听力重建术治疗混合性聋的疗效分析

The Surgical Treatment of the Mixed Hearing Loss

目的总结分析混合性聋的原因、听力重建术的方法及效果。方法回顾性分析32例混合性聋且行听力重建手术治疗患者的临床资料,分析其病因及根据不同病因所采取的听力重建手术方法,比较手术前后各频率气导听阈、骨导听阈、气骨导差及言语频率平均听阈,观察治疗效果。结果 32例患者中,慢性化脓性中耳炎15例、耳硬化症13例、Van der Hoeve综合征2例、先天性中耳畸形2例;听力重建术后言语频率气导听力提高15dB以上者26例,有效率为81.25%(26/32),全部患者术后言语频率气、骨导听力分别提高24.94±8.15dB和5.90±7.96dB,气骨导差缩小19.04±11.06dB(P<0.05)。术后0.25-4kHz气导听力较术前有不同程度提高(P<0.05),而手术前后8kHz气导听力无明显变化(P>0.05);术后骨导听力在1、2kHz处有提高(P<0.05),在2kHz处提高最明显。结论混合性聋多见于耳硬化症、慢性化脓性中耳炎、鼓室硬化等疾病。听力重建手术是治疗混合性聋的有效方法。

Objective To summarize and analyze the pathogenesis, methods of hearing reconstruction and curative effect of mixed hearing loss. Methods Patients with mixed hearing loss who underwent hearing reconstruction from Jan 2009 to Dec 2011 in the ENT department of PLA General hospital were reviewed retrospectively. After the operation, air conduction （AC）, bone conduction （BC）, air--bone gap （ABG） at main frequencies and audiometry changes were analyzed. Results Among 32 cases, 15 cases were chronic otitis media, 13 cases otosclerosis, 2 cases Van der Hoeve, and 2 eases congenital middle ear malformations. There were 26 cases with significantly improved hearing after surgery,and the effective rate was 81.25%. AC showed great improvement at 0.25±4 kHz （P d0.05） while there was no change at 8 kHz （P〉0.05）. BC showed improvements at 1 and 2 kHz and improved significantly only at 2 kHz. After operation, pure tone audiometry at AC and BC separately improved 24.94±8.15 dB and 5.90±7.96 dB;ABG narrowed down to 19.04±11.06 dB. Conclusion Mixed hearing losses are mostly seen in chronic otitis media and tympanosclerosis. After auditory rehabilitation, patients can experience improved hearing.