鼓索神经对听骨链重建术中纯音听阈测试结果的比较

Results of chorda tympani nerve application or no in tympanoplasty

目的:论证鼓索神经对听骨链重建的作用。方法:141例(154耳)患者分成3组:①鼓索神经弹压组(索弹组)35例(41耳)。鼓膜穿孔,鼓索尚存,臼柱即PORP或枪柱即TORP都在听骨外侧横行磨一细槽,嵌入鼓索神经,使鼓索神经能稳定弹压听骨,不使其移位。②残余鼓膜弹压组(膜弹组)67例(72耳)。用鼓膜弹压听骨。③无弹压组(无弹组)39例(41耳)。3组分别进行术前、术后气骨导差(ABG)自身配对St检验,并作术后ABG差值的两两对比和St检验。结果:显效、有效、无效率索弹组分别为:29.3%,51.2%,19.5%;膜弹组分别为:22.2%,50.0%,27.8%;无弹组分别为:19.5%,36.6%,43.9%;与无弹组比较,均P<0.01。索弹组和膜弹组的术前、后ABG差值分别与无弹组比较,均P<0.05。索弹组1耳术后有暂时味觉减退,1耳有迟发性轻度面瘫,均2周内自愈。结论:索弹听骨能使听骨稳定,获得良好的听力改善,不必二期手术;也不产生味觉及面神经功能障碍。

Objective：To demonstrate the effect of chorda tympani nerve used in tympanoplasty. Method： One hundred and forty-one cases （154 ears） were divided into 3 groups： ①chorda applying group （CA） 35 cases （41 ears）： had perforation in pars tensa but chorda nerve still exist, the nerve were applied to spring and press a PORP or TORP prosthesis which were made by auto-osseous tissue and had a fine groove for nerve inlay. ②residual pars tensa applying group （RTP） 67cases （72 ears） ： residual pars tensa was used to spring and press prosthesis. ③no applying group （NA） 39 cases （41 ears）. The effect measurement： ABG over 30 dB as excellent over 15 dB as effective; less than 10 dB as noneffective. Three groups were analyzed by S- t test. Result： Excellent, effective and noneffective ears（%） ;CA group： 29.3%, 51.2%, 19.5%;RPT group： 22.2%, 50.0%,27.8%;NA group： 19.5 %, 36.6 %, 43.9 %; the previous two groups contrast with NA group, P 〈0.01. Pre-and post-operation ABG odds and paired contract：CA and NA, P 〈0.05;RTP and NA, P 〈0.05. In CA group only one ear had taste letdown temporarily and another ear had delayed and mild facial paralysis, both were auto-recovered within two weeks. Conclusion：Chorda tympani nerve applied in tympanoplasty for spring and press prosthesis can make PORP or TORP prosthesis more steady and improve hearing.