118例鼓室硬化临床资料分析

Clinical analysis of 118 patients with tympanosclerosis

目的通过临床资料分析,探讨鼓室硬化的发病情况及影响听力的主要因素。方法回顾性总结2004年1月至2009年5月我科收治的118例(137耳)鼓室硬化病例,265例(311耳)慢性化脓性中耳炎的病例列为对照组,比较患病年龄、病程长短、性别构成的差别。进一步分析鼓室硬化的病变部位和听力改变的特点。结果(1)鼓室硬化女性患病年龄较大,患病率较高。(2)不同部位病变的发生率由高到低是:鼓膜、锤骨、砧骨、锤砧关节、其它部位、砧镫关节、镫骨。(3)纯音听阈检查听骨链有硬化或破坏的听力较差(P<0.05);女性较男性听力差(P<0.05)。Carhart切迹和气导听力倒"V"形曲线出现率接近。听力损失影响因素按比重,从大到小顺序为:砧骨、锤骨、锤砧关节、砧镫关节、镫骨、伴发病变、其它部位病变、鼓膜、性别。结论性别可能是鼓室硬化发病的影响因素之一。骨导carhart切迹与气导听力倒"V"形曲线可能是鼓膜和听骨链钙化的标志。听骨链病变对听力影响严重,处理好听骨链的重建是手术成败的关键。

objective To study the incidence of tympanosclerosis（TS） and the major risk factors of hearing loss.Method A total of 118 TS patients（137 ears） were compared with 265 patients with chronic otitis media（COM）（311 ears） for gender,age and course of disease.The disease regions and hearing loss of the TS patients were analyzed.Results TS showed higher prevalence in women of older ages.Sclerosis was seen most frequently in the tympanic membrane,followed by the malleus,incus,incudomalleolar joint,other regions,ariticulus incudostapedius and stapes.The patients with sclerosis or deterioration in the ossicular chain had worse hearing loss than the other patients.Carhart notch occurred in 45 ears（32.85%）,an incidence similar to that of inverted ＂V＂-shaped curve of air-conduction audiometry near 2 kHz（47 ears,34.31%）.The factors contributing to the hearing loss,listed in the order of their importance,included pathologies in the incus,malleus,incudomalleolar joint,ariticulus incudostapedius,stapes,other regions,tympanic membrane,and gender.Conclusions Female patients may had increased risk of TS.The presence of Carhart notch and inverted ＂V＂-shaped curve in air-conduction audiograph may indicate myringosclerosis or ossicular chain sclerosis.Abnormal ossicular chain is the leading factor contributing to hearing loss.