耳科手术中电钻噪声所致内耳声损伤的防治

The prevention and cure of inner ear sound trauma due to electric drill noise in middle ear and mastoid surgery

目的观察电钻性能的改善、缩短电钻噪声暴露时间和药物干预对电钻噪声所致内耳声损伤的防护作用。方法总结1995年前病例24例,1995年后92例。1995年后的患者随机分组,对照组44例,术后常规治疗;治疗组48例,术后除常规治疗外,同时给予ATP80mg/d和辅酶A100u/d静脉滴注,阿米三嗪30mg、萝巴新10mg(都可喜1片)2次/d口服,持续一周。将对照组分别与1995年前病例和1995年后同期病例中的治疗组比较。结果1995年前和1995年后的对照组4kHz平均骨导听力损失分别为18.96±3.22dB和16.02±4.62dB,差异显著;平均骨导听力损失大于15dB的发生率分别为33.3%(8/24例)和11.4%(5/44例),差异显著。1995年后病例的对照组和治疗组间的比较表明,2、4kHz和平均骨导听力下降程度对照组明显重于治疗组;2、4kHz和平均骨导听力下降大于15dB的例数在对照组显著多于治疗组。结论选用性能良好的电钻、尽量使用高转速、缩短电钻使用时间以及电钻噪声暴露后及时给予药物干预治疗可以显著的减轻术后感音神经性聋发生的可能性和严重程度。

Objective To explore effective methods of prevention and cure of inner ear sound trauma due to electric drill noise during middle ear and mastoid surgery. Methods 24 cases before 1995 and 92 cases after 1995 were included in the study. The 92 cases were grouped randomly into therapy and control group. The control group cases were treated ordinarily , and the therapy group cases were given ATP and coenzyme A by intravenous injection and duxil taken orally. Control group were comparion with the cases before 1995 and the therapy group. Results The 4kHz threshold shift of bone conduction were 16.02±4.62dB and 18.96±3.22dB in control group and the cases before 1995, respectively. The incidences of average threshold shift more than 15dB were 11.4%(5/44 cases) and 33.3%(8/24 cases) in the control group and the cases before 1995, respectively. The threshold shift of 2kHz, 4kHz and average bone conduction in the control group were more than that in the therapy group. And the incidences of 2kHz, 4kHz and average bone conduction threshold shift more than 15dB in the control group were more than that in the therapy group. Conclusion The study suggest that selecting quality electric drill, using higher rotate speed, shorting time of expose to drill noise and medication can obviously reduce the possibility and severity of sensorineural deafness in middle ear and mastoid surgery.