Xiangya Hospital Central South University
目的:分析不同分型鼓室硬化患者的听力学特点,探讨其手术治疗效果,为术前评估提供参考。方法:对135例(135耳)鼓室硬化手术患者进行回顾性分析,对比术前术后听力学资料。结果:I、II型鼓室硬化患者多表现为传导性耳聋(分别为71.4%、68.8%),IV型鼓室硬化患者中混合性耳聋出现的比例更高(66.7%)。各型鼓室硬化的听力曲线以平坦型为主。卡哈切迹出现率为13.3%(18/135),IV型鼓室硬化患者中有38.9%的患者听力图出现了卡哈切迹。各型鼓室硬化患者(除III型鼓室硬化外)术后气骨导差值和气导平均听阈均较术前降低。将满足术后气骨导差(Post-op ABG)＜20dB、术后气导平均听阈(Post-op AC)＜30dB、术后气导平均听阈提高(ΔPost-op AC)＞20dB中其一即可认为手术成功标准时,I型鼓室硬化的手术成功率最高(79%),IV型鼓室硬化的成功率最低(63.9%)。结论:各型鼓室硬化患者听力图多呈现平坦型曲线,混合性耳聋最多见于IV型鼓室硬化,卡哈切迹的出现可提示镫骨的固定。手术清除鼓室内硬化灶是主要的治疗方式,I型鼓室硬化术后成功率最高,IV型鼓室硬化最低。
Objective: To analyze the audiological characteristics of patients with tympanosclerosis of different types, and to discuss the effect of surgical treatment, so as to provide reference for preoperative evaluation. Methods: 135 cases (135 ears) with tympanosclerosis were retrospectively analyzed, and the audiological data before and after operation were compared. Results: Conduction deafness was more common in type I and II tympanosclerosis patients (71.4% and 68.8%, respectively), and mixed deafness was more common in type IV tympanosclerosis patients (66.7%). The hearing curve of tympanosclerosis was mainly flat. The incidence of Kaha notch was 13.3% (18/135), and 38.9% of patients with type IV tympanosclerosis had Kaha notch on audiogram. In patients with all types of tympanosclerosis (except type III tympanosclerosis), the values of air bone conductance and the mean auditory threshold of air conductance were lower after surgery than before surgery. The success rate of surgery for type I tympanosclerosis was the highest (79%) when one of the criteria for surgical success was satisfied: Post-op ABG < 20dB, Post-op AC < 30dB, and ΔPost-op AC > 20dB. Tympanosclerosis IV had the lowest success rate (63.9%). Conclusion: The audiogram of patients with tympanosclerosis is mostly flat, and mixed deafness is most common in type IV tympanosclerosis, The appearance of the Kaha marks may indicate fixation of the stapes. Surgical removal of intractympanosclerosis is the main treatment method. The success rate is highest for type I tympanosclerosis and lowest for type IV tympanosclerosis.