慢性化脓性中耳炎老年患者的听力损害

Hearing impairment in elderly patients with chronic otitis media

目的慢性化脓性中耳炎和老化均可导致听力损害，本文探讨了慢性化脓性中耳炎老年患者的听力学损害特征。方法回顾性研究了2007年4月至2010年5月，上海交通大学附属第六人民医院耳鼻咽喉科手术治疗的单侧慢性化脓性中耳炎老年患者39例（≥60岁）和中青年患者30例（30至40岁），分析两组患者在术前言语频率和4kHz纯音听阈以及疾病所致并发症、术后病理和治疗费用等方面的差异。结果老年组患耳言语频率气导、骨导纯音听阈，4kHz气导、骨导纯音听闽均高于中青年组，差异具有统计学意义（均P〈0．01）。分别以相对健侧耳为自身对照，计算了两组患者的耳间听阈差值，以排除组间年龄因素对听力的影响，发现两组间的耳间言语频率气导听闽差值差异无统计学意义（P=0．160），撕老年组的耳间言语频率骨导听阈差值高于中青年组（P=0．014）。老年组患者的并发症发生率及治疗费用均高于中青年组（P〈0．05）。结论慢性化脓性中耳炎对老年患者的内耳感音功能损害更为严重，疾病所致并发症的发生率和所需治疗费用较高。本研究提示了慢性化脓性中耳炎早期诊治的必要性。

Objective To investigate the characteristics of hearing impairment in elderly patients with chronic otitis media. Methods A retrospective study was carried out. Clinical data of 39 elderly patients （aged 〉160 years） and 30 young patients （aged from 30 to 40 years） with unilateral chronic otitis media receiving surgical treatment from April 2007 to May 2010 were collected in our hospital. The means of preoperative speech frequency air and bone conduction pure tone threshold, 4 kHz air and bone conduction pure tone thresholds were compared between the two groups. Complications, pathology and treatment costs were also analyzed. Results For the diseased ear, the elderly group showed a significantly higher pure tone thresholds in aspects of the mean preoperative speech frequency air and bone conduction, as well as that of 4 kHz in the comparison with the young group （P〈0.01）. A significant difference was found in the interaural pure tone thresholds of bone conduction （P=0.014）, but no that of air conduction （P=0.160） between the two groups. Treatment costs and the rate of complaints in the elderly group were significant higher than the young group （P〈0.05）. Conclusions The elderly patients with chronic otitis media are damageable to sensorineural hearing loss and present higher rate of complications and treatment costs, which suggest the importance of early diagnosis and treatment of chronic otitis media.