儿童及青少年中耳炎听力损失相关因素分析

Analysis of factors related to hearing loss in children and adolescents with otitis media

目的总结儿童及青少年慢性化脓性中耳炎的听力学特点,为儿童及青少年慢性化脓性中耳炎的临床早期诊断及手术制定方案提供思路。方法对121例(134耳)儿童及青少年患者进行纯音测听检查,并对病变类型、鼓膜穿孔的位置,病变范围及听骨链损伤的程度进行总结和比较。结果本组患者的气导平均听阈(Air conduction-Puretone average,AC-PTA)为45.6±16.3dBHL(简写为dB)。其中中耳胆脂瘤、化脓性中耳炎、鼓室硬化症对听力的影响无显著性差异。穿孔位于松弛部或紧张部对AC-PTA的影响没有显著性差异(P=0.25);病变范围同时累积上鼓室及中后鼓室的,其PTA明显高于上鼓室单独受累的病例(P=0.027)。胆脂瘤患者中,AC-PTA>41.9dB及ABG>30.7dB对于听骨链中断有着一定的诊断价值(P<0.001)。结论在儿童及青少年慢性化脓性中耳炎的患者中,病变类型、病变范围及听骨链中断是影响听力的重要因素。

Objective To report auditory characteristics in children and adolescents with chronic suppurative otitis me- dia for early diagnosis and intervention. Methods Air conduction pure tone average （PTA） was tested among 121 children and adolescent patients （134 ears）. Pathological types, location of tympanic membrane perforation, ossicular chain damage and extent of lesion were also reviewed. Results PTA was 45.6±16.3 dB HL in these patients with no significant differences when compared among cholesteatoma, chronic suppurative otitis media and tympanosclerosis cases, or when compared between pars tensa and pars fiaccida perforations （P=0.25）. PTA was significantly higher for lesions in the mesotympanum than those in the epitympanum （P=0.027）. In cases with cholesteatoma, PTA 〉41.9 dB HL with ABG〉30.7 dB was correlated with ossicular chain discontinuity. Conclusion Among children and adolescent patients with chronic suppurative otitis media, pathology, extent of lesion and ossicular chain discontinuity have great influence on hearing.