Gedlicka Claudia, Formanek Michael, Ehrenberger Klaus
Department of Otorhinolaryngology, Head and Neck Surgery, University of Vienna, Vienna, Austria.
Am J Otolaryngol. 2009 May-Jun;30(3):157-61. doi: 10.1016/j.amjoto.2008.04.003. Epub 2008 Sep 21.
This retrospective study was performed to evaluate the effectiveness of tympanotomy and sealing of the round window membrane after unilateral acute hearing loss.
All patients presenting idiopathic sudden hearing loss, acoustic, or barotrauma were treated with prednisolone and caroverine. Thirty-six patients had a mean pure tone hearing level worse than 70 dB. Recovery was defined as improvement of hearing threshold for 5 frequencies (250, 500, 1000, 2000, and 4000 Hz). If hearing did not improve after conservative treatment, an exploratory tympanotomy and sealing of the round window membrane were suggested. In the last 8 years, 60 patients with idiopathic sudden hearing loss, acoustic, or barotrauma underwent tympanotomy.
In 40 patients, we observed improvement of hearing level up to complete remission. In 20 patients, no change could be detected. In the group of patients with documented barotrauma, 12 patients showed improved hearing levels. Of 37 patients with idiopathic sudden hearing loss, 26 had an improved hearing after surgery. Most patients were operated on within 14 days (range, 1-60 days), but time of surgery had no influence on outcome in patients with idiopathic hearing loss. In contrast, in patients with barotrauma, time of surgery seems to have an influence on outcome.
Tympanotomy and sealing of the round window membrane can be recommended in cases of acute hearing loss after failure of conservative treatment.
本回顾性研究旨在评估单侧急性听力损失后鼓室切开术及圆窗膜封闭术的有效性。
所有出现特发性突发听力损失、声学性或气压性创伤的患者均接受泼尼松龙和卡络维林治疗。36例患者的平均纯音听力水平超过70分贝。听力恢复定义为5个频率（250、500、1000、2000和4000赫兹）的听力阈值改善。如果保守治疗后听力未改善，则建议进行探索性鼓室切开术及圆窗膜封闭术。在过去8年中，60例特发性突发听力损失、声学性或气压性创伤患者接受了鼓室切开术。
40例患者听力水平改善直至完全缓解。20例患者未检测到变化。在有气压性创伤记录的患者组中，12例患者听力水平有所改善。在37例特发性突发听力损失患者中，26例术后听力有所改善。大多数患者在14天内接受手术（范围为1至60天），但手术时间对特发性听力损失患者的预后没有影响。相比之下，在气压性创伤患者中，手术时间似乎对预后有影响。
对于保守治疗失败后的急性听力损失病例，可推荐鼓室切开术及圆窗膜封闭术。
