Tang Yiyang, Lian Bing, Zhang Mingyan, Tu Xinfeng, Zhang Tao, Wang Haiyan
Department of Otolaryngology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China.
Ann Transl Med. 2022 Jul;10(14):778. doi: 10.21037/atm-22-2606.
Chronic suppurative otitis media (CSOM) is a common otolaryngology disease, and cholesteatoma is the most aggressive type of CSOM. CSOM with and without cholesteatoma both result in a certain level of sensorineural damage, which can be categorized as air conduction (AC), bone conduction (BC), or air-bone gap (ABG), and AC, BC, and ABG are affected by many factors. Further analyses and comparisons of factors affecting sensorineural damage in CSOM with and without cholesteatoma were conducted in this study.
A comparative study was conducted of 79 patients with CSOM (39 with cholesteatoma and 40 without cholesteatoma) whose diagnoses were mainly based on chronic middle ear infections and hearing loss (HL), typical computed tomography (CT) and surgical findings. Audiological evaluation included AC, BC and ABG, and sensorineural damage was defined as mixed and sensorineural HL (SNHL).
In relation to the types of HL, there were no significant differences between both groups. The CSOM with cholesteatoma group had significantly greater AC (P=0.000) and a significantly greater ABG (P>0.05) than the CSOM without cholesteatoma group, but BC did not differ significantly between both groups (P>0.05). The average AC-middle frequency (MF), AC-high frequency (HF), ABG-MF and ABG-HF of CSOM without cholesteatoma were smaller than these of CSOM with cholesteatoma (P<0.05). The degree of HL differed significantly between both groups (P=0.000). The CSOM with cholesteatoma group showed a higher level of HL than the CSOM without cholesteatoma group. The presence of cholesteatoma was presented a protective factor associated with sensorineural damage (P<0.05), while higher degrees of hearing and aging were risk factors (P<0.05), respectively.
Our direct comparisons showed that HL progressed more rapidly in the CSOM with cholesteatoma group, which had higher frequencies in relation to AC, the ABG, and severity. However, in relation to BC, there were no significant differences between both groups, which was in line with the similar proportions of the types of HL in both groups. The logistic regression showed that the presence of cholesteatoma was a protective factor, and the degree of hearing and aging were risk factors associated with sensorineural damage.
慢性化脓性中耳炎（CSOM）是一种常见的耳鼻喉科疾病，胆脂瘤型是CSOM中最具侵袭性的类型。伴有或不伴有胆脂瘤的CSOM均会导致一定程度的感音神经性损害，可分为气导（AC）、骨导（BC）或气骨导差（ABG），且AC、BC和ABG受多种因素影响。本研究对影响伴有和不伴有胆脂瘤的CSOM感音神经性损害的因素进行了进一步分析和比较。
对79例CSOM患者（39例伴有胆脂瘤，40例不伴有胆脂瘤）进行了一项对比研究，其诊断主要基于慢性中耳感染和听力损失（HL）、典型的计算机断层扫描（CT）及手术结果。听力学评估包括AC、BC和ABG，感音神经性损害定义为混合性和感音神经性听力损失（SNHL）。
在HL类型方面，两组之间无显著差异。伴有胆脂瘤的CSOM组的AC（P=0.000）和气骨导差（ABG）（P>0.05）显著大于不伴有胆脂瘤的CSOM组，但两组之间的BC无显著差异（P>0.05）。不伴有胆脂瘤的CSOM组的平均AC-中频（MF）、AC-高频（HF）、ABG-MF和ABG-HF均小于伴有胆脂瘤的CSOM组（P<0.05）。两组之间HL程度差异显著（P=0.000）。伴有胆脂瘤的CSOM组的HL水平高于不伴有胆脂瘤的CSOM组。胆脂瘤的存在是与感音神经性损害相关的保护因素（P<0.05），而较高的听力程度和年龄分别是危险因素（P<0.05）。
我们的直接比较表明，伴有胆脂瘤的CSOM组中HL进展更快，该组在AC、ABG及严重程度方面频率更高。然而，在BC方面两组之间无显著差异，这与两组中HL类型的比例相似相符。逻辑回归显示，胆脂瘤的存在是一个保护因素，听力程度和年龄是与感音神经性损害相关的危险因素。
