Hao X P, Chen S B, Yu Z L, Liang F H, Wang J, Shi Y, Li Y X
Department of Otolaryngology Head and Neck Surgery, Beijing Tong Ren Hospital, Capital Medical University, Beijing, 100730, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Oct 20;31(20):1545-1548;1553. doi: 10.13201/j.issn.1001-1781.2017.20.001.
To identify the audiological improvement postoperatively and improve the understand of otosclerosis for a better performance of personalized surgical treatment.We retrospectively reviewed a series of 200 cases after surgery for ototsclerosis.The clinical characteristics,pre-and postoperative audiometric results,signs of Carhart notch, Gelle test and the characteristics of high-resolution computed tomography of temporal bone were analyzed retrospectively.73% of patients had tinnitus, while 4% had sense of ear fullness,80.79% had Carhart notch,92.09% had negative result in Gelle test and 45.66% had positive signs on computed tomography. 68% of the patients revealed a type A tympanogram with only 22% type As.Fifty-six cases with laser stapedotomy achieved a the air bone gap at 250 Hz,500 Hz,1 kHz,2 kHz and 4 kHz of 25.54,16.25,13.75,6.34,15.96 dB,respectively. The bone conduction thresholds at 250 Hz,500 Hz,1 kHz,2 kHz improved 2.05,1.51,3.75 and 3.93 dB,respectively. At 4 kHz, bone conduction threshold increased by 1.34 dB.The improvement of bone conduction threshold at 250 Hz,1 kHz,2 kHz was significantly but for the revisions at 500 Hz and 4 kHz.The diagnosis of otosclerosis should be based on the combination of medical history, pure tone audiometry, tympanometry, Carhart notch, Gelle test and high resolution computed tomography of temporal bone.Surgical technique of stapedotomy with Piston artificial auditory ossicle implantation could improve not only the air conduction threshold, but also the bone conduction threshold at 250 Hz,1 kHz,2 kHz.
为了确定术后听力改善情况，并增进对耳硬化症的了解以更好地开展个性化手术治疗。我们回顾性分析了200例耳硬化症手术后患者的情况。对其临床特征、术前和术后听力测试结果、卡哈特切迹体征、盖莱试验以及颞骨高分辨率计算机断层扫描特征进行了回顾性分析。73%的患者有耳鸣，4%有耳闷胀感，80.79%有卡哈特切迹，92.09%盖莱试验结果为阴性，45.66%计算机断层扫描有阳性体征。68%的患者鼓室导抗图为A型，只有22%为As型。56例行激光镫骨切除术的患者在250Hz、500Hz、1kHz、2kHz和4kHz的气骨导间距分别为25.54dB、16.25dB、13.75dB、6.34dB、15.96dB。250Hz、500Hz、1kHz、2kHz的骨导阈值分别改善了2.05dB、1.51dB、3.75dB和3.93dB。在4kHz时，骨导阈值升高了1.34dB。250Hz、1kHz、2kHz处骨导阈值的改善显著，但500Hz和4kHz处的改善不明显。耳硬化症的诊断应基于病史、纯音听力测试、鼓室导抗测试、卡哈特切迹、盖莱试验以及颞骨高分辨率计算机断层扫描的综合判断。采用活塞式人工听骨植入的镫骨切除术不仅可以改善气导阈值，还能改善250Hz、1kHz、2kHz处的骨导阈值。
