慢性化脓性中耳炎患者经开放式鼓室成形术治疗对听力恢复的影响

Effect of open tympanoplasty on hearing recovery in patients with chronic suppurative otitis media

目的研究慢性化脓性中耳炎(CSOM)患者经开放式鼓室成形术治疗后对听力恢复的影响。方法 80例接受开放式鼓室成形术治疗的CSOM患者,均采用开放式鼓室成形术联合改良乳突根治术治疗。比较手术前后纯音测试结果 ,分析临床疗效、术后听力障碍的相关因素。结果 80例CSOM患者治疗显效率为47.50%(38/80),治疗有效率为42.50%(34/80),无效率为10.00%(8/80),治疗总有效率为90.00%(72/80)。患者治疗后的气导(AC)听阀(47.41±6.25)dB和气骨导差(ABG)(11.68±2.34)dB均低于治疗前的(66.03±7.02)、(30.58±3.18)dB,差异均具有统计学意义(P<0.05);治疗前后的骨导(BC)听阈比较,差异无统计学意义(P>0.05)。镫骨及其底板未破坏和后鼓室开放的患者听力恢复情况更佳,不同听力障碍程度的患者镫骨及其底板未破坏、后鼓室开放情况比较,差异均具有统计学意义(P<0.05);术后患者镫骨及其底板是否破坏、后鼓室是否开放是开放是鼓室成形术治疗CSOM术后听力障碍的影响因素(P<0.05)。结论采用开放式鼓室成形术治疗CSOM具有显著的临床疗效,而后鼓室是否开放、镫骨和镫骨底板是否完整对术后听力恢复具有很大影响。

Objective To study the effect of open tympanoplasty on hearing recovery in patients with chronic suppurative otitis media.Methods All 80 patients with CSOM were treated with open tympanoplasty combined with modified radical mastoidectomy.The pure tone audiometry before and after operation was compared,and the clinical efficacy and related factors of postoperative hearing impairment were analyzed.Results In this study,the excellent rate of treatment of 80 CSOM patients was 47.50%(38/80),effective rate of treatment was 42.50%(34/80),ineffective rate was 10.00%(8/80),and the total effective rate of treatment was 90.00%(72/80).After treatment,the air conduction(AC)thresholds(47.41±6.25)dB and air-bone gap(ABG)(11.68±2.34)dB of patients were lower than(66.03±7.02)and(30.58±3.18)dB before treatment,and the difference was statistically significant(P<0.05).There was no statistically significant difference in bone conduction(BC)thresholds before and after treatment(P>0.05).Patients with undamaged stapes and its bottom plate and open posterior tympanum have better hearing recovery.There was statistically significant difference in damage of stapes and its bottom plate and opening of posterior tympanum among patients with different hearing impairment levels(P<0.05).whether the stapes and its bottom plate was damaged or not and whether the posterior tympanum was open or not were influencing factors of postoperative hearing impairment after open tympanoplasty for CSOM,whether the posterior tympanum was open,and whether the stapes and its bottom plate were intact had a great influence on the recovery of hearing(P<0.05).Conclusion Open tympanoplasty shows remarkable clinical efficacy in the treatment of CSOM.