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目的:探讨先天性外、中耳畸形的特点,术前评估和治疗效果。方法:分析2000年6月~2005年6月接受手术治疗的先天性外耳道闭锁中耳畸形患者21例(22耳)的临床资料,全部患者均行外耳道鼓室成形术。结果:术中发现鼓室腔狭小16耳(72.7%);听骨链畸形20耳(90.9%),其中锤砧骨畸形19耳(86.4%),镫骨畸形7耳(31.8%);面神经畸形8耳(36.4%);鼓室隔板1耳(4.5%);垂直外耳道1耳(4.5%)。术后1个月平均语频听力提高>15dB15耳(68.2%),其中提高≥30dB9耳(40.9%)。随访6个月~5年,听力保持在术后水平或有轻度提高者17耳,下降3耳,失访2耳。并发外耳道闭锁1耳,狭窄3耳,鼓膜外侧愈合2耳。结论:先天性外、中耳畸形表现复杂多样,术前详细的影像学和听力学评估是保证手术成功的前提,成形一个宽敞的外耳道、预防术后感染是防止外耳道再闭锁和狭窄的关键。
Objective: To investigate the characteristics of congenital and middle ear deformities, preoperative evaluation and therapeutic effect. Methods: Clinical data of 21 cases (22 ears) of congenital external ear canal atresia with middle ear malformation undergoing surgery from June 2000 to June 2005 were analyzed. All patients underwent external ear tympanoplasty. Results: There were 16 ears (72.7%) with tympanic cavity narrowing, 20 ears (90.9%) with malocclusion, 19 ears (86.4%) with hammer anvil and 7 ears (31.8%) with deformity of hammerbone. Facial nerve deformity 8 ears (36.4%); 1 tympanic barrier (4.5%); 1 vertical ear canal (4.5%). One month after operation, the average speech audition was improved> 15dB15 ears (68.2%), which increased ≥30dB9 ears (40.9%). Follow-up 6 months to 5 years, hearing remained at postoperative levels or mild increase in 17 ears, down 3 ears, lost 2 ears. Concomitant external ear canal atresia 1 ear, narrow 3 ears, lateral ear healing 2 ears. CONCLUSION: Congenital and middle ear deformities are complex and diverse. Preoperative detailed imaging and audiological evaluation are the prerequisites for successful operation. Forming a spacious external auditory canal and preventing postoperative infection are the keys to prevent reocclusion and stenosis of external auditory canal.