中耳胆脂瘤听骨链破坏与传导性听力损失的关系

The relationship between ossicular status and conductive hearing loss in cholesteatoma

目的:探讨中耳胆脂瘤患者听骨链病变特点及其与传导性听力损失的关系。方法:回顾性分析204例(213耳)中耳胆脂瘤患者的临床资料,分析术中显微镜下听骨病变特点及其与术前纯音听阈测定结果的关系。结果:中耳胆脂瘤患者砧骨破坏最常见,锤骨、镫骨的破坏往往伴随着砧骨的破坏,砧骨破坏较听骨仅接触胆脂瘤的气骨导差更大(P<0.05),砧镫骨均有破坏较仅有砧骨破坏的气骨导差更大(P<0.05),砧骨完全缺失较仅有部分破坏气骨导差更大(P<0.05)。软连接可在部分听骨链破坏类型中发挥传导声能的作用(P<0.05)。胆脂瘤接触听骨将影响听力(P<0.01)。结论:听骨链不同的破坏部位和程度所造成的气骨导差不同。

Objective：To investigate and analyze the characteristic of destructive ossicular chain and it＇s impact on air bone gap（ABG） among patients with cholesteatoma. Method：Data from 204 cases（213 ears） undergoing an initial surgery for cholesteatoma were retrospectively reviewed to evaluate the relationships between preoperative pure tone audiometry data and intraoperative assessment of individual ossicular destruction. Result： Incus was the most significantly affected ossicle. Furthermore, the destruction of malleus and stapes was often accompanied by the destruction of incus. A partially eroded incus caused significantly increase in ABG from that of an intact incus with cholesteatom aabutting（P〈0.05）. A partially eroded incus and a partially eroded stapes caused significantly increase in ABG compared to a partially eroded incus（P〈0.05）. A completely eroded incus caused significantly increase in ABG compared to a partially eroded incus（P〈0.05）. False fibre-connected would significantly influ- ence on ABG in some ossicular chain erosion patterns（P〈0.05）. Cholesteatoma abutting an intact ossicle signifi cantly altered average ABG compared to a normal ossicle（P〈0.01 ）. Conclusion： Different ossicular chain erosion pattern caused different degrees of ABG.