慢性化脓性中耳炎鼓膜穿孔特征与听力损失的相关性研究

A Study of the Correlation between the Characteristics of Tympanic Membrane Perforation and Hearing Loss in Chronic Suppurative Otitis Media

目的探讨慢性化脓性中耳炎鼓膜穿孔特征与听力损失的相关性。方法回顾性分析2022年7月~2023年7月于兰州大学第二医院耳鼻咽喉头颈外科确诊为慢性化脓性中耳炎并行Ⅰ型鼓室成形术治疗的80例患者(104耳)的纤维耳内镜图像及完整的听力学资料。采用ImageJ图像软件测量鼓膜穿孔面积,以穿孔边界面积占完整鼓膜边界面积的百分比(RAp值)为鼓膜穿孔相对面积。分析不同面积鼓膜穿孔、穿孔涉及象限、穿孔边缘是否钙化以及穿孔范围是否累及锤骨柄与气骨导差(ABG)的关系。结果慢性化脓性中耳炎鼓膜穿孔患者的鼓膜穿孔面积与平均气骨导差之间呈显著正相关关系(R^(2)=0.141,P<0.0001),相对穿孔面积越大者ABG越大;穿孔累及锤骨柄的患者较未累及锤骨柄的患者气骨导差更大(P<0.05);鼓膜穿孔边缘钙化情况和穿孔位置对听力损失的影响很小,几乎可以忽略不计。结论鼓膜穿孔引起的传导性听力损失与穿孔大小和穿孔是否累及锤骨柄有关,穿孔相对面积越大及穿孔累及锤骨柄患者的传导性听力损失往往更重。

Objective To study the correlation between the characteristics of tympanic membrane perforation and hearing loss in chronic suppurative otitis media.Methods Ear fibreoptic endoscopic images and complete audiological data of 80 patients(104 ears)diagnosed with chronic suppurative otitis media and treated with tympanoplasty type I surgery at the Department of Otorhinolaryngology-Head and Neck Surgery of the Second Hospital of Lanzhou University from July 2022 to July 2023 were reviewed.The area of tympanic membrane perforation was measured using ImageJ software.Qualitative variables were professionally assessed by a senior practitioner in otology,including whether the perforation involved the quadrant,whether the edge of the perforation was calcified,and whether the extent of the perforation involved the malleus.Results There was a significant positive correlation between the area of tympanic membrane perforation and the mean air-bone conductance difference in patients with tympanic membrane perforation due to chronic suppurative otitis media(R^(2)=0.141,P<0.001).The patients with perforation involving the malleus handle had a greater air-bone conductance difference than those without malleus handle involvement(P<0.05).The effect of calcification at the edge of the tympanic membrane perforation and the location of the perforation on hearing loss was minimal and almost negligible.Conclusion Conductive hearing loss due to tympanic membrane perforation is related to the size of the perforation and whether or not the perforation involves the malleus handle,and the patients with larger perforation as well as those with perforations involving the handle of malleus tend to exhibit worse conductive hearing loss.