Tan Zhiqiang, Peng Tao, Liu Bin, Miao Gangyong, Bu Meixiang, Zhou En, Xiao Xuping, Ling Keji
Department of Otolaryngology Head and Neck Surgery，Hunan Provincial People's Hospital，Changsha，410005，China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Dec;34(12):1070-1074. doi: 10.13201/j.issn.2096-7993.2020.12.004.
To explore the clinical efficacy of transcanal endoscopic ear surgery in the diagnosis and treatment of conductive hearing loss with intact tympanic membrane. 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. 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 （<0.01） and the mean ABG decreased from（36.8±3.2） dB HL to （10.7±6.9） dB HL （<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. 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.
探讨经耳道内镜耳科手术在诊断和治疗鼓膜完整的传导性听力损失中的临床疗效。回顾性分析16例鼓膜完整的传导性听力损失患者的临床资料。他们均接受经耳道内镜耳科手术进行诊断和治疗。所有患者均经探查性鼓室切开术确诊，其中先天性中耳畸形6例，先天性胆脂瘤5例，先天性中耳畸形合并先天性胆脂瘤2例，耳硬化症2例，外伤性听骨链中断1例。在经耳道内镜耳科手术进行鼓室探查时，根据术中病变情况采用不同的听力重建方法。14例（14耳）中，7例患者采用部分听骨赝复物（PORP）进行重建，5例患者采用全听骨赝复物（TORP），2例患者采用人工镫骨。其余2例患者未进行听骨重建。术后，14例患者的平均气导阈值从（61.7±6.5）dB HL降至（29.8±10.7）dB HL（<0.01），平均气骨导差从（36.8±3.2）dB HL降至（10.7±6.9）dB HL（<0.01）。1例先天性中耳畸形合并先天性胆脂瘤患者未进行听骨重建仅行病变切除。1例先天性中耳畸形伴镫骨固定患者因缺乏合适的人工镫骨未进行听力重建。术后未发生严重并发症。经耳道内镜耳科手术适用于鼓膜完整的传导性听力损失的诊断和治疗。该手术微创，并发症少，听骨重建后患者听力恢复良好。
