中耳胆脂瘤并发迷路瘘管的术后听力回顾性研究

A Retrospective Study of the Postoperative Hearing of Patients with Middle Ear Cholesteatoma and Labyrinthine Fistula

目的探讨手术治疗对中耳胆脂瘤并发迷路瘘管患者听力的影响。方法回顾性分析35例（35耳）中耳胆脂瘤并发迷路瘘管患者的临床资料；其中21例（21耳）患者随访术后听力情况。结果21例（21耳）术后随访纯音测听3个月～5年，12例平均骨导阈值（0．5、1、2,N4kHz）与术前差别小于5dBHL，较术前听力提高者3例，较术前下降者5例，1例于术后3个月成功植入人工耳蜗。21例患者中11例行开放式乳突切开＋鼓室成形术，其手术前后骨气导各频率间（0．5、1、2、4～118kHz）听力阈值未见明显差异（配对样本t检验，P值均大于0．05）。结论中耳胆脂瘤并发迷路瘘管的术后骨导听力阈值无明显变化，有条件者仍可行鼓室成形术保存听力。

Objective To study the impact of surgical treatment on the hearing of patients with middle ear cholesteatoma and labyrinthine fistulamethods The clinical data of 35 patients （35 ears） with middle ear cholesteatoma and labyrinthine fistula were analyzed retrospectively. Results Three months to five years after the surgery, the 21 patients were assessed with pure-tone audiometry. In 12 cases, the difference between the postoperative and preoperative bone-conduction threshold averaged across 0.5, 1, 2 and 4 kHz was less than 5 dB HL. The hearing of 3 patients was improved as compared with that before the surgery, while the hearing of 5 patients deteriorated. One patient received cochlear implantation 3 months after the first tympanoplasty. For the 11 patients treated with tympanoplasty and canal wall down mastoidectomy, there was no significant difference in the average bone- and air-conduction thresholds（0.5, 1, 2,4 and 8 kHz） before and after the surgery（P〉0.05）. Conclusion There is no significant change in the bone-conduction hearing thresholds for patients with middle ear cholesteatoma and labyrinthine fistula after the surgery, so tympanoplasty should be performed to preserve the hearing if possible.