14例先天性听骨链畸形诊断与手术重建结果分析

Diagnosis and surgical reconstruction results for 14 cases of patients with congenital ossicular chain malformation

目的：探讨先天性听骨链畸形的诊断及手术疗效。方法：14例（15耳）先天性听骨链畸形患者，其中10例为单侧传导性聋，1例为双侧传导性聋，3例混合性聋且以传导性为主。15耳均行鼓室探查，并行14耳听骨链重建术（3耳行全听骨重建术，10耳行部分听骨重建术，1耳行人工镫骨手术），1例松解听骨链与鼓室壁的软骨固定。通过术前术后气骨导差比较疗效。结果：术前听力检查示平均气骨导差为39．9dB，术后3周平均气骨导差为22．3dB，较术前缩小17．6dB（t=22．10，P〈0．01），术后6～8个月平均气骨导差为19．6dB，较术前缩小20．3dB（t=12．813，P〈O．01）。结论：先天性听骨链畸形引起的传导性听力下降，根据术中情况采用不同听骨链重建术可以明显提高听力，以手术治疗为首选。

Objective：To investigate the diagnosis of common congenital ossicular chain malformation and the efficacy of ossicular chain reconstruction. Method：Fourteen cases with 15 ears of congenital ossicular chain malfor- mation were included, consisting of 10 cases unilateral conductive hearing loss（10 ears）, 1 case bilateral conduc- tive hearing loss （2 ears） and 3 cases unilateral mixed hearing loss with significant conductive hearing loss （3 ears）. Tympanoplasty was proceed on all 15 ears, 1 ear was proceed by loosen the cartilage fixation of ossicular chain and tympanic cavity wall. Fourteen ears were proceed with ossicular chain reconstruction, including 3 ears with TORP, 10 ears with PORP and 1 ear with artificial stapes operation. The efficacy was measured by comparing the values of air bone gap（ABG） before and after the operation. Result： The average ABG of pre-operation was 39.9 dB, the ABG for 3 week and 6 to 8 months after operation were 22.3 dB and 19, 6 dB, which were 17.6 dB and 20.3 dB improve respectively（t= 22.10 ,P〈0.01 and t= 12. 813 ,P〈0.01）. Conclusion： Operation is the first choice for those conductive hearing loss causing by simple congenital ossicular chain malformation, relevant ossicu- lar chain reconstruction due to particular situation of the surgery can significantly improve hearing.