air bone gap(ABG)were analyzed.Results Changes of ABG at all frequencies after surgery were noticed(P<0.05),along with significant changes in air conduction thresholds at various postoperative time points(P<0.05).In particular,postoperative ABG changes were statistically significant at 500 Hz and 1000 Hz(P<0.05),but not at 2000 Hz(P>0.05).When artificial ossicle protheses were used during the operation,postoperative ABG showed significant differences at 500 Hz,1000 Hz and 4000 Hz(P<0.05),with significant changes in air conduction thresholds at all frequencies(P<0.05).Conclusion Postoperative hearing recovery can be variable at different frequencies in patients with chronic suppurative otitis media.Patients requiring artificial ossicle implantation tend to have worse preoperative hearing with greater ABG at 500 Hz,1000 Hz and 4000 Hz.While hearing recovery may vary along with frequency and time,overall,hearing improvement stabilizes and remains stable around 3 to 6 months after surgery.Particularly,hearing at 2000 Hz stabilizes within 1 to 2 months after surgery,while hearing improvement at 500 Hz and 1000 Hz may take 3 to 6 months.

关 键 词：慢性化脓性中耳炎 纯音测听 气骨导差 听力恢复 

分 类 号：R764.92[医药卫生—耳鼻咽喉科]