非I型鼓室成形术后耳鸣相关因素分析  

Factors Affecting Tinnitus Following Non-TypeⅠTympanoplasty

作　　者：周亚光 翟毓红[2] 郭莉 陈彦文 曹现宝 陈显权 郑天娥 ZHOU Yaguang;ZHAI Yuhong;GUO Li;CHEN Yanwen;CAO Xianbao;CHEN Xianquan;ZHENG Tiane(The 920th Hospital of Joint Logistics Support Force,PLA,Kunming 650032,China)

机构地区：[1]联勤保障部队第九二〇医院耳鼻咽喉头颈外科,昆明650032 [2]云南省中医中药研究院附属医院 [3]云南省第一人民医院耳鼻咽喉头颈外科

出　　处：《中华耳科学杂志》2024年第5期740-743,共4页Chinese Journal of Otology

基　　金：联勤保障部队第九二O医院院内科技计划(2020YGB09)。

摘　　要：目的分析因中耳疾病伴传导性耳聋行非Ⅰ型鼓室成形术后耳鸣的情况,探讨非Ⅰ型鼓室成形术后发生耳鸣的影响因素和改进策略。方法回顾分析2009年5月至2020年3月于联勤保障部队第九二○医院耳鼻咽喉头颈外科收治的各类传导性耳聋患者,所有患者均系同一术者在全麻下行Ⅱ、Ⅲ型鼓室成形或Piston术。分析Ⅱ、Ⅲ型鼓室成形和Piston术后耳鸣发生的时间特征、发生率以及听力恢复与术后耳鸣的情况,比较Ⅱ型中用或不用锤骨柄和砧骨长脚术后耳鸣的发生差别。结果术后耳鸣发生时间特征:标准Ⅱ型和Piston多发于术后1月,随听力的恢复有些可改善;非标准Ⅱ型、Ⅲ型多发于术后3月内;除标准Ⅱ型外,其他三型,甚至一年内都存在迟发性耳鸣;术后3月Ⅱ13组(标准Ⅱ型组术后随访3个月,耳鸣改善13例)较Ⅱ9组(标准Ⅱ型组术后随访3个月,耳鸣未改善9例)气导(air conduction,AC)听力提高和骨气导差(air-bone-gap,ABG)缩小均较明显(P<0.05);标准Ⅱ型术后耳鸣发生率低于后三者,存在显著差别,且气导听力提高和ABG缩小均较非标准Ⅱ型和Ⅲ型明显(P<0.05),但与Piston相较则差别不明显(P>0.05)。结论重视锤骨柄、砧骨长脚在各型鼓室成形中的利用,避免PORP通过软骨垫直接与筋膜硬性相联,术中尽量保留听韧带和镫骨肌,以达术后鼓室及听骨链的顺应性,倡导谐性鼓室成形理念,对TORPⅢ型并发症需进一步临床研究。Objective To report characteristics of tinnitus in patients with middle ear disease and conductive deafness after non-typeⅠtympanoplasty,and factors that may affect postoperative tinnitus as well as management strategies.Methods Data from patients with conduction deafness admitted to the Department of Otolaryngology,Head and Neck Surgery,920th Hospital of the Joint Logistics Support Force from May 2009 to March 2020 who were treated with typeⅡorⅢtympanoplasty or Piston procedure under general anesthesia by the same surgeon were retrospectively analyzed,including the timing and incidence of tinnitus and the correlation between tinnitus and hearing recovery,as well as between postoperative tinnitus and use of manubrium of the malleus or long process of incus inⅡtympanoplasty.Results Following standard typeⅡtympanoplasty and Piston procedure,tinnitus mostly occurred within 1 month and might improve along with hearing recovery.In non-standard typeⅡand typeⅢtympanoplasty,tinnitus mostly occurred within 3 months.Except for standard typeⅡtympanoplasty,tinnitus could occur in as late as one year.At 3 months,cases with tinnitus improvement showed better air conduction(AC)hearing and Air-bone-gap(ABG)improvement than those with persisting tinnitus(P<0.05).Standard typeⅡtympanoplasty was associated with lower incidence of tinnitus and better improvement of air conduction hearing and ABG as compared to non-standard typeⅡand typeⅢtympanoplasty(P<0.05),but not Piston procedure(P>0.05).Conclusion Our results emphasize the use of malleus manubrium and long process of incus in tympanoplasty.Avoiding direct coupling of PORP with the fascia via cartilage graft and preservation of ligaments and stapedius muscle may help achieve tympanic and ossicular chain compliance.The concept of coherent tympanoplasty is important and further research is needed for complications after TORP typeⅢtympanoplasty.

关 键 词：术后耳鸣 谐性鼓室成形 硬性鼓室成形 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]