腭裂修复术及年龄对中耳功能的影响

Effect of Cleft Palate and Age to the Middle Otic Function

目的 探讨腭裂患者中耳功能障碍听力损失发病特点、腭裂修复术及术前年龄对听力的影响 ,了解腭裂患者分泌性中耳炎鼓室分泌物细菌培养情况 ,为临床治疗提供依据。方法 对住院 12岁以下腭裂患者 6 0例 ,在术前、术后 6个月分别用脑干听觉诱发电位 ,声阻抗进行听力及中耳功能检查 ,术前鼓室分泌物进行细菌培养。结果 腭裂患儿术前听力损失发生率为 74% ,异常鼓室图为 80 % ,3岁前达 81% ,术后 6个月患者听力有一定程度恢复 ,异常鼓室图占 42 % ,鼓室分泌物细菌培养 ,G+ ,G-细菌阳性率分别为 2 3% ,2 4% ,且多为低毒性条件致病菌。结论 腭裂患者听力损失在婴儿时期已经存在 ,且听力损失严重 ,随年龄增大听力有所改善 ,听力损失与腭裂部位类型无关 ,早期修复腭裂有助于咽鼓管功能恢复 ,避免或减少听力损失 ,有利于语言发育 ,腭裂伴有分泌性中耳炎的治疗 ,有别于化脓性中耳炎的治疗 ,早期中耳置管能改善听力 ,并对腭裂患者听力损失原因及腭裂修复时间进行了讨论。

Objective Discuss the feature of middle otic function impediment combining hearing lost of cleft palate and the effect of cleft palate repair and age to hearing. Realize organism culture of otitis media with effusion of the patients with cleft palate. Provide proof to clinical treating. Methods 60 cases under 12 year-old with cleft palate were tested with middle otic function and hearing by acoustic impedance and evoked auditory brainstem potential before and after operation. The organism culture of tympanic scretion was done before operation. Results The ratio of hearing lost before operation was 74%, the abnormal tympanic graph rate was 80% (82% before 3-year-old). Hearing was improved at a certain degree 6 months after operation, the abnormal tympanic graph rate was 42%. The G + and G - positive rate of organism culture of tympanic scretion was 23% and 24%, most organisms were low poisonous and conditional infective. Conclusion The hearing lost of children with cleft palate is severe and exists in infancy. Hearing is improved with growth. The hearing lost has no relation with the site or type of cleft palate. Early cleft palate repair allows the recovery of otosalpinx function, decreases hearing lost, is profit to speech. The treating of otitis media with effusion associating with cleft palate is different from otitis purulent. Early ventilation tube placement can improve hearing. The reason for hearing lost of cleft palate and age of cleft palate repair was discussed.