不同类型听骨链病变的听力学特征与术后听力效果  

Audiological Characteristics in Different Types of Ossicular Chain Lesions and Postoperative Hearing Outcomes

作　　者：王宇[1] 罗慧文 鲁兆毅[1] 潘滔[1] WANG Yu;LUO Huiwen;LU Zhaoyi;PAN Tao(Department of Otolaryngology,Peking University Third Hospital,Beijing 100191,China;不详)

机构地区：[1]北京大学第三医院耳鼻咽喉头颈外科,北京100191 [2]福建医科大学附属南平第一医院耳鼻咽喉头颈外科

出　　处：《中华耳科学杂志》2024年第6期930-935,共6页Chinese Journal of Otology

基　　金：北京大学第三医院创新转化基金(BYSYZHKC2022111);北京大学第三医院海淀创新转化专项(HDCXZHKC2022211)。

摘　　要：目的研究纯音测听对听骨链病变类型的预测价值,以及不同类型听骨链病变患者听骨链重建术后的远期听力效果。方法回顾性分析2013年至2017年间于北京大学第三医院耳鼻咽喉头颈外科行鼓室成形及听骨链重建术的患者,按照术中发现的听骨链病变类型将其分为3组:(A)听骨链中断组,(BC)听骨链固定组,(D)听骨链完整而被病变包绕组。比较3组患者术前、术后的纯音测听结果,包括平均气导听阈(pure tone audiometry,PTA)、气骨导差(airbonegap,ABG)以及各频率的气、骨导阈值。结果入组92例患者,共计93侧耳,随访时间均大于6个月。3组患者术前PTA、ABG及各频率气导阈值均有统计学差异(P<0.05)。D组术前气导呈低频下降为主的听力曲线,骨导听力基本正常;A组与BC组术前气导呈平坦型下降曲线,伴有明显的中高频骨导下降。3组患者术后PTA、ABG均较术前显著降低(P<0.05),其中BC组阈值降低最明显,D组术后低频听阈基本恢复到正常范围。结论当听骨链中断且固定时,其听力损失主要由听骨链固定所致。听骨链固定引起的听力下降程度最重,骨气导间距最大,听骨链完整但被病变包绕引起的听力损失最轻。听骨链重建术能够有效改善患者的听力,其中听骨链固定的患者术后听力改善程度最明显。Objective To report pure tone audiometry characteristics in different types of ossicular chain lesions,and long-term hearing outcomes after ossicular chain reconstruction.Methods Patients who underwent tympanoplasty and ossicular chain reconstruction in our department from 2013 to 2017(n=92,93 ears)were grouped according to the type of ossicular chain lesions found during the operation,i.e.ossicular chain discontinuity(group A),ossicular chain fixation(group BC),and entrapment of continuous ossicular chain(group D).Pre-and post-operative PTA and ABG were compared among the 3 groups.Results Patients were follow-up for more than 6 months.The preoperative PTA,ABG and thresholds of each frequency were significantly different between 3 groups.In group D,air conduction thresholds showed mainly low frequency damaged preoperative and normal bone conduction thresholds,compared to flat air conduction thresholds decline and significant middle and high frequency bone conduction decline in groups A and BC.Postoperative PTA and ABG significantly improved in all three groups(P<0.05),especially in group BC,with low-frequency hearing thresholds essentially restored to within normal in group D.Conclusion When ossicular chain fixation and discontinuity coexist,hearing loss is mainly caused by fixation,causing the most severe hearing loss with the largest ABG,whereas entrapment of a continuous ossicular chain causes the least severe hearing loss.Ossicular chain reconstruction can effectively improve hearing,with patients with fixed ossicular chain showing the best improvement.

关 键 词：听骨链 听骨链重建 纯音测听 平均气导听阈(PTA) 气骨导差(ABG) 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]