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摘要: 目的 评估一期鼓室成形术治疗鼓室硬化致镫骨固定患者的听力效果及并发症。方法 对59例(61耳)行一期鼓室成形术的鼓室硬化致镫骨固定的患者进行回顾性研究。所有患者诊断慢性化脓性中耳炎并在术中确定因鼓室硬化导致镫骨固定。手术清除镫骨底板上及其周围硬化灶恢复镫骨动度，用自体砧骨或部分听骨赝复物(PORP)重建听骨链。分析手术前后500 Hz、1 kHz、2 kHz和4 kHz 4个频率的气骨导听阈变化。听力改善的评价标准为平均气导听阈降低≥10 dB。结果 手术后并发症包括暂时性面瘫1例，暂时性眩晕2例，骨导听阈轻度升高2例，鼓膜延迟愈合1例。术后1个月和3个月时1 kHz、2 kHz的骨导听阈较术前降低(P < 0.01)。术后1年和2年时4个频率的气导听阈较术前明显降低(P < 0.01或P < 0.05)。术后1年的听力改善率为72.13%。自体砧骨组及PORP组术后平均气导听阈均较术前明显降低(P < 0.01)，而且两组的听力改善率差异无统计学意义(P>0.05)。结论 对于鼓室硬化致镫骨固定的患者，鼓室成形术能通过一期清除硬化灶和重建听骨链改善听力。但术者应操作细致，避免出现感音神经性聋和面瘫等严重并发症。Abstract: Objective To evaluate hearing outcome and complications of one-stage tympanoplasty in patients with stapes fixation due to tympanosclerosis.Method 59 patients(sixty-one ears) underwent one-stage tympanoplasty for stapes fixation due to tympanosclerosis were retrospectively analyzed. Stapes fixation due to tympanosclerosis were proved during the surgery in these patients diagnosed with chronic otitis media. For all the patients, tympanosclerotic plaques around stapes were removed for stapes mobilization. Then the ossicular chain was rebuilt by autogenous incus or PORP. The pre-and post-operative audiometric results(500 Hz, 1 kHz, 2 kHz and 4 kHz) were evaluated for each patient. Improvement of pure-tone average more than 10 dB postoperatively were accepted as success criteria.Result Complications included temporary facial paralysis(1/61), temporary vertigo(2/61), mild elevation in bone conduction thresholds(2/61) and delayed healing of tympanic membrane(1/61). Postoperative(1 and 3 months) bone conduction thresholds improved at frequencies of 1 and 2 kHz(P < 0.01). Postoperative(1 and 2 years) air conduction thresholds improved at all frequencies(P < 0.01 or P < 0.05). A gain ≥10 dB in pure-tone average was found in 44(72.13%) patients at 1 year after surgery. The air conduction levels were significantly improved in both autogenous incus and PORP groups(P < 0.01). There was no difference about success rate between these two groups(P>0.05).Conclusion For patients with stapes fixation due to tympanosclerosis, one-stage tympanoplasty can improve hearing threshold though ossicular chain reconstruction and stapes release. The major complications such as facial paralysis and sensorineural hearing loss should be avoided by delicate surgical operation.
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Key words:
- tympanosclerosis /
- stapes /
- tympanoplasty /
- otitis media, suppurative /
- retrospective studies
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表 1 术后短期骨导听阈变化
dB，x±s 频率 骨导听阈 F P 术前 术后1个月 术后3个月 500 Hz 21.48±8.33 18.36±9.69 18.84±9.93 1.972 0.1421 1 kHz 24.02±9.95 18.44±11.011) 17.44±8.892) 7.688 0.0060 2 kHz 28.93±11.22 23.28±12.841) 21.63±9.042) 7.201 0.0010 4 kHz 24.18±11.44 26.64±15.94 24.19±13.88 1.988 0.1399 平均值 24.65±8.97 21.68±10.82 20.52±8.68 3.043 0.0502 与术前比较，1)P < 0.05，2)P < 0.01。 
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表 2 术后气导听阈变化
dB，x±s 频率 气导听阈 F P 气导听阈 t P 术前
(n=61)术后6个月
(n=61)术后12个月
(n=61)术后24个月
(n=24)500 Hz 67.83±8.56 47.67±9.692) 47.83±14.772) 47.41 < 0.001 46.67±19.262) 5.330 < 0.001 1 kHz 67.42±10.64 46.67±15.992) 45.58±14.852) 47.02 < 0.001 42.71±17.442) 7.325 < 0.001 2 kHz 56.58±15.14 40.67±15.962) 37.00±14.332) 28.76 < 0.001 33.13±15.732) 8.932 < 0.001 4 kHz 53.50±15.47 47.25±19.58 45.67±19.951) 3.07 0.049 41.25±20.972) 3.550 0.002 平均值 61.33±10.44 45.56±14.492) 42.57±12.822) 38.47 < 0.001 40.94±16.412) 6.985 < 0.001 与术前比较，1)P < 0.05，2)P < 0.01。
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表 3 自体砧骨及PORP对平均气导听阈的影响
dB，x±s 组别 耳数 术前 术后1年 t P 自体砧骨组 43 60.78±10.95 44.71±13.46 9.090 < 0.001 PORP组 18 62.15±9.22 41.39±13.96 5.958 < 0.001
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