单侧听力耳鼓室成形术的临床探讨

Clinical Observation of Tympanoplasty Performed on Patients with Unilateral Hearing

目的分析单侧听耳患者的鼓室成形术，了解手术方法和手术疗效。方法对9耳慢性化脓性中耳炎胆脂瘤型进行了乳突根治术加鼓室成形术，对37耳慢性化脓性中耳炎单纯型和中耳炎后遗症进行鼓室成形术，并比较术后效果。手术后3个月～1年之间进行术后听力评价。结果46耳单侧听力耳术前言语频率气导平均听阈为60．2±23．1dBHL，骨导听阈35．7±17．0dBHL；手术后的平均气导听阈为51．3±22．6dBHL，骨导听阈为36．3±10．6dBHL。鼓室成形术后疗效评定：37耳外耳道宽敞，人工鼓膜完整，血运好，近正常鼓膜色泽；纯音测听500～2000Hz平均气导听力改善23例（62．16％，23／37），听力不变13例（35．14％，13／37），听力恶化（下降10dB以上）1例（2．70％，1／37）。乳突根治术加鼓室成形术后疗效评定：9耳术腔干洁，人工鼓膜完整，血运好，近正常鼓膜色；纯音测听500～2000Hz平均气导听力改善5例（56．56％，5／9），听力不变4例（44．44％，4／9）。结论各型慢性化脓性中耳炎都可作为单侧听力耳的手术适应症。手术时只要注意手术技巧，认真仔细，一般不会造成手术后骨导听力的下降。术后干耳和保持原有听力是手术的最终目的。

Objective To observe the effect of tympanoplasty on the treatment for the patient with unilateral heating and to discuss the various operation employed. Methods From 1999 to 2003, tympanoplasty was performed on 46 patients with uniteleral hearing at Ear Nose Thoat Head - Neck Sugery of Beijing Tong Ren Hospital. The heating was evaluated during 3 months to one year after operation. Results The pure tone test showed that the average air conduction thresholds of 60.2 ± 23.1 dB HL and hone conduction threshold of 35.7 ± 17.0 dB HL before operation, and 51.3 ± 22.6 dB HL and 36.3 ± 10.6 dB HL after operation respectively. The effect evaluation showed that the average air conduction threshold was improved in 23 case（ 62.16% ）, unchanged in 13 ones（35.14%） and decreased in lease（2,70%） after tympanoplasty,while it was improved in 5 case（55.56%）, unchanged in 4 ones（44.44% ） after tympanoplasty together with radical mastoidectomy. Conelusion Each chronic purulent middie ear infection can be regarded as the clinical symptom of unilateral hearing. The postoperation effect is designated for dry ear and original heating remaining.