耳硬化症患者激光镫骨底板开窗术的短期疗效分析

Short-term postoperative outcome of laser-assisted stapedotomy in patients with otosclerosis

目的:评估耳硬化症患者行激光镫骨底板开窗术后的短期疗效。方法:回顾性分析21例(21耳)行激光镫骨底板开窗术的耳硬化症患者的临床资料。比较术前和术后3个月纯音测听0.5、1、2、4 kHz频率的气导(AC)、骨导(BC)阈值和气骨导差(ABG)平均值,并统计手术并发症的发生情况。结果:21耳术前和术后AC阈值分别为(58.2±12.7)dB HL和(43.0±23.1)dB HL,术后AC阈值降低15.2 dB HL(P<0.01);0.5、1、2、4 kHz各频率术后AC阈值较术前均显著降低。术前术后BC阈值分别为(31.4±10.3)dB HL和(33.3±16.6)dB HL,差异无统计学意义;各频率的手术前后BC阈值差异亦无统计学意义。3耳(14.3%)术后BC阈值减低>10 dB HL,出现过度闭合。手术前后ABG平均值分别为(27.0±9.1)dB HL和(9.6±9.9)dB HL,术后ABG缩小17.4 dB HL(P<0.01);各频率ABG平均值均显著缩小。14耳(66.7%)术后ABG≤10 dB HL,18耳(85.7%)术后ABG≤20 dB HL。术后2耳(9.5%)出现感音神经性听力损失;15耳(71.4%)耳鸣和3耳(14.3%)眩晕均于术后第3天缓解。结论:激光辅助下镫骨底板开窗术治疗耳硬化症安全有效,虽然术后骨导阈值稍有提高,但不影响总体听觉康复效果。

Objective:To assess the short-term efficacy of laser-assisted stapedotomy in patients with otosclerosis.Method:The clinical data of twenty-one patients with otosclerosis who underwent laser-assisted stapedotomy were retrospectively analyzed.Preoperative and 3-month postoperative standardized audiometric evaluations were carried out in all patients.The occurrence of surgical complications was observed.Result:The mean preoperative and postoperative air conduction(AC)thresholds were(58.2±12.7)dB HL and(43.0±23.1)dB HL respectively;the postoperative AC threshold decreased by 15.2 dB HL which was statistically significant at 0.5,1,2,and 4 kHz(P<0.01).The mean preoperative and postoperative bone conduction(BC)thresholds were(31.4±10.3)dB HL and(33.3±16.6)dB HL,and there was not significant difference between them as well as BC thresholds at each frequency.Overclosure>10 dB HL was occured in 3 ears(14.3%)while sensorineural hearing loss>10 dB HL was found in 2 ears(9.5%).The mean ABG decreased by 17.4 dB HL(P<0.01)from preoperative(27.0±9.1)dB HL to postoperative(9.6±9.9)dB HL,and the ABG at each frequency had significant decrease.Fourteen ears(66.7%)had postoperative ABG of≤10 dB HL while 18 ears(85.7%)had postoperative ABG of≤20 dB HL.Sensorineural hearing loss occurred in 2 ears(9.5%)after surgery,tinnitus in 15 ears(71.4%)and vertigo in 3 ears(14.3%).But all were relieved on the third day after operation.Conclusion:Laser-assisted stapedotomy is a safe and effective treatment of otosclerosis.Although BC thresholds was slightly increased after surgery,it did not affect the overall hearing outcomes.