慢性鼻窦炎患者中耳功能测定.docVIP

慢性鼻窦炎患者中耳功能测定 　【摘要】 目的 探讨慢性鼻窦炎对中耳功能的影响。 方法 对53例慢性鼻窦炎患者、10例健康成人做声阻抗和纯音测听。结果 (1)53例患者中，声阻抗鼓室导抗图A型33例（62.26%），As型4例（7.55%），B型2例（3.77%），C型14例（26.42%）；正常听阈35例（66.04%），轻度聋16例（30.19%），中度聋2例（3.77%）；(2)As、B、C型异常导抗图、峰压值、同侧对侧镫骨肌反射、坡度在鼻窦炎各分型与对照组、各分型之间比较，30组比较中9组有统计学差异。静态声顺值无统计学差异；(3)听阈各频率中鼻窦炎各分型与对照组、各分型之间进行比较，60组比较中47组有统计学差异。结论 随慢性鼻窦炎分型分期加重，异常导抗图、镫骨肌反射消失增多，峰压值偏向负压，坡度值增加；静态声顺值无或少变化；同时听力损伤加重。 【关键词】 鼻窦炎 鼓室导抗图 纯音测听 中耳功能 Abstract: Objective To investigate the effects of chronic sinusitis on middle ear function. Methods 53 patients with chronic sinusitis and 10 healthy controls were involved in this study. All were determined by the acoustic immitance audiometer and pure tone audiometry. Results （1）A type was determined in 33 patients (62.26%), As type in 4 patients (7.55%), B type in 2 patients (3.77%), and C type in 14 patients (26.42%). 35 patients (66.04%) had normal air hearing threshold, 16(30.19%) had a little deafness and 2 (3.77%) had middle deafness.（2）There were significant differences between the chronic sinusitis and the controls, among stages in As, B and C types tympanograms, were peak pressure, acoustic stapedius reflex and gradient. But statical compliance showed no change. （3）There were significant differences between the chronic sinusitis and the controls, and among stages in air hearing threshold of each frequency of chronic sinusitis. Conclusions As the stage of chronic sinusitis proceeds, both abnormal tympanograms and the acoustic stapedius reflex vanishing greatly grow, and as the peak pressure trends to negative, the gradient raises, though the statitical compliance shows no or few changes, the hearing impairment is heavier than before. Key words: Sinusitis; Tympanogram; Pure tone audiometry; Middle ear function 临床上可见到慢性鼻窦炎患者出现中耳炎,并且证实需氧、厌氧致病菌、变态反应、鼻纤毛将脓性分泌物后输导致咽鼓管咽口水肿和鼻咽感染逆入中耳等，参与鼻窦炎引起中耳炎的机制［12］。咽鼓管功能损伤通常被鼻窦疾病，主要是筛窦系统，尤其前组筛窦炎引起［35］。鼻窦炎可使咽鼓管黏膜的形态出现改变。听力学检查有鼓室负压、C、B型导抗图、听阈提高等［6］。功能性鼻内镜手术通过小的操作程序，清除鼻窦开口狭窄区域的病变，重新建立引流和通气，使咽鼓管功能恢复正常。使用外源性表面活性物质也有效。这些资料启示治疗鼻窦