Clinical application of transcanal endoscopic ear surgery in the diagnosis and treatment of conductive hearing loss with intact tympanic membrane
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摘要: 目的 探讨经外耳道耳内镜手术诊治鼓膜完整的传导性聋的疗效。方法 回顾性分析16例鼓膜完整的传导性聋患者的临床资料，所有患者均经外耳道耳内镜手术探查。结果 16例患者经鼓室探查均明确诊断，先天性中耳畸形6例，先天性中耳胆脂瘤5例，先天性中耳胆脂瘤合并中耳畸形2例，耳硬化2例，外伤性听骨链中断1例。经外耳道耳内镜手术探查鼓室并根据术中情况行听力重建，14例(14耳)中植入PORP 7例，TORP 5例，Piston 2例，其余2例未行听力重建。术后14例患者平均气导听阈由术前的(61.7±6.5) dB HL下降到术后的(29.8±10.7) dB HL(P < 0.01)，平均气骨导差由术前的(36.8±3.2) dB HL下降到术后的(10.7±6.9) dB HL(P < 0.01)。1例先天性中耳胆脂瘤合并中耳畸形患者仅切除病灶，未行听力重建；1例患者听骨链畸形，镫骨底板固定，术中因无合适听骨，未行人工听小骨植入。术后无严重并发症发生。结论 经外耳道耳内镜手术适合鼓膜完整的传导性聋患者的诊治，该手术微创、并发症低，行听力重建后患者听力恢复较好。Abstract: Objective To explore the clinical efficacy of transcanal endoscopic ear surgery in the diagnosis and treatment of conductive hearing loss with intact tympanic membrane.Method The clinical data of 16 patients with conductive hearing loss with intact tympanic membrane were retrospectively analyzed. They were diagnosed and treated by transcanal endoscopic ear surgery.Result All patients were diagnosed by exploratory tympanotomy, including 6 cases of congenital middle ear anomalies, 5 cases of congenital cholesteatoma, 2 cases of congenital middle ear anomalies with congenital cholesteatoma, 2 cases of otosclerosis, and 1 case of traumatic ossicular chain disruption. During the tympanic exploration by transcanal endoscopic ear surgery, different methods of hearing reconstruction were applied according to the intraoperative lesions. Among 14 cases(14 ears), 7 patients underwent reconstruction with partial ossicular replacement prosthesis (PORP), 5 patients had total ossicular replacement prosthesis (TORP), and 2 patients had piston. The remaining 2 patients did not undergot ossicular reconstruction. After the operation, the mean air-conductive threshold of 14 patients decreased from (61.7±6.5) dB HL to (29.8±10.7) dB HL (P < 0.01) and the mean ABG decreased from(36.8±3.2) dB HL to (10.7±6.9) dB HL (P < 0.01). 1 case of congenital middle ear anomalies with congenital cholesteatoma underwent the lesion resection without ossicular reconstruction. Due to lack of suitable Piston, 1 case of congenital middle ear anomalies with fixed stapes did not perform hearing reconstruction. No serious complications occured after operations.Conclusion Transcanal endoscopic ear surgery was suitable for the diagnosis and treatment of conductive hearing loss with intact tympanic membrane. It was minimally invasive with low complications, and the patients had a good hearing recovery after ossicular reconstruction.
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表 1 传导性聋的病因及植入听骨类型
病因 术中探查 例数 植入听骨类型 先天性中耳畸形 Ⅱ型：镫骨底板固定合并其他听骨链畸形 1例 未植入 Ⅲa型：镫骨底板活动，听骨链中断 4例 PORP Ⅲb型：镫骨底板活动，砧骨或锤骨固定 1例 TORP 先天性中耳胆脂瘤 镫骨上结构、砧骨长脚破坏 3例 TORP 砧骨长脚破坏，镫骨上结构完好 2例 PORP 先天性中耳胆脂瘤合并中耳畸形 砧骨发育畸形，镫骨底板活动 1例 TORP 镫骨上结构、砧骨缺如，镫骨底板活动 1例 未植入 耳硬化 镫骨底板固定 2例 Piston 外伤性听骨链中断 砧镫关节分离 1例 PORP 
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