耳内镜在人工听骨听力重建术中的应用和优势分析

Application and advantage analysis of ear endoscope in artificial ossicular hearing reconstruction

目的探讨对慢性化脓性中耳炎(CSOM)和中耳胆脂瘤在耳内镜下植入部分听骨链赝复物(PORP)人工听骨听力重建的应用和优势。方法回顾分析我院2020年12月—2022年10月收治的30例(30耳)在耳内镜下行PORP人工听骨听力重建术后的CSOM和中耳胆脂瘤患者的临床资料,比较术前、术后不同频率的骨导听阈、气导听阈和气骨导差(ABG)。结果各个频率(0.25~4 kHz)骨导听阈与术前相比,差异均无统计学意义(P值均>0.05)。0.25~2 kHz气导听阈较术前相比,差异均有统计学意义(P值均<0.05);0.25~2 kHz ABG听阈较术前比较,差异均有统计学意义(P值均<0.05);4 kHz气导及ABG听阈较术前差异均无统计学意义(P值均>0.05)。术后各频率听骨链重建成功率差异均具有统计学意义(P值均<0.05)。多因素Logistic回归分析结果显示,鼓室内黏膜水肿、鼓膜钙化斑、鼓室内胆脂瘤上皮堵塞为患者行耳内镜下人工听骨听力重建术后听力影响的独立危险因素(P<0.05)。结论耳内镜是CSOM及中耳胆脂瘤患者行人工听骨听力重建术的优选,可恢复或提高患者听力水平,中频听阈疗效最为显著。内镜下手术可缩短手术时间,副作用小、安全性高、复发率低、术后患者疼痛轻,值得临床应用。

Objective To explore the application and advantages of implanting partial ossicular replacement prosthesis(PORP)type artificial ossicles under otoscopy in chronic suppurative otitis media and cholesteatoma.Methods The clinical data of 30 patients(30 ears)with chronic suppurative otitis media and cholesteatoma after PORP artificial ossicular reconstruction in our hospital were retrospectively analyzed.The bone conduction threshold,air conduction threshold and air bone gap(ABG)of different frequencies before and after operation were compared.Results The postoperative hearing thresholds of bone conduction at all frequencies(0.25~4 kHz)were not statistically different with those before operation(P>0.05).The air conduction hearing thresholds and ABGs of 0.25 kHz to 2 kHz were all statistically different(P<0.05)compared with the preoperative data,while there was no significant difference in 4 kHz air conduction hearing threshold or air bone gap difference compared with preoperative data(P>0.05).The success rates of ossicular chain reconstruction at different frequencies were statistically significantly different(P<0.05).Multivariate logistic regression analysis showed that mucosal edema,calcification spots of tympanic membrane,and epithelial obstruction of cholesteatoma of ear canal were independent risk factors for hearing loss after artificial ossicular reconstruction under otoendoscope(P<0.05).Conclusions Endoscope is the preferred method for hearing reconstruction with artificial ossicles in patients with chronic suppurative otitis media and cholesteatoma of the middle ear.It can restore or improve the patient’s hearing level,with the most significant effect on the intermediate frequency hearing thresholds.Endoscopic surgery can shorten the operation time,with low postoperative pain,small side effects,high safety,and low recurrence rate.It is worthy of wide application.