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因鼓室硬化症导致的孤立性锤骨固定的手术

Surgery of isolated malleus fixation due to tympanosclerosis.

作者信息

Sakalli Erdal, Celikyurt Cengiz, Guler Burak, Biskin Sultan, Tansuker Hasan Deniz, Erdurak Selcuk Cem

机构信息

Department of Otorhinolaryngology, Safa Private Hospital, Istanbul, Turkey.

, Fevzi cakmak mah. Sisecam bloklari. Emek apt. D:8, Bagcilar, Istanbul, Turkey.

出版信息

Eur Arch Otorhinolaryngol. 2015 Dec;272(12):3663-7. doi: 10.1007/s00405-014-3445-0. Epub 2014 Dec 14.

Abstract

The aim of the present study was to describe our surgical approach for isolated malleus fixation in patients with tympanosclerosis and to analyze the postoperative results. A total of 30 patients presented with isolated malleus fixation were operated. The fixation was reached via canalplasty. Fixated areas were cleaned without damaging the ossicle. Pre- and postoperative audiometric results were evaluated for each patient. Improvement of the pure-tone average (PTA) by at least 10 dB and an air-bone gap (ABG) of less than 20 dB after 12 months of follow-up was accepted to indicate success. The recovery of the postoperative PTA and ABG measurements was significant. Pre- and postoperative PTA was 48.00 ± 11.86 and 24.90 ± 12.45 dB, respectively (p < 0.001). According to PTA measurements, 40-50 dB recovery was achieved in four (13.3 %) patients, 31-40 dB in six (20 %) patients, 21-30 dB in ten (33.3 %) patients, and 11-20 dB in five (16.6 %) patients, with a total success rate of 25/30 (83.2 %). Pre- and postoperative ABG levels were 38.95 ± 9.92 and 16.10 ± 7.79 dB (p < 0.001), respectively. The ABG level was between 0 and 10 dB for 8 (26.6 %) patients, and 11-20 dB for 16 (53.3 %), with a total success rate of 24/30 (80 %). In cases of isolated malleus fixation with tympanosclerosis, performing a canalplasty to clean the sclerotic plaques without damaging the normal anatomy of the ossicle system using a diamond burr is a safe surgical option that provides significant recovery in hearing levels.

摘要

本研究的目的是描述我们针对鼓室硬化症患者单纯锤骨固定的手术方法,并分析术后结果。共有30例表现为单纯锤骨固定的患者接受了手术。通过外耳道成形术暴露固定部位。在不损伤听小骨的情况下清理固定区域。对每位患者术前和术后的听力测试结果进行评估。随访12个月后,纯音平均听阈(PTA)至少提高10 dB且气骨导差(ABG)小于20 dB被视为手术成功。术后PTA和ABG测量值的恢复情况显著。术前和术后PTA分别为48.00±11.86 dB和24.90±12.45 dB(p<0.001)。根据PTA测量结果,4例(13.3%)患者恢复了40 - 50 dB,6例(20%)患者恢复了31 - 40 dB,10例(33.3%)患者恢复了21 - 30 dB,5例(16.6%)患者恢复了11 - 20 dB,总成功率为25/30(83.2%)。术前和术后ABG水平分别为38.95±9.92 dB和16.10±7.79 dB(p<0.001)。8例(26.6%)患者的ABG水平在0至10 dB之间,16例(53.3%)患者的ABG水平在11至20 dB之间,总成功率为24/30(80%)。对于鼓室硬化症合并单纯锤骨固定的病例,使用金刚砂钻头进行外耳道成形术以清理硬化斑块,同时不损伤听小骨系统的正常解剖结构,是一种安全的手术选择,能使听力水平得到显著恢复。

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