耳内镜下鼓室成形术治疗慢性化脓性中耳炎术后听力恢复不良的相关因素分析

Analysis of related factors of poor hearing recovery after otoscopic tympanoplasty for chronic suppurative otitis media

目的分析耳内镜下鼓室成形术对静止期慢性化脓性中耳炎患者听力恢复不良的相关因素。方法选择2017年2月—2019年11月在四川省八一康复中心治疗的静止期慢性化脓性中耳炎患者131例,所有患者均在全身麻醉下行耳内镜鼓室成形术。根据手术后6个月行纯音测听检测结果,骨气导间距(ABG)的不同将患者分为两组,ABG≤20 dB为听力良好组,ABG>20 dB为听力不良组。采用单因素分析术后听力改善不良的原因及多因素Logistic回归法分析各因素对患者听力的综合作用。结果术后ABG≤20 dB患者81例,ABG>20 dB患者50例。两组患者因镫骨、鼓膜张肌腱、鼓室黏膜、咽鼓管、人工听骨类型及人工听骨材料的不同,导致术后听力差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,镫骨完整并活动(OR=0.606,95%CI=0.393~0.919)、镫骨完整活动不佳(OR=0.563,95%CI=0.329~0.844)、存在鼓膜张肌腱(OR=1.913,95%CI=1.508~2.449)、咽鼓管通畅(OR=1.818,95%CI=1.417~2.328)及人工听骨材料为钛合金(OR=2.250,95%CI=1.816~2.755)为慢性化脓性中耳炎患者行耳内镜下鼓室成形术后影响听力恢复的独立危险因素。结论耳内镜下鼓室成形术可一定程度改善静止期慢性化脓性中耳炎患者听力,其听力恢复效果受镫骨状况、鼓膜张肌腱、咽鼓管功能及人工听骨材料的影响。

Objective To analysis of related factors of poor hearing recovery after otoscopic tympanoplasty for static chronic suppurative otitis media.Methods A total of 131 patients with static chronic suppurative otitis media hospitalized in Sichuan Bayi Rehabilitation Center from Feb 2017 to Nov 2019 were selected.All patients underwent otoscopic tympanoplasty under general anesthesia.According to the results of pure tone audiometry at 6 months after operation and the difference of air bone gap(ABG),all the patients were divided into two groups:ABG≤20 dB group and ABG>20 dB group.The causes of poor postoperative hearing improvement were analyzed by univariate analysis and the comprehensive effect of various factors on patients’hearing was analyzed by multivariate logistic regression.Results There were 81 cases in group G and 50 in group B.The differences in stapes,tympanic tensor tendon,tympanic mucosa,eustachian tube,types and materials of artificial ossicles between the two groups led to significant difference in postoperative hearing recovery(all P<0.05).Multivariate logistic regression analysis showed that the intact and active stapes(OR=0.606,95%CI=0.393~0.919),the intact but poorly active stapes(OR=0.563,95%CI=0.329~0.844),existence of tensor tympanic tendon(OR=1.913,95%CI=1.508~2.449),unobstructed eustachian tube(OR=1.818,95%CI=1.417~2.328)and titanium alloy artificial ossicle(OR=2.250,95%CI=1.816~2.755)were independent risk factors of hearing recovery after otoscopic tympanoplasty for chronic suppurative otitis media.Conclusion Otoscopic tympanoplasty can improve the hearing of patients with chronic suppurative otitis media in quiescent stage to a certain extent.The hearing recovery is affected by stapes,tympanic tensor tendon,Eustachian tube function and artificial ossicular material.