Ishimoto Shin-ichi, Ito Ken, Karino Shotaro, Takegoshi Hideki, Kaga Kimitaka, Yamasoba Tatsuya
Department of Otolaryngology, Social Insurance Central General Hospital, Tokyo, Japan.
Laryngoscope. 2007 Mar;117(3):461-5. doi: 10.1097/MLG.0b013e31802ca4d4.
To evaluate the relationship between hearing level and temporal bone abnormalities in patients with microtia.
Retrospective case series study between 1992 and 2004.
Academic, tertiary care referral medical center.
We evaluated 115 ears of 89 patients (68 males, 21 females; mean age, 11 yr; range, 5-44 yr) with microtia.
Hearing level was examined in patients with microtia. Developmental abnormalities of the temporal bone were evaluated by Jahrsdoerfer's computed tomography (CT) scoring system using high-resolution CT (HRCT) scans of the temporal bone. Temporal bone malformation scores were divided into four subgroups: ossicular development, windows connected to the cochlea, aeration of the middle ear cavity, and facial nerve aberration. Patients were divided into the stenosis and atresia groups on the basis of the appearance of the external auditory canal (EAC). We also evaluated the relationships between hearing level and four subtotal scores of the HRCT findings in the stenosis and atresia groups.
There was no relationship between hearing level and total points of HRCT scoring system or between hearing level and severity of microtia scored by Marx classification. With regard to subtotal points related to ossicles (4 points), the hearing level in ears with low scores (<2) (64.7 +/- 1.6 dB) was significantly different (P = .03) from that in ears with high scores (> or =2) (54.0 +/- 2.8 dB) in the stenosis group. In the atresia group, the hearing level was 64.3 +/- 2.2 dB in ears with low scores and 62.3 +/- 1.1 in ears with high scores (P > .5). As for subtotal points related to the windows connected to cochlea (2 points), the hearing level was 64.8 +/- 2.6 dB in ears with low scores (0) and 55.9 +/- 2.4 dB in ears with high scores (> = 1) in the stenosis group. In the atresia group, the hearing level was 67.7 +/- 2.3 dB in ears with low scores and 61.5 +/- 1.0 in ears with high scores. There was significant difference between ears with low and high scores in the stenosis group (P = .03) and atresia group (P = .009). There was no significant difference between ears with low and high scores with respect to the subtotal points related to aeration of the middle ear cavity and aberration of the facial nerve.
The hearing level in microtic ears correlated with the formation of oval/round windows and ossicular development but not with the degree of middle ear aeration, facial nerve aberration, or severity of microtia. The hearing level can also serve as an indictor, such as the HRCT findings, to determine whether a subject's hearing will likely improve after reconstructive surgery.
评估小耳畸形患者听力水平与颞骨异常之间的关系。
1992年至2004年的回顾性病例系列研究。
学术性三级医疗转诊中心。
我们评估了89例小耳畸形患者的115只耳朵（68例男性，21例女性；平均年龄11岁；范围5 - 44岁）。
对小耳畸形患者进行听力水平检查。使用颞骨高分辨率CT（HRCT）扫描，通过耶尔施多费尔计算机断层扫描（CT）评分系统评估颞骨的发育异常。颞骨畸形评分分为四个亚组：听骨链发育、与耳蜗相连的窗、中耳腔的气化以及面神经畸变。根据外耳道（EAC）外观将患者分为狭窄组和闭锁组。我们还评估了狭窄组和闭锁组中听力水平与HRCT检查结果的四个总分之间的关系。
听力水平与HRCT评分系统总分之间，以及听力水平与马克思分类法所评定的小耳畸形严重程度之间均无关联。在狭窄组中，就与听骨链相关的亚组分数（4分）而言，低分（<2）耳朵的听力水平（64.7±1.6 dB）与高分（≥2）耳朵的听力水平（54.0±2.8 dB）有显著差异（P = 0.03）。在闭锁组中，低分耳朵的听力水平为64.3±2.2 dB，高分耳朵的听力水平为62.3±1.1 dB（P>0.5）。对于与连接耳蜗的窗相关的亚组分数（2分），狭窄组中低分（0）耳朵的听力水平为64.8±2.6 dB，高分（≥1）耳朵的听力水平为55.9±2.4 dB。在闭锁组中，低分耳朵的听力水平为67.7±2.3 dB，高分耳朵的听力水平为61.5±1.0 dB。狭窄组（P = 0.03）和闭锁组（P = 0.009）中低分和高分耳朵之间存在显著差异。在与中耳腔气化和面神经畸变相关的亚组分数方面，低分和高分耳朵之间无显著差异。
小耳畸形耳朵的听力水平与椭圆窗/圆窗的形成以及听骨链发育相关，但与中耳气化程度、面神经畸变或小耳畸形严重程度无关。听力水平也可作为一种指标，如HRCT检查结果一样，用于判断患者在重建手术后听力是否可能改善。
