分泌性中耳炎骨导听阈改变的临床观察

目的 证实分泌性中耳炎可导致感音神经性聋,为临床干预分泌性中耳为,尤其是顽固的分泌性中耳炎提供依据。方法 115例（164耳）分泌性中耳炎患者治愈后或未愈患者病程中复查的纯音测听检查结果,记录0．5、1、2、4kHz频率骨导听阈,计算骨导听力损失dB数。分为单侧组66例,双侧组49例,将66例单耳患者的健耳作为对照组。结果 在164耳中,出现骨导听阈提高的共94耳（57．3％）。双侧组与单侧组骨导听力损失程度差异均无显著性（P＞0．05）;单侧组和双侧组患耳在同一频率的骨导听力损失程度相似,且平均的骨导听力损失程度也相似;同频率之间的骨导听力损失不同,4kHz的骨导听力损失为最大。结论 半数以上分泌性中耳为可以导致感音神经性耳聋。在不同频率间的骨导听力损失不同,以高频损失为主,并有向语言频率区过渡的趋势。     

慢性化脓性中耳炎与感音神经性聋的相关性分析

目的：探讨慢性化脓性中耳炎与感音神经性聋之间的相关性。方法：回顾分析174例单侧慢性化脓性中耳炎患者的骨导阈值改变。采用配对t检验分析0．5kHz，1．0kHz，2．0kHz，4．0kHz患耳与健耳骨导阈值的差异，单因素方差分析法分析胆脂瘤存在及听骨链破坏对语频(0．5kHz，1．0kHz，2．0kHz)和4．0kHz骨导阈值的影响，直线回归法讨论了语频和4．0kHz骨导阈值改变与年龄和病程之间的相关性。结果：患耳与健耳各频率骨导阈值之间差异有统计学意义。语频骨导听力损失程度随着患者年龄的增加而逐渐加重。胆脂瘤的存在以及听骨链破坏亦未增加感音神经性聋的发生概率。结论：慢性化脓性中耳炎可引起感音神经性聋。高频骨导听阈较低频更易受到影响。     

慢性化脓性中耳炎与感音神经性聋

目的：观察慢性化脓性中耳炎（CSOM）对感音神经性聋（SNHL）的影响。方法：测量135例（168耳）CSOM患者的骨导听阈，并以66例单侧患者的健耳为对照，比较不同类型、不同病程的CSOM的骨导听阈。结果：CSOM各组骨导听阈均值明显高于对照组，且与中耳炎的类型和病程相关。结论：CSOM可引起SNHL，且中耳病变越重，病程越长，听力下降越明显     

成人感音神经性聋的听觉稳态反应反应阈与纯音听阈

目的探讨成人感音神经性聋的听觉稳态反应（auditory steady-state responses,ASSR）反应阈与纯音听阈的关系。方法选择中国医科大学附属一院耳鼻咽喉科门诊感音神经性聋的成人患者,分别进行纯音听力测试、ASSR检查,比较ASSR在0.5、1、2、4 kHz频率处的反应阈与纯音听阈的相关性及按听力损失程度比较两者的差值。结果 ASSR反应阈与纯音听阈在各频率处的相关系数分别为0.840、0.905、0.886、0.924;随着感音神经性听力损失的加重二者的差值明显缩小。随着频率的增加,两者的差值明显缩小。结论成人感音神经性聋ASSR反应阈与纯音听阈有显著相关性,随着听力损失的加重,ASSR反应阈愈接近纯音听阈,ASSR作为成人感音神经性聋听力定量诊断的客观方法有很大的临床应用价值。     

感音神经性聋与分泌性中耳炎的相关性研究

目的：探讨感音神经性聋与分泌性中耳炎的关系。方法：对治疗后骨导听力下降仍未恢复的38例分泌性中耳炎患者进行分析，观察健耳和患耳在不同频率的骨导听阈情况，并分别就其发病年龄、病程、积液性质和积液量与骨导听阈的关系进行观察。结果：患耳在不同频率的骨导听阈均大于健耳（均P＜0．01）；年龄愈大、病程愈长，感音神经性聋发生率愈高；积液为黏液者发生率高于浆液者；但与积液量无明显关系。结论：分泌性中耳炎可导致感音神经性聋，其发病原因和机制是多方面的，年龄大、病程长、积液为黏液者更易导致感音神经性聋的发生；应提高认识，早诊断，早治疗。     

鼻咽癌放疗后突发感音神经性聋14例临床分析

目的 探讨鼻咽癌放射治疗后突发感音神经性聋患者的临床特点及疗效,以利临床诊治。方法 回顾性分析14例（15耳）鼻咽癌放疗后突发感音神经性聋患者的临床特点及疗效。结果 鼻咽癌放射治疗后突发感音神经性聋的患者中男10例、女4例,左耳10耳、右耳5耳,平均发生时间为放疗后6.6年,突聋前多存在听力损失。250、500、1000、2000、4000 Hz的平均听阈（听力级）：突聋耳为(78.5±24.7) dB,非突聋耳为(57.0±32.4) dB。突聋耳73.33％ (11/15)为感音神经性聋,26.67％为混合性聋(4/15)。12例合并放疗后并发症,至少1例存在后循环障碍。治疗总有效率为26.67％ (4/15),其中4例复发且再治疗无效。结论 鼻咽癌放疗后患者发生突发感音神经性聋的程度较重,疗效较差,易复发。其发病机制可能与放疗所致后循环障碍有关。     

Baha在单侧聋治疗中的应用

植入式骨导助听装置Baha（bone—anchoredhearingaid）于1977年始应用于临床治疗听力损失,目前正广泛用于治疗一系列单侧和双侧听力损失,类型包括传导性、混合性及严重单侧感音神经性听力损失。Baha在技术上和机制上有别于传统意义上的气导和骨导助听器,美国医疗补助和医疗保险中心认定Baha系统为一种装置（骨整合移植）而非助听器。     

分泌性中耳炎骨导听力下降的临床观察

目的 分泌性中耳炎导致骨导听力下降的比例比人们认识的要高。方法:收集分泌性中耳炎患者33例(36耳),传导性聋16例(16耳);感音神经性聋11例(12耳),混合性聋6例(8耳),鼓室图为B或C,声反射消失。结果 经过4—12周治疗后,传导性聋患者听力改善或恢复12耳,无效4耳;感音神经性聋听力改善7耳,无效5耳,混合性聋听力改善2耳,无效6耳;结论 分泌性中耳炎可导致感音神经性聋。病程的长短是影响治疗效果的主要因素,鼓室图能否转为A型是判断疗效的客观指标指标。     

正常人及单侧感音神经性聋患者听觉皮层的fMRI研究

目的:利用功能磁共振成像技术研究正常人及单侧长期感音神经性聋患者调幅音刺激任务时听觉皮层的激活,探讨单侧长期感音神经性聋患者听觉皮层优势半球的变化及可能存在的功能重组.方法:对11例健康受试者及21例单侧长期重度感音神经性聋患者分别进行正弦调幅音任务下的功能磁共振扫描,实验刺激声音为500 Hz的载波频率,8 Hz的正弦调幅音.正常对照组分别左、右耳呈现;耳聋组于健耳呈现.采用事件相关Sparse设计采集数据以减少扫描噪音,运用SPM2软件对数据进行统计学分析,得到脑功能活动的图像.结果:正常人组单耳刺激时,对侧听觉皮层激活容积及激活强度均明显大于同侧,表现为明显的对侧半球优势;耳聋组健耳刺激时,双侧听觉皮层均有激活,但仍为对侧优势.结论:听觉中枢具有可塑性,单侧感音神经性聋患者听觉皮层存在着结构重组.     

慢性化脓性中耳炎对老年患者骨导听阈的影响

目的 探讨慢性化脓性中耳炎对老年患者骨导听阈的影响.方法 回顾性分析2005年1月至2009年3月在北京同仁医院耳鼻咽喉头颈外科住院治疗且资料完整的60岁以上单侧慢性化脓性中耳炎患者76例,分别记录患侧耳与对侧耳0.5、1、2、4 kHz四个频率的骨导阈值,以及每例患者中耳炎发病持续时间、听骨链是否中断、是否存在胆脂瘤等情况,并对记录的数据进行统计学分析.结果 患耳0.5、1、2、4 kHz四个频率的骨导阈值均高于对侧耳,差异有统计学意义(P值均＜0.01);胆脂瘤组与非胆脂瘤组相比,仅2 kHz双耳骨导阈值差的差异具有统计学意义(Z=-1.975,P=0.048);听骨链中断组与非中断组双耳骨导阙值差的差异也仅在2 kHz具有统计学意义(Z=-2.721,P=0.007);中耳炎病程10年以下组与10年以上组在1 kHz和2 kHz这两个频率的双耳骨导阈值差的差异具有统计学意义(Z值分别为-2.877和-2.624,P值均＜0.01).结论 慢性化脓性中耳炎可以使老年患者骨导阈值提高,对于老年慢性化脓性中耳炎仍应尽早积极治疗,避免感音神经性听力损失.     

以听力突然下降为特征的分泌性中耳炎（附24例报告）

目的：提高对以听力突然下降为特征的分泌性中耳炎的确诊率。方法：回顾性分析24例（28耳）以听力突然下降为特征的分泌性中耳炎的临床资料,结果：11例患者被误诊或漏诊,各频率的平均气导阈值在60．2－66．5dBHL,平均骨导阈值在40．5－58．6dBHL,听力图示感音神经性聋9耳,混合性聋19耳,鼓室压图为B型,治疗后听力明显改善,结论,鼓室积液影响圆窗及卵圆窗间的相位差,导致听力突下降,它们的听力图无特征,并对产生误诊的原因进行了讨论。     

Predisposing factors for inner ear hearing loss association with chronic otitis media

The aim of the present study was to investigate the consequences of chronic otitis media on inner ear function. Retrospective analysis of conventional pure-tone audiometry tests was carried out on 344 patients who were scheduled for surgical treatment of unilateral chronic otitis media without other risk factors for sensorineural hearing loss. Bone conduction thresholds of diseased ears were compared with those of contralateral, non-diseased ears. Selected clinical features were assessed among diseased ears to examine possible influences on inner ear function. Mean bone conduction threshold differences varied from 0.6?dB at 0.5?kHz to 3.7?dB at 4?kHz. These differences augmented with increasing duration of middle ear disease. Impaired hearing by bone conduction thresholds of diseased ears correlated with increased age at every frequency and with an interruption of the ossicular chain only at higher frequencies. The severity of sensorineural hearing loss correlated with longer duration of middle ear disease. Thus, surgical treatment of dry and apparently stable tympanic membrane perforation is warranted.     

慢性化脓性中耳炎骨导听力分析

对530例单耳慢性化脓性中耳炎患者的骨导听力损失情况进行总结和回顾性分析,探讨慢性化脓性中耳炎对耳蜗的损害.530例患者均未接受过耳科手术治疗,对侧耳为正常耳(作对照耳),其中男328例,女202例;年龄10～56岁,平均34岁;病程3个月～50年,平均20.19年.所有病例均采用Mad-sen—OB 822纯音测听仪在隔声室对患耳和正常耳进行听力测试,并对骨导听阈的平均值进行统计学处理,对影响骨导听力的因素做相关分析.所有患者中有334例(63.01%)发生骨导听力损害.0.5～4 kHz每个频率的骨导听力均有损失,主要损害在2～4 kHz的骨导听力损害程度与年龄、病程和病变程度有关.慢性化脓性中耳炎可以导致耳蜗损害,并以蜗底损害为著.     

108例重及极重度聋幼儿助听效果观察

目的　为双耳重、极重度感音神经性聋患儿选配助听器 ,并进行定期调试 ,观察助听效果。方法　用功能增益法评估助听器效果。结果　佩戴助听器 1～ 3年后的助听器效果较初戴时好 ,两者之间有显著性差异 (P<0 .0 1) ,高频差异更大。结论　聋儿佩戴经验配后的助听器 ,听敏度特别是高频部分的听敏度有提高     

Incidence of coexisting sensorineural hearing loss and secretory otitis media

There are currently no standard guidelines for assessing hearing in children who are evaluated for tympanostomy tubes. We describe the results of audiologic testing on 587 children, age 2 months to 17 years admitted to Pediatric Otolaryngology Department Bia?ystok for treatment of secretory otitis media. Ten children (1.7%) were found to have previously unrecognized sensorineural hearing loss. In four cases total unilateral deafness, in six others moderate to severe sensorineural bilateral hearing loss was diagnosed. Three other children referred to our clinic as sensorineural hearing loss were found to have secretory otitis media as the only or coexisting cause of deafness. Results of our study show the importance of age--appropriate hearing assessment as part of diagnostic procedure for secretory otitis media.     

Sensorineural hearing loss in patients with chronic otitis media

Chronic otitis media is generally associated with some degree of hearing loss, which is often the patient’s chief complaint. This hearing loss is usually conductive, resulting from tympanic membrane rupture and/or changes in the ossicular chain due to fixation or erosion caused by the chronic inflammatory process. When cholesteatoma or granulation tissue is present in the middle ear cleft, the degree of ossicular destruction is even greater. An issue that has recently gained attention is additional sensorineural hearing loss due to chronic otitis media. While the conductive loss can be minimized through surgery, sensorineural hearing loss constitutes a permanent after effect, attenuated only through the use of a hearing aid. However, a few groups have reported a decrease in sensorineural function in these patients as well. This survey study performed at a referral center evaluates the occurrence of sensorineural hearing loss in ambulatory patients with this disease. We reviewed the files of patients with unilateral chronic otitis media. One hundred and fifty patients met the inclusion criteria: normal otoscopy and normal hearing in the contralateral ear. Main outcome measure: bone-conduction threshold averages were calculated for frequencies of 500, 1,000, 2,000, 3,000 and 4,000 Hz, with comparison between the normal ear and the ear with chronic otitis media. Thresholds were examined separately for each frequency. The bone-conduction threshold averages for the normal side were lower than those for the ear with chronic otitis media. The threshold shift was statistically significant for each frequency (P < 0.0001, Student’s t test). There were differences between the groups when analyzed for age (500 and 1,000 Hz) or the presence of cholesteatoma (1,000 Hz). This study shows that chronic otitis media is associated with a decrease in cochlear function.     

感音神经性聋患儿伴分泌性中耳炎同期人工耳蜗植入效果分析

目的探讨伴分泌性中耳炎的感音神经性聋患儿同期植入人工耳蜗术后的听觉言语康复效果。方法回顾性分析安徽医科大学第一附属医院2015年1月到2017年12月期间伴分泌性中耳炎同期植入人工耳蜗的感音神经性聋患儿30例(A组)的临床资料,并与同期不伴分泌性中耳炎的感音神经性聋患儿30例(B组)比较。所有患儿均采用面隐窝入路植入人工耳蜗,术后随访24个月,采用听觉行为分级(categories of auditory performauce-Ⅱ,CAP-Ⅱ)和言语可懂度分级(speech intelligibility rating,SIR)评估并比较两组患儿的听觉言语康复效果。结果 A组患儿同期植入人工耳蜗后均未出现术后并发症,术前A组CAP-II评分为0.87±1.07分,SIR评分为1.07±0.37分,术后分别为5.07±0.91和3.73±0.87分,术后较术前明显提高(P<0.01)。B组术前CAP-II评分为0.93±1.17分,SIR评分为1.10±0.40分,术后分别为5.23±0.77和3.77±0.73分,术后较术前明显提高(P<0.01)。A组与B组之间术前、术后CAP-II和SIR评分差异均无统计学意义(P>0.05)。结论感音神经聋患儿伴分泌性中耳炎患儿同期人工耳蜗植入安全可行,且分泌性中耳炎对术后听觉言语康复效果无明显影响。     

Hearing loss after “refractory” secretory otitis media

Conclusions The results indicate that SOM of extreme duration, and maybe also the treatment of SOM, are risk factors for developing permanent hearing loss, both conductive and sensorineural. Objective Fluctuating or persisting hearing loss of varying degrees is known to accompany secretory otitis media (SOM). The aim of this study was to detect possible hearing sequelae in young adults who had suffered from “refractory” SOM during childhood. Material and methods A total of 33 subjects (age 16–25 years) with previous SOM that had persisted for a mean of 11 years (range 6–19 years) were retrospectively examined at a mean of 18 years after their first myringotomy or tube insertion and compared to 15 healthy controls. The follow-up included audiometric examinations (pure-tone audiometry, distorted speech and impedance audiometry), otomicroscopy and scrutiny of medical records. Results The SOM group had poorer hearing at all frequencies with the exception of 1.5 kHz in the range 0.125–16 kHz. Those with the greatest number of myringotomies and tube insertions and those with the longest duration of SOM had significantly poorer hearing at high frequencies (8–16 kHz) than those with fewer tube insertions and a shorter duration of SOM. The SOM group scored lower on distorted speech tests than the controls.