先天性外耳道闭锁听骨链的虚拟耳镜观察

目的：探讨虚拟耳镜对先天性外耳道闭锁听骨链畸形术前评估的作用。方法：23例（28耳）先天性外耳道闭锁、中耳畸形患者，经高分辨率螺旋CT轴位、冠状位颞骨扫描，应用仿真内镜软件行图像三维重建。术前虚拟耳镜结果与手术探查结果进行对比分析。结果：28耳外耳道闭锁、中耳畸形，虚拟耳镜提示25耳听小骨发育不全，3耳狭小鼓室未见听骨。24耳行手术治疗，术中发现锤、砧骨发育不全19耳，镫骨畸形11耳，镫骨缺失3耳，前庭窗闭锁1耳。术前虚拟耳镜观察与术中探查符合率为100％。结论：虚拟耳镜为先天性外耳道闭锁听骨链畸形的术前评估提供了可靠的影像学信息。     

单纯性中耳畸形术前虚拟CT耳镜评估及手术进路选择

目的探讨虚拟CT耳镜对单纯性中耳畸形的术前评估并依其分型选择合适的手术进路。方法对21例(23耳)单纯性中耳畸形患者行颞骨CT三维重建技术—虚拟CT耳镜观察,依听骨链畸形程度将中耳畸形分为三型。A型(上半部畸形)和C型(全听骨链畸形)经耳后切口行保留完整外耳道后壁的上鼓室进路鼓室探查术;B型(下半部畸形)经耳道内进路行传统的鼓室探查术。结果 21例(23耳)中耳畸形,虚拟CT耳镜发现9耳为A型,5耳C型,经完壁式上鼓室进路行听骨链松解术或听骨链成形术;9耳为B型,经耳道内进路完成前庭窗开窗与人工镫骨手术。23耳术后外耳道和鼓膜均保存或恢复完好,语频听力平均提高15~35dB。手术探查听骨链畸形与术前虚拟CT耳镜观察基本符合。结论虚拟CT耳镜能为单纯性中耳畸形听骨链病变提供清晰的三维立体图像,有助于选择手术进路。     

虚拟CT耳镜评价先天性单纯性中耳畸形的临床应用

目的：探讨虚拟CT耳镜评价先天性中耳畸形中听骨链病变的临床应用。方法：对13例（16耳）先天性中耳畸形患者行高分辨率CT扫描,将获取的原始图像数据经三维重建后,以虚拟CT耳镜的方式从不同角度与方向观察听骨链的病变情况,并依观察结果进行术前评估,将术前虚拟CT耳镜观察结果与手术探查结果对比分析。结果：13例（16耳）中耳畸形,虚拟CT耳镜发现5耳锤骨及砧骨上部结构发育不良或固定在上鼓室内壁,镫骨存在;3耳锤骨、砧骨及镫骨均发育不全或缺如,均经完壁式上鼓室进路行听骨链松解术或听骨链成形术;8耳为砧骨长脚或镫上结构发育不全、镫骨缺如或镫骨异位,经耳道内进路完成前庭窗开窗与人工镫骨手术。16耳术后外耳道和鼓膜均保存或恢复完好,语频听力平均提高25～45dB。手术探查听骨链畸形与术前虚拟CT耳镜观察符合率为100％。结论：虚拟CT耳镜是中耳畸形术前评估的重要参考依据。     

慢性中耳炎听骨链病变虚拟耳镜观察

目的 探讨虚拟耳镜对慢性中耳炎听骨链病变的评估作用。方法 慢性中耳炎95耳（82例），均经高分辨螺旋CT轴位、冠状位颞骨扫描，应用虚拟耳镜软件包进行图像三维重建。将术前虚拟耳镜与手术探查结果进行对比分析。结果 95耳慢性中耳炎术前经虚拟耳镜观察，提示86耳听骨链不同程度的破坏．术中证实67耳锤、砧骨破坏，15耳镫骨头或镫骨上结构缺失，4耳听骨链完整连续。结论 虚拟耳镜是术前评估中耳炎听骨链病变的可靠的影像学手段。     

虚拟耳镜在先天性外耳道闭锁术前评估中的价值

目的：探讨虚拟耳镜在先天性外耳道闭锁术前评估中的价值。方法：选取20例先天性外耳道闭锁患者行颞骨薄层CT检查，其中8例接受外耳道成形术、鼓室成形术。螺旋CT获取原始图像数据，经软件三维重建后，以虚拟耳镜方式观察中耳等结构。结果：虚拟耳镜能够清晰显示镫骨、锤砧复合体、面神经（仅限鼓室段）、砧镫关节、圆窗龛及中耳腔等结构，与手术探查结果的符合率分别为87．5％、100．0％、i00．0％、75．0％、100．0％和100．0％。结论：虚拟耳镜有助于先天性外耳道闭锁的术前评估，使手术方案达到个体化。     

耳内镜下听骨链畸形手术疗效分析

目的 探讨耳内镜下听骨链手术的可行性及疗效.方法 回顾性分析2017年6月至2019年9月耳内镜手术探查确诊为先天性听骨链畸形15例(17耳),其中单纯镫骨底板固定3耳,伴有其他听骨链畸形的镫骨底板固定5耳,镫骨底板活动伴听骨链畸形8耳,前庭窗或蜗窗发育不良或闭锁1耳,依据其畸形类型分别行耳内镜下鼓室探查术+鼓室成型I...     

开放式鼓室成形术听力改善因素探讨

目的观察开放式鼓室成形术治疗伴有听骨残缺的慢性化脓性中耳炎的疗效.方法伴有听骨残缺的慢性化脓性中耳炎130耳,实施开放式鼓室成形术,以生物陶瓷人工听骨重建听骨链,常规充填乳突腔,重建外耳道后壁.结果术后随访6月～5年,鼓膜I期愈合115耳(89%),听力提高112耳(86%).均未发生人工听骨排出,外耳道形状良好.结论对于伴有听骨残缺的慢性化脓性中耳炎,开放式鼓室成形术疗效较优.     

虚拟CT耳镜对先天性耳畸形听骨链病变的诊断价值

目的 通过虚拟CT耳镜观察,探讨其对先天性耳畸形听骨链病变的诊断价值.方法 对30例(43耳)先天性耳畸形患者,高分辨率CT扫描获取病变部位的原始图像数据,经三维重建后,以虚拟CT耳镜方式观察听骨链病变情况,然后与手术探查结果对比分析.结果 虚拟CT耳镜清楚显示发育不全的听小骨及畸形听骨链状态,其中外耳道闭锁21例(3...     

自体改形听骨成形术的临床疗效观察

应用自体或同种异体听骨及人工听骨行听骨链重建术可有效提高术耳听力。近几年国外学者提出听骨成形术(ｏｓｓｉｃｕｌｏｐｌａｓｔｙ) [1 ,2 ] ,将用于赝复的听骨雕刻成型以重建听骨链。现总结 1990年11月～ 2 0 0 0年 6月我科完成鼓室成形术 2 86耳中应用自体改形听小骨行听骨成形术 196耳 ,报告如下。一、材料与方法1.临床资料 :196耳听骨成形术中慢性化脓性中耳炎 16 8耳 ,先天性外耳道狭窄或闭锁并中耳畸形 2 3耳 ,颞骨外伤听骨链中断 5耳。男 115例 ,女 81例。<2 0岁 2 6耳 ,<30岁 46耳 ,<40岁 46耳 ,<5 0岁 43耳 ,<6 0岁 2 9耳 ,<73…     

中耳结构及中耳病变的虚拟耳镜表现

目的探讨基于高分辨率CT数据的虚拟耳镜显示听骨链及颞骨重要解剖结构的能力。方法选取50例患者行颞骨薄层CT检查，其中17例中耳炎患者接受了手术治疗。螺旋CT获取原始图像数据，经软件三维重建后，以虚拟耳镜方式观察中耳等结构。结果虚拟耳镜能够清晰显示听小骨、面隐窝、圆窗龛、面神经嵴等正常鼓室各壁的精细结构；以及在中耳炎、外伤、颞骨畸形等情况下的听骨链移位、中断、缺失及各种畸形。虚拟耳镜在诊断单纯性中耳炎听骨链的连续性上具有较高的准确性，11耳中有10耳与手术探察的结果一致，而胆脂瘤型6耳中有3耳与手术探察结果不一致。结论虚拟耳镜有多种优势，可以帮助术前评估中耳诸结构，做到手术方案的个体化。     

不同类型先天性中耳畸形的手术治疗

探讨先天性中耳畸形的临床分型及其手术策略。方法选取2016年6月—2019年12月收治的23例（33耳）先天性中耳畸形患者进行中耳畸形临床分型及不同的手术策略进行回顾分析，观察术后疗效和听力的恢复情况。术前对23例（33耳）中耳畸形患者均行耳内镜检查、听力学检查及颞骨CT并听骨链三维重建检查。结果23例患者中18例为术前明确畸形，5例为术中探查发现畸形。其中15例为锤、砧骨畸形，选择人工听骨赝复物（TORP或PORP）或自体听骨植入修复；6例为镫骨畸形，选择人工镫骨赝复物（Piston）植入；1例为鼓膜穿孔伴有先天性中耳畸形，先行鼓膜成形术，二期行听骨链重建手术；1例畸形程度比较复杂，面神经走形异常，在前庭窗处分叉，遮挡前庭窗，未能行进一步治疗。术后气导阈值提高至正常的有15例（65.2%）；骨气导差（ABG）恢复至30 dB以内的有16例（69.6%），ABG术后仍超过30 dB的有5例（21.7%），1例听力未改善（4.3%），1例无法行听骨重建（4.3%）。结论先天性中耳畸形术前诊断比较困难，CT检查很难精确评估，手术探查为最有说服力的诊断标准，明确中耳畸形临床分型后选择最佳的手术方式，是治愈疾病并提高患者术后听力最佳选择。     

Congenital auditory ossicle malformation without external ear abnormality]

In 29 ears of 24 patients with auditory ossicle malformation, but without external ear abnormalities, who were operated on at our clinic in the 10 years between June 1993 and June 2002, we studied the condition of ossicles, preoperative examination, surgical procedures, and postoperative hearing improvement. Our study did not include patients with cholesteatoma or those with only fixed stapes but without ossicular deformity. Samples were 12 ears of 11 men and 17 ears of 13 women. We clinically distinguished 3 major categories: (i) discontinuity between the incus and stapes with mobile stapes, (ii) congenital fixation of the stapes with ossicular deformity, and (iii) congenital fixation of the malleus and deformity of the incus with mobile stapes. We classified each category into minor abnormalities based on the condition of the long process of the incus, the superstructure of the stapes, and the stapes footplate. We conducted auditory ossicle reconstruction by mobilization of the malleus and incus in 2 ears, by type III tympanoplasty in 5 ears, by type IV tympanoplasty in 13 ears, and by stapes surgery in 8 ears. Improvement in hearing after the operation was observed in 25 of the 29 ears treated. In the classification of the auditory ossicle malformation without external ear abnormalities, we should evaluate discontinuity or fixation of the ossicles and their deformity. This requires that varied ossicular reconstruction be prepared for surgery, but the possibility of hearing improvement is high, so intensive treatment is needed in many cases of auditory ossicle malformation.     

Surgery for congenital anomalies of the middle ear with mobile stapes

Summary In a series of 104 patients with congenital middle ear anomalies operated on from 1964 to 1986, 27 cases were found in which the stapes footplate was mobile and the conductive deafness was due to an anomaly in the remaining part of the ossicular chain. In 8 cases the middle ear anomaly was caused by discontinuity of the ossicular chain owing to congenital malformation. In the other 19 ears, epitympanic fixation of the ossicular chain was observed, whether or not in combination with malformation of the stapes, incus or malleus. Ossicular chain reconstruction produced an improvement of at least 15 dB in 6 of the first 8 cases with discontinuity of the ossicular chain. The mean gain was 31 dB. Epitympanotomy with exposure of the fixed ossicle and if necessary ossicular chain reconstruction led to an improvement of at least 15 dB in 12 of the 19 ears, with a mean gain of 28 dB. Correspondence to: E. Teunissen     

Diagnosis of ossicular chain in the middle ear by high-resolution CT]

This study was conducted to assess the usefulness and limitation of high-resolution CT for evaluating the condition of ossicular chain in the middle ear. Preoperative CT findings of the ossicular chain were compared with the operative findings of ossicles in 26 patients with chronic otitis media or congenital ossicular anomaly who underwent tympanoplasty. Total defect of head of the malleus, body of the incus and long process of the incus were completely detected by high-resolution CT. But the reliability in detecting the defect of handle of the malleus and superstructure of the stapes were 33.3% and 60%, respectively. Defect of the I-S joint (1 case) and partial defect of stapes crus (2 cases) could not be diagnosed correctly in the preoperative estimation. Although these findings demonstrate the limitations of high-resolution CT in the diagnosis of ossicular chain, it will be diminished by the advanced space resolution of CT in the future.     

耳硬化症和中耳畸形患者的宽频声导抗研究

目的探讨宽频声导抗测试对耳硬化症和中耳畸形辅助诊断中的应用价值。方法收集耳硬化症组45耳,先天性中耳畸形组13耳,另有正常组76耳作为对照,所有受试者均行宽频声导抗测试,对各组峰压下的声能吸收率进行分析比较。结果峰压下,耳硬化症组的声能吸收率在917/972~1029/1091~1297/1456/1731/2059~3462/4000~5339Hz比正常组的显著减小(P<0.05)。耳硬化症患者在1kHz以下较正常组无异常切迹。峰压下,先天性中耳畸形组的声能吸收率在408~749/7336~7772Hz比正常组的显著增大(P<0.05),在1059~1224/1297/1414~1456/4000~4490Hz比正常组的显著减小(P<0.05)。69%(9/13)的先天性中耳畸形患者在1kHz以下有一切迹。结论声能吸收率鼓室图在1kHz以下出现切迹提示患者存在镫骨畸形合并锤骨和/或砧骨畸形。仅镫骨固定患者1kHz以下无切迹。宽频声导抗对于术前评估耳硬化症和中耳畸形患者中耳听骨链情况具有现实意义,可作为辅助耳硬化症和中耳畸形诊断的听力学检查之一。     

72 cases of the auditory ossicle malformations but with normal findings in the tympanic membrane

We evaluated 66 patients (72 ears) with auditory ossicle malformations, but with normal findings in the tympanic membrane, who underwent ossicular reconstruction and stapes surgery at our department between 1984 and 1997. There were 27 men (30 ears) and 39 women (42 ears). Classification of pathologic condition based on surgical findings showed separation of the incus-stapes joint in 43%, fixation of the malleus or incus in 16%, fixation of the stapes footplate in 26%, in incidence of fixation of the auditory oosicles that is higher than that previously reported. In 33% of the patients, conductive hearing loss or mixed hearing loss similar to that observed on the affected side was also present on the contralateral side. Abnormalities in the arrangement of the facial nerves were noted in 4%, inner ear malformation in 1%, and congenital cholesteatoma in 3%. Auditory ossicle reconstruction was performed by the modified type III method in 57% and by the modified type IV method in 37% of the cases. During stapes surgery, 86% underwent small-fenestra stapedectomy. Improvement in hearing after the operation was observed in 90% of the cases and the improvement was relatively high compared with tympanoplasty for chronic otitis media.