先天性外中耳畸形的诊断和治疗

Diagnosis and treatment of congenital abnormality in external and middle ear

目的：探讨先天性外、中耳畸形的特点，术前评估和治疗效果。方法：分析2000年6月～2005年6月接受手术治疗的先天性外耳道闭锁中耳畸形患者21例（22耳）的临床资料，全部患者均行外耳道鼓室成形术。结果：术中发现鼓室腔狭小16耳（72．7%）；听骨链畸形20耳（90．9％），其中锤砧骨畸形19耳（86．4％），镫骨畸形7耳（31．8％）；面神经畸形8耳（36．4％）；鼓室隔板1耳（4．5%）；垂直外耳道1耳（4．5％）。术后1个月平均语频听力提高〉15dB15耳（68．2％），其中提高≥30dB9耳（40．9％）。随访6个月～5年，听力保持在术后水平或有轻度提高者17耳，下降3耳，失访2耳。并发外耳道闭锁1耳，狭窄3耳，鼓膜外侧愈合2耳。结论：先天性外、中耳畸形表现复杂多样，术前详细的影像学和听力学评估是保证手术成功的前提，成形一个宽敞的外耳道、预防术后感染是防止外耳道再闭锁和狭窄的关键。

Objective：To investigate the clinical characters , methods of evaluation before surgery and effects of treatment of congenital abnormality in external and middle ear. Method： The data of 21 cases （22 ears） with congenital abnormalities in external and middle ear who received operation in ENT Department of the First Affiliated Hospital of Zhengzhou University during 5 years from June 2000 to June 2005 were analyzed. Result： Malformations of middle ear were presented in all cases. These mainly consisted of small tympanic cavities in 16 ears （72.7%）, ossicular chain anomalies in 20 ears （90.9%） and facial nerve abnomalities in 8 ears （36.4%）. The hearing improvement was observed in 15 ears （68.2%） after surgery, of which 9 ears had hearing improvement greater than 30 dB. Long term （0. 5-5 years） follow-up demonstrated that the hearing in 17 ears were kept unchanged after surgery. The postoperative complications were external auditory canal stenosis in 4 ears and lateralization of the tympanic membrane in 2 ears. Conclusion：Careful evaluation of the hearing and CT of congenical abnormalities of external and middle ear before operation are important. Maintenance of width of the external acoustic meatus and prevention of infection are crucial in the treatment of congenical abnormalities of external and middle ear.