耳屏软骨环-软骨膜行鼓膜成形后的听力

Hearing results following the tragus cartilage ring with perichondrium in myringoplasty

背景:国内外尚缺乏一种行之有效的评估系统来评估慢性化脓性中耳炎的治疗效果,主观听力改善是判断鼓膜成形成功与否最重要的标准。目的:观察耳屏软骨环-软骨膜鼓膜成形后听力疗效,并对其相关影响因素进行分析。方法:耳屏软骨环-软骨膜行鼓膜成形后患者240例随访3年,追踪观察鼓膜生长情况及行纯音听阈检查,并记录患者日常生活中听力改善情况。对可能影响疗效的10项因素进行多元线性回归分析。结果与结论:使用多元线性回归对可能影响鼓膜成形后听力的因素进行筛选,按其作用大小依次为:鼓膜成形前气导听阈平均值、干耳时间、病程、年龄。主观听力的改变与客观听力的改变具有相关性。鼓膜成形前气骨导差与鼓膜成形后主观听力情况的比较83.3%鼓膜成形后主观听力有明显改善;鼓膜成形后气导阈值与主观听力改善的比较,鼓膜成形后主观听力有明显改善(83.9%)。鼓膜成形后气导听阈下降≤10dB的患者中54.5%有主观听力改善;而气导听阈下降30dB以上时,97.8%的患者主观听力改善。提示主观听力改善的程度与鼓膜成形后气导阈值下降的程度成正相关,鼓膜成形后气导听阈下降越多,其主观听力改善越明显。

BACKGROUND： At present, there is still lack of a valid valuation system for evaluating chronic maturation treatment effect and subjective hearing improvement is the most important criteria to judge the success of myringoplasty. OBJECTIVE： To evaluate the hearing results following the tragus cartilage ring with perichondrium in myringoplasty and to analyze the related impact factors. METHODS： A total of 240 patients treated with tragus cartilage ring with perichondrium in myringoplasty were selected and followed-up for 3 years, then the eardrum growth was tracking observed and the pure tone threshold checking was performed, and then the hearing improvement was daily recorded. Multiple linear regression analysis was performed on 10 factors that may affect the efficacy. RESULTS AND CONCLUSION： Multiple linear regression statistical analysis was subsequently carried out on these prognostic factors of hearing outcomes and yielded the following relative importance of predictive as follows; mean preoperative air conduction threshold, duration of dry ear, duration of disease and age. The subjective hearing changes were correlated with the objective hearing changes. Comparing the preoperative airbone gap and the postoperative subjective hearing ability, we found that the subjective hearing ability of 83.3% patients was significantly improved; comparison between preoperative air conduction threshold and postoperative subjective hearing ability showed that the subjective hearing ability of about 83.9% patients were significantly improved. Among the patients with decreased air conduction threshold less than 10 dB, the subjective hearing of 54.5% patients was improved; and when the air conduction threshold decreased more than 30 dB, the subjective hearing of 97.8% patients was improved. It suggests that the improvement degree of the subjective hearing is positively correlated with the decreasing degree of the air conduction threshold after myringoplasty, the more the air conduction threshold decreased, the more the subjective hearing improved.