慢性化脓性中耳炎并发全聋的临床研究

Clinical investigation on anacusis associated with chronic suppurative otitis media

目的 :研究慢性化脓性中耳炎 (CSOM )引起全聋或极度聋的相关危险因素。方法 :回顾性分析我院1 9932 0 0 0年手术的伴极度聋或全聋的CSOM患者 6 0例 6 2耳 (全聋组 )的临床资料 ,并与同期不伴耳聋的CSOM患者 6 2耳 (对照组 )进行比较。结果 :全聋或极度聋相关的危险因素包括流脓血、听骨链破坏及镫骨足板或板上结构消失 ,两组比较具有极显著性意义 (P <0 .0 1 ) ;与迷路瘘管有无亦相关 (P <0 .0 5 )。而与病程、并发面瘫及再次中耳乳突手术等因素无明显相关。结论 :全聋或极度聋的发生与流脓血、胆脂瘤对听骨链侵蚀、镫骨板上结构或足板消失、迷路瘘管等相关。

Objective:To investigate the risk factors and clinical features of anacusis or severe deafness associated with chronic suppurative otitis media (CSOM ).Method: A retrospective review of 62 ears consecutive cases of severe deafness (15 ears) and anacusis (47 ears) associated with CSOM were investigated . There were 5 ears severe deafness deteriorated to anacusis after procedures. This represented 6.42 % of our total series of CSOM with or without cholesteatoma in adults and children (965 ears) in 1993~2000. The series with cholesteatoma or granuloma or tympanosclerosis were 46 ( 74.19 %)ears 13 ( 20.97 %)ears and 3 ( 4.84 %)ears respectively. The symptoms and operative findings were analyzed. All patients underwent preoperative CT scans and preoperative audiometry. With respect to surgical technique, the canal wall down procedure was performed in(50/62) 80.6 %, and classical modified mastoidectomy was performed in(12/62) 19.4 %. Result: The results demonstrated that chronic otorrhea with bloody,ossicular chain destructive and erosion of the supraplate structure or disappear of footplate were helpful predicting indicators for anacusis or severe deafness. There was a high significant association (Chi square Fisher exact test P< 0.001 ) with these factors compared with CSOM without anacusis or severe deafness. Labyrinthine fistula was also correlated to anacusis or severe deafness (P< 0.05 ). There were no significant with the courses and facial paralysis and revision mastoidectomy. Conclusion: Anacusis or severe deafness intimately associated with chronic otorrhea with bloody, ossicular chain destructive, erosion of the supraplate structure or disappear of footplate and labyrinthine fistula. The surgical procedure should be performed earlier to eradicate the chronic or acute infection and to avoid anacusis or severe deafness.