鼓室硬化患者鼓室成形术后听力效果评估

Evaluation of Audiological Outcomes following Tympanoplasty in Patients with Tympanosclerosis

目的探讨鼓室硬化患者鼓室成形术后的听力康复效果及其影响因素。方法回顾性分析2014-2018年于北京大学第三医院行鼓室成形术的69例鼓室硬化患者。采用以下两种分组方法:1)按照病变类型分为2组:单纯型组与胆脂瘤及其他病变组;2)按照病变范围分为2组:镫骨未受累组及镫骨受累组。观察术后纯音听阈(PTA)及骨气导间距(ABG)、手术前后PTA差值(ΔPTA)及ABG差值(ΔABG)。结果所有患者术后PTA平均值为36.48dB,术后ABG平均值为17.87dB,ΔPTA平均值为17.56dB,ΔABG平均值为13.26dB。单纯型组与胆脂瘤及其他病变组术后PTA、术后ABG、ΔPTA、ΔABG差异均有统计学意义。镫骨未受累组及镫骨受累组术后PTA、术后ABG差异有统计学意义;ΔPTA、ΔABG差异无统计学意义。结论鼓室成形术是治疗鼓室硬化的有效手术方法,总体术后听力改善良好。病变类型及硬化灶累及范围是影响术后听力效果的因素,慢性化脓性中耳炎静止期的患者以及未累及镫骨者术后有较好的听力学效果。

Objective To report hearing rehabilitation outcomes after tympanoplasty in patients with tympanosclerosis and identify potential influencing factors.Methods Data from 69 patients who received tympanoplasty at the Peking University Third Hospital from 2014 to 2018 were retrospectively reviewed,and subgrouped based on the type of lesions(simple type and with cholesteatoma and other pathologies)and whether the stapes was involved.Outcome measures included PTA,ABG and PTA/ABG change after operation(ΔPTA/ΔABG).Results Mean PTA,ABG,ΔPTA andΔABG were 36.48 dB HL,17.87 dB,17.56 dB and 13.26 dB,respectively,and significantly different between cases with simple type tympanosclerosis and those with cholesteatoma and other pathologies.PTA and ABG,but notΔPTA andΔABG,showed statistically significant differences between cases with stapes involvement and those without.Conclusion Tympanoplasty is an effective treatment for tympanosclerosis.The type of lesion and involvement of the stapes may affect hearing outcomes.Patients with stable chronic suppurative otitis media and those without stapes involvement may enjoy better hearing improvement.