先天性外耳道闭锁听力重建术的疗效分析  

Auditory Rehabilitation Surgery for the Treatment of Congenital Aural Atresia

作　　者：伍伟景[1] 胡鹏[1] 任基浩[1] 谢鼎华[1] 卢永德[1] 田丰[1] 陈忠[1] 

机构地区：[1]中南大学湘雅二医院耳鼻咽喉科和听力研究室,长沙410011

出　　处：《听力学及言语疾病杂志》2003年第3期177-179,共3页Journal of Audiology and Speech Pathology

摘　　要：目的　对先天性外耳道闭锁听力重建术的疗效进行评估。方法　回顾分析 1990～ 2 0 0 1年手术治疗的先天性外耳道闭锁患者 36例 (38耳 ) ,按Altmann分型法分为Ⅰ型畸形 11耳 ,Ⅱ型 2 3耳 ,Ⅲ型 4耳。手术采取上鼓室 -鼓窦进路 17耳 ,乳突前上进路 2 1耳 ,根据外耳道、鼓室和听骨链发育情况分别行单纯外耳道成形术或外耳道 -鼓室成形术。结果　术后 2周语频听力提高 15dB以上者 2 9耳 (76 % ) ,其中听力改善 30dB以上、气 -骨导间距小于 15dB者 14耳 (37% ) ,术后听力无明显好转者 9耳 (2 4 % )。术后随访 1年以上听力改善者 2 4耳 (6 3% )。术后并发外耳道再狭窄 2耳、鼓膜外侧移位 6耳、不完全性面瘫 6耳和轻度感音神经性聋 1耳。结论　听力重建术是治疗先天性外耳道闭锁的有效手段 ,其效果与患耳畸形程度、手术方式及术后并发症有关。术前全面评估听力水平和影像学检查。Objective To evaluate the efficacy of auditory rehabilitation surgery for the treatment of congenital aural atresia. Methods Thirty-six patients (38 ears) with congenital aural atresia underwent auditory rehabilitation surgery between 1990 and 2001,were retrospectively analyzed among them,11 cases were diagnosed as Altmann Grade Ⅰ, 23 as Grade Ⅱ and 4 as Grade Ⅲ. Transmastoid or anterior approaches were applied in 17 and 21 patients, respectively.Operations of simple canaloplasty or canal-tympanoplasty were performed according to the development of external auditory canal, tympanum and ossicle chain.Results Two weeks after operation, 29 ears (76%) showed hearing improvement more than 15 dB, in which hearing increases above 30 dB and air-bone conduction gap less than 15 dB were shown in 14 ears (37%), and the remaining 9 ears (24%) had no hearing amelioration. Long-standing hearing improvement in an over-one-year follow-up period was demonstrated in 24 ears (63%). The surgical complications included canal restenosis, tympanic membrane lateralization, facial palsy and sensorineural hearing loss.Conclusion Auditory rehabilitation surgery is efficacious for congenital aural atresia. The factors influencing the outcome of operation include the degree of deformity, surgical technique and complications. An overall preoperative assessment such as audiological and radiological evaluation, detection of the atretic tympanum and prevention of complication are the key points to obtain satisfactory hearing improvement.

关 键 词：先天性外耳道闭锁 听力重建术 疗效 外耳道畸形 术后并发症 手术方式 

分 类 号：R764.91[医药卫生—耳鼻咽喉科]