An observation of long term effect of one-stage hearing reconstruction on tympanosclerosis
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摘要: 目的 研究鼓室硬化患者一期听力重建术后远期听力的稳定性。方法 回顾性分析41例(44耳)鼓室硬化患者术前以及术后3个月、6个月、1年、2~5年的纯音听阈, 总结言语频率(0.5、1、2、4 kHz)气骨导差(ABG)及平均ABG的变化。结果 44耳术前ABG为(36.0±10.4) dB, 术后3个月、6个月、1年、2~5年ABG分别为(24.1±8.8) dB、(24.5±9.8) dB、(22.4±11.3) dB和(22.5±4.1) dB, 术后ABG较术前ABG缩小且差异有统计学意义, 但术后不同时间平均ABG差异无统计学意义。在术后不同时间, 不同类型鼓室硬化患者的平均ABG均是Ⅰ型 < Ⅱ型 < Ⅳ型, 各频率ABG介于9.3~33.7 dB之间, 不同频率之间和不同类型之间均有显著差异。术后不同时间ABG与术前ABG之差无显著差异, 不同频率的术前术后ABG之差亦无显著差异。结论 听力重建术对鼓室硬化患者不同频率的听力改善效果相当, Ⅰ型鼓室硬化术后听力效果最好, Ⅳ型听力效果最差, 术后远期(术后1年及2年以上)与近期(术后3、6个月)的听力无明显差异, 术后远期的听力效果稳定。Abstract: Objective To observe the long-term hearing stability of patients with tympanosclerosis after one-stage hearing reconstruction.Method Forty-one patients with tympanosclerosis were included in the study. Their puretone thresholds before operation and those at 3 months, 6 months, 1 year, 2 to 5 years after operation were retrospectively analyzed. Differences between pre-and postoperative air-bone gaps(ABG) for speech frequencies(0.5, 1, 2, 4 kHz) as well as those of averaged ABG were calculated.Result Preoperative averaged ABG of 44 ears was (36.0±10.4) dB. Averaged ABG at 3 months, 6 months, 1 year, 2 to 5 years after operation were (24.1±8.8) dB, (24.5±9.8) dB, (22.4±11.3) dB and (22.5±4.1) dB respectively. Averaged ABG at different time after operation were all significantly less than preoperative results but didn't differ between each other. Postoperative ABG for different frequencies varied between 9.3 and 33.7 dB. They were significantly less than preoperative results, but didn't differ between the four frequencies. At different time after operation, averaged ABG of type Ⅰ were always significantly less than those of type Ⅱ, while the latter were always significantly less than those of type Ⅳ. Differences between preoperative ABG and ABG at different postoperative time were not significantly different. Neither were differences between pre-and postoperative ABG for different frequencies.Conclusion Hearing reconstruction has the same effect on hearing improvement of patients with tympanosclerosis at different frequencies. Type Ⅰ patients has the best hearing results while type Ⅳ patients has the worst. There is no significant difference between the long-term(1 year and more than 2 years after operation) and the short-term(3 months and 6 months after operation) hearing level. Hearing level of patients with tympanosclerosis remain stable in a long time after operation.
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Key words:
- tympanosclerosis /
- hearing reconstruction /
- puretone audiometry /
- air-bone gap
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表 1 术后不同时间平均ABG
dB，x±s 分型 耳数 术后时间 3个月 6个月 1年 2~5年 Ⅰ型 8 16.3±7.5 15.0±4.2 12.3±8.2 15.4±7.3 Ⅱ型 17 23.6±9.5 23.7±6.5 23.4±6.1 22.5±8.3 Ⅲ型 1 - - - - Ⅳ型 18 31.3±9.5 34.5±7.6 34.1±8.3 32.7±11.5 合计 44 24.1±8.8 24.5±9.8 22.4±11.3 22.5±4.1 
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表 2 术后不同时间纯音测听各频率ABG(n=44)
dB，x±s 术后时间 频率/kHz 0.5 1 2 4 3个月 27.8±10.7 27.8±10.3 16.9±14.1 23.9±11.7 6个月 33.7±12.9 26.7±10.3 13.7±11.3 26.8±12.0 1年 28.5±12.5 26.5±13.6 12.7±11.8 21.9±12.7 2~5年 32.9±6.4 28.6±7.5 9.3±6.7 19.3±9.8
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表 3 术后纯音测听各频率ABG两两多重比较
频率/kHz 频率/kHz 0.5 1 2 4 0.5 - P=0.037 P < 0.001 P=0.016 1 P=0.037 - P < 0.001 P=0.993 2 P < 0.001 P < 0.001 - P < 0.001 4 P=0.016 P=0.993 P < 0.001 -
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表 4 术前术后各频率ABG的差值比较(n=44)
dB，x±s 术后时间 频率/kHz 0.5 1 2 4 3个月 22.2±14.1 17.8±15.1 7.5±16.8 14.4±18.3 6个月 13.7±14.9 17.7±13.8 8.3±21.5 4.3±19.8 1年 20.4±15.5 19.2±14.6 10.8±18.3 12.7±17.2 2~5年 13.6±8.0 10.7±12.1 15.0±10.8 18.6±16.8
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