手术治疗鼓室硬化症

Surgical treatment of tympanosclerosis

目的介绍鼓室硬化症的手术方法及手术体会。方法回顾性分析152耳鼓室硬化症患者的临床资料,152耳均清除全部或部分硬化灶,并进行听骨链重建,出院3个月后复查1次,6个月~1年内复查第2次,以最后1次作为随访结果(取0.5、1.0、2.0、4.0 kHz语言频率均数)。结果以术后气导听力提高15 dB且气骨导差小于20 dB视为成功,以术后气导听力提高15 dB视为有效,成功率为46.7%,有效率为71.1%。结论手术治疗鼓室硬化症的疗效可靠,应成为主要治疗手段。同期听骨链重建的患者采用切除砧骨、锤骨头、听小骨植入的III型鼓室成形术,二期采用镫骨底板切除、全人工听骨植入术后听力优于底板打孔、人工镫骨植入术后听力。

OBJECTIVE To introsuce different operations for tympanosclerosis and experience. METHODS Clinical data of 152 cases of tympanosclerosis were retrospectively reviewed. Ossicular chain reconstruction were conducted after removing focal tympanosclerosis in different positions. The first check-up was at 3 months, the second check-up was at 6-12 months, the last follow-up result was taken as the final result(taking the mean value of language frequency at the level of 0.5, 1.0, 2.0, 4.0 kHz HL). RESULTS Evaluation standard: air conduction hearing improve 15 dB and air-bone gap less than 20 dB postoperatively as success, air conduction hearing improve 15 dB as effective.Accroding to the evaluation standard above,successful operative ears were 46.7%, the effective operative ears were 71.1%. CONCLUSION The curative effect of surgical treatment of tympanosclerosis is reliable and should be the main treatment. In onestage operation, the type III tympanoplastyshould be conducted with removal of the incus、hammer head, ossicular prosthesis implantation, in two-stage operation, postoperative hearing of stapes footplate resection、artificial ossicular prosthesis implantation is better than that of footplate punching、artificial stapes implantation.