慢性中耳炎听骨链病损部位对气导听力损失的影响.docVIP

慢性中耳炎听骨链病损部位对气导听力损失的影响 The effect of lesion site of ossicular chain on air conductive hearing loss in chronic otitis media patients Wang Shaozhi　Yang Qingwen　Leng Tongjia （Otolaryngology Head and Neck Surgery,Tongren Hopital,Beijing 100730） 【Abstract】　Objective　To investigate the relationship between the diseased site of ossicular chain in chronic otitis media and the degree of air conductive hearing loss in speech interval.Methods　Seventy cases of chronic otitis media were divided into 3 groups according to the lesion of ossicular chain.In group 1 lesion site was anterior to incudomalleolar articulation,in group 2 lesion site was anterior to incudostapedial articulation and in group 3 the lesion involved whole ossicular chain.Compare was carried out among the 3 groups with Newman Keuls test (q test).Results　There were significant difference of air conductive hearing loss among the 3 groups in 500Hz,1 000Hz and 2 000Hz.Conclusions　The degree of conductive hearing loss in speech interval is highly related to the lesion site of ossicular chain. 　　【Key words】　Otitis media　　Hearing loss　　Ossicular chain 　　骨导正常的慢性中耳炎，听骨链的完整性及活动性是影响气导听阈的主要因素，尽管慢性中耳炎病变类型各异，对听骨链的破坏方式亦不尽相同，但对听骨链病损部位的探查及处理是临床医生在手术中需注意的实际问题。本文通过探讨其与听阈阈值的相关性，为制定手术方案提供有参考价值的依据。 资料与方法 　　选择术前纯音测试为传导性耳聋、有明确手术指征的慢性中耳炎病人，再由有经验的听力技师重复测试取平均值，绘成听力曲线，经术中探查明确传音障碍系由听骨链病变所致，本组共70例，其中男性32例，女性38例；左耳33例，右耳37例。根据听骨链受累部位分为三组：G1：病变位于槌砧关节以前(含槌砧关节)，探查砧镫骨正常，连接良好；G2：病变位于砧镫关节以前(含砧镫关节)，探查镫骨形态正常；G3：病变累及全部听骨链。 　　将以上三组术前纯音测试语言区500Hz、1 000Hz、2 000Hz平均阈值输入微机采用q检验，进行统计学处理。 结　　果 　　随着听骨链病变部位的加深，其语言区气导听阈明显提高，其中G1/G2、G1/G3、G2/G3在500Hz和1 000Hz有极显著性差异(P＜0.01)；随着频率增高，在2 000Hz除G1/G3有极显著性差异(P＜0.01)外，其余G1/G2、G2/G3均有显著性差异，见表1～3。 表1　G1组与G2组各频率气导听阈(dB,±s) 频率(Hz) G1(n=24) G2(n=18) P值 　500 42.30±2.19 50.56±2.68 ＜0.01 1 000 40.42±2.87 51.67±3.05 ＜0.01 2 000 38.33±2.10 47.22±3.86 ＜0.05 表2　G1组与G3组各频率气导听阈(dB,±s) 频率(Hz) G1(n=24) G3(n=28) P值 　500 42.30±2.19 58.81±1.68 ＜0.01 1 000 40.42±2.87 53.89±1.93 ＜0.01 2 000 38.33±2.10 45.19±2.19 ＜0.01 表3　G2组与G3组各频率气导听阈(dB,