光纤激光镫骨底板开窗治疗耳硬化症及听骨畸形58例疗效分析

Analysis of the efficacy of fiber laser stapes fenestration in the treatment of 58 cases of otosclerosis and ossicular malformation

目的探讨波长980 nm光纤激光镫骨底板开窗术治疗耳硬化症及听骨畸形所致传导性聋的疗效。方法回顾性分析宁波市医疗中心李惠利医院2018年1月至2023年7月58例(耳)使用980 nm Diode光纤激光镫骨底板开窗术治疗耳硬化症(49例)及听骨畸形(9例)所致传导性聋患者的临床资料,比较手术前后0.5、1、2、4 kHz频率的气导听阈、骨导听阈和气骨导差,总结波长980 nm光纤激光优势与其注意事项。以SPSS26.0软件对手术前后的听力数据进行配对t检验。结果57例均顺利完成光纤激光镫骨底板开窗及人工镫骨植入手术,1例漂浮畸形镫骨底板脱落患者听力较术前下降。术前0.5、1、2、4 kHz气导听阈为(65.4±9.7)dB HL,骨导听阈为(27.2±8.9)dB HL,气骨导差(38.2±9.8)dB。术后3个月气导听阈(42.1±11.3)dB HL,骨导听阈(26.9±6.6)dB HL,气骨导差(15.2±9.1)dB。手术前后的气骨导差和气导听阈的差异均具有统计学意义(t值分别为13.270、13.948,P值均<0.01),手术前后骨导听阈差异无统计学意义(t=0.418,P>0.05)。结论980 nm光纤激光镫骨底板开窗术治疗耳硬化症及听骨畸形所致的传导性聋有效。

ObjectiveTo explore the surgical efficacy of conductive deafness caused by otosclerosis and ossicular malformation with 980 nm fiber laser stapedial floor fenestration.MethodsData of 58 patients(ears)who were diagnosed with conductive deafness caused by otosclerosis(49 ears)and ossicular malformation(9 ears)treated by 980 nm Diode laser small-fenestra stapedotomy were retrospectively analyzed.Air conduction(AC)thresholds,bone conduction(BC)thresholds,and air-bone gap(ABG)at 0.5,1,2,4 kHz pure tone frequencies were compared before and 3 months after surgery,and the advantages and precautions of 980 nm fiber laser were summarized.Paired t-test(SPSS 26.0 software)was use to analyze the listening data.ResultsFiber optic laser stapes fenestration and artificial stapes implantation were successfully completed in all 57 cases(ears),the hearing of another one patient(ear)with floating malformation of detachment of stapedial floor was lower than that before surgery.Preoperative at 0.5,1,2,4 kHz frequencies of AC thresholds,BC thresholds,and ABG were(65.4±9.7)dB,(27.2±8.9)dB,and(38.2±9.8)dB respectively.Postoperative 3 months at the same frequency of AC thresholds,BC thresholds,and ABG were(42.1±11.3)dB,(26.9±6.6)dB,and(15.2±9.1)dB.Preoperative and postoperative of AC threshold and ABG were statistically significant at 0.5,1,2,4 kHz(t value was 13.270 and13.948,both P<0.01),and yet the BC threshold was not statistically significant before and after surgery at the same frequency(t=0.418,P>0.05).Conclusions980 nm fiber laser stapes floor fenestration is an effective treatment for conductive deafness caused by otosclerosis and ossicular malformation.