本文選題：鼓室硬化　切入點：術(shù)前診斷　出處：《鄭州大學(xué)》2011年碩士論文

【摘要】：研究背景 鼓室硬化(Tympanosclerosis)又稱為鼓室硬化癥,是指中耳在長期的慢性炎癥愈合后,所遺留的中耳結(jié)締組織退行性改變,是引起傳導(dǎo)性聾的重要原因之一；其主要病理變化表現(xiàn)為中耳粘膜下層及鼓膜固有層出現(xiàn)透明變性和鈣質(zhì)沉著。鼓室硬化是由Von Troltsch于1869年首次進行詳細(xì)描述并提出“硬化(sclerosis)'”一詞。1956年,Zollner在進行了大量鼓室成形術(shù)后發(fā)表了“鼓室硬化”論文,鼓室硬化因此得以正式命名。國內(nèi)外關(guān)于鼓室硬化發(fā)病率的報道不一,國外為20-43%[2,3],國內(nèi)為3.7-11.7%。 目前,鼓室硬化的病因及發(fā)病機制仍不清楚。隨著鼓室成形術(shù)的廣泛開展和手術(shù)顯微鏡的普遍應(yīng)用,該病越來越受到關(guān)注,有關(guān)鼓室硬化病因?qū)W和治療效果的研究報道逐漸增多,而診斷方面的較少。目前鼓室硬化通常依賴于手術(shù)探查和病理得以確診。如何提高鼓室硬化的術(shù)前診斷水平,即術(shù)前確診、明確病變性質(zhì)和范圍、了解聽骨鏈情況,以便制定恰當(dāng)?shù)氖中g(shù)方案,更好地與患者進行術(shù)前溝通,是目前耳科臨床尚待解決的問題。 目的 1.研究鼓室硬化的顳骨高分辨率CT (High Resolution computed tomography, HRCT)的特點,探討HRCT對鼓室硬化的診斷及其病變范圍和聽骨鏈狀態(tài)的判斷價值。 2.研究鼓室硬化純音聽閩測定的聽力學(xué)特點,探討純音測聽對鼓室硬化聽骨鏈功能狀態(tài)評估的術(shù)前判定價值。 3.研究并探討耳內(nèi)窺鏡對伴有鼓膜穿孔的鼓室硬化病例的病變性質(zhì)、病變范圍和聽骨鏈狀態(tài)的診斷價值。 4.研究聯(lián)合應(yīng)用HRCT、純音測聽和耳內(nèi)窺鏡三種術(shù)前檢查方法,對鼓室硬化病例的確診及漏診結(jié)果進行綜合分析,探討聯(lián)合診斷對鼓室硬化的確診、病變性質(zhì)、病變范圍和聽骨鏈狀態(tài)的判定價值及對術(shù)前手術(shù)方案制定和預(yù)后評估的指導(dǎo)意義。 研究對象和方法1.研究對象： 納入標(biāo)準(zhǔn)：①臨床診斷需手術(shù)探查鼓室或開放乳突的鼓室硬化病例；②臨床、聽力和影像資料(HRCT數(shù)據(jù))均完整；③首次手術(shù),非修正性多次手術(shù)；④手術(shù)由同一治療組成員完成。 2006年8月到2010年8由同一治療組成員完成的鼓室硬化住院手術(shù)52例56耳符合研究納入標(biāo)準(zhǔn)。其中男35例,女17例,年齡12-64歲,平均35.74歲。病史1-40年,平均16.48年。雙耳34例,單耳18例,其中雙耳均手術(shù)的4例。其中鼓膜完整8耳,合并鼓膜穿孔者48耳,其中緊張部穿孔39耳,松弛部穿孔9耳。所有病例均經(jīng)手術(shù)和病理診斷確診為鼓室硬化。 2.檢查方法和結(jié)果判斷 HRCT:采用美國GE64排Lightspeed VCT掃描儀進行軸位掃描和冠位重建。軸位掃描基線為聽眶上線,掃描范圍自弓狀隆起至外耳道下壁。靶掃描,骨算法重建,矩陣為512×512,掃描層厚、層間距均為1mm,窗寬4000Hu,窗位700Hu, FOV=32。以鼓膜、鼓室及聽骨周圍出現(xiàn)高密度鈣化或骨化影像為鼓室硬化的特征性改變,以鼓膜增厚、鼓室乳突軟組織密度影、聽骨及鼓室壁破壞等為非特征性改變。 純音測聽：術(shù)前純音聽閾測定各變量指標(biāo)：將500,1000,2000,4000Hz氣導(dǎo)和骨導(dǎo)的均值作為平均純音聽閩PTA (pure-tone audiometry)氣骨導(dǎo)差A(yù)BG (air bone gap)為同期氣導(dǎo)AC(air conduction)減去骨導(dǎo)BC(bone conduction)的值。以ABG30dB作為聽骨鏈固定或中斷的判斷標(biāo)準(zhǔn)。 耳內(nèi)窺鏡檢查：對伴有鼓膜穿孔的病例進行耳內(nèi)窺鏡檢查,記錄病變情況。以鼓膜、鼓室腔及聽骨周圍出現(xiàn)鈣化或硬化病灶作為鼓室硬化的診斷標(biāo)準(zhǔn)。 3.手術(shù)探查和病變分型 全麻,常規(guī)探查鼓室或/和開放乳突。根據(jù)病變范圍和聽骨鏈情況將病例分成4型：Ⅰ型,硬化病灶僅累及鼓膜；Ⅱ型,硬化病灶累及上鼓室致錘砧骨固定,或與盾板融合,鐙骨活動良好且結(jié)構(gòu)完整;Ⅲ型,上中鼓室硬化病灶累及聽骨鏈致鐙骨固定；Ⅳ型,鼓室及鼓竇充滿硬化組織致聽骨鏈包裹固定,部分聽骨破壞吸收。 4.對比研究和統(tǒng)計分析 ①顳骨HRCT表現(xiàn)與手術(shù)探查結(jié)果進行對比分析,統(tǒng)計各型診斷符合率 ②純音測聽結(jié)果與術(shù)中病變分型和聽骨鏈狀態(tài)的統(tǒng)計分析。 ③耳內(nèi)窺鏡檢查與術(shù)中探查結(jié)果進行對比研究。 ④分析顳骨HRCT診斷后的漏診病例的純音測聽特點和耳內(nèi)窺鏡檢查結(jié)果,對該類病例進行分析。 結(jié)果 1.顳骨HRCT表現(xiàn)與手術(shù)探查結(jié)果 術(shù)前CT表現(xiàn)：①鼓膜：增厚20耳,鈣化29耳,穿孔44耳；②鼓竇、鼓室：鈣化灶或高密度骨化影23耳,鈣化灶或高密度骨化影與軟組織影共存9耳,僅見軟組織影7耳；③乳突腔：軟組織影6耳；④聽骨鏈：鈣化包裹21耳,蟲蝕樣改變或以骨質(zhì)破壞為主且未見中斷15耳,骨質(zhì)破壞且中斷6耳；⑤鼓室腔及聽骨鏈未見明顯異常14耳。 術(shù)中探查發(fā)現(xiàn)：①鼓膜：增厚24耳,鈣化33耳,穿孔48耳；②鼓竇及鼓室：僅見鈣化灶或硬化斑塊20耳,合并有肉芽19耳,合并膽脂瘤4耳,合并慢性分泌性中耳炎2耳,鼓竇及鼓室未見異常11耳；③乳突腔肉芽組織6耳；④聽骨鏈：周圍硬化灶致聽骨固定,其中錘砧骨固定21耳,鐙骨固定14耳,全聽骨鏈包埋10耳；僅見聽骨的鈣化包裹14例,鈣化包裹并骨質(zhì)破壞但尚未中斷22耳,鈣化包裹并骨質(zhì)破壞且中斷9耳；聽骨鏈未見異常11耳。 高分辨CT未見鈣化者18(11+7)耳,其中1l耳影像學(xué)表現(xiàn)有鼓膜穿孔外未見其他明顯異常,此11耳經(jīng)手術(shù)探查存在鼓膜鈣化4耳,鼓竇、上鼓室有鈣化9耳,鼓岬表面有鈣化5耳,聽骨鏈被鈣化包裹7耳,5耳為錘、砧骨固定型,2耳為鐙骨固定型；另外7耳影像學(xué)僅表現(xiàn)為軟組織影,手術(shù)探查發(fā)現(xiàn)鼓膜鈣化1耳,鼓竇上鼓室鈣化灶2耳,鼓岬表面鈣化3耳,聽骨鏈鈣化包裹1耳。 術(shù)中病變分型及CT擬分型診斷符合率：Ⅰ型11耳,符合率9//11=81.82%；Ⅱ型21耳,符合率14/21=66.67%；Ⅲ型14耳,符合率6/14=42.86%；IV型10耳,符合率3/10=30%；其中影像擬診斷病例中分型診斷和手術(shù)探查一致的僅有32耳,I型的診斷率高,其他均不高,總的分型診斷符合率為57.14%。 CT診斷總診斷率為67.86%,漏診率為18/56=32.14% 2.純音測聽特點與術(shù)中病變分型 術(shù)前測聽結(jié)果：①氣導(dǎo)聽閾范圍為35-65dBHL,②骨氣導(dǎo)間距≥30dBHL51耳,≤30dBHL5耳；Ⅰ型之外的所有病例骨氣導(dǎo)間距均≥30dBHL。③34耳的聽力圖出現(xiàn)類Carchart切跡改變。 術(shù)中探查聽骨鏈功能：完整并活動良好11耳,錘砧骨固定14耳,鐙骨固定21耳,全聽骨鏈固定10耳；聽骨鏈鈣化包裹22耳,骨質(zhì)破壞但尚未中斷16耳,骨質(zhì)破壞并中斷7耳,聽骨鏈無異常11耳。 術(shù)中病變分型及各型測聽ABG均值：Ⅰ型11耳,ABG=2.60±6.33dBHL;Ⅱ型21耳,ABG=35.70±8.43dBHL;Ⅲ型14耳,ABG=41.33±9.87dBHL;Ⅳ10耳,ABG=39.23+8.75dBHL。 3.耳內(nèi)窺鏡檢查 48耳合并鼓膜穿孔者術(shù)前耳內(nèi)鏡檢查結(jié)果：①鼓膜增厚24耳,鈣化32耳,穿孔48耳；②鼓岬表面珊瑚礁樣或蔥皮樣鈣化灶14耳,合并肉芽10耳,合并膽脂瘤4耳；③聽骨鏈周圍出現(xiàn)鈣化灶包裹17耳,聽骨鏈合并骨質(zhì)破壞未見中斷7耳,聽骨鏈合并骨質(zhì)破壞并中斷4耳,聽骨鏈未見異常11耳。 同一批病人術(shù)中發(fā)現(xiàn)：①鼓膜增厚24耳,鈣化32耳,鼓膜穿孔48耳；②鼓竇及上中鼓室鈣化灶或硬化斑塊17耳,合并有肉芽10耳,合并膽脂瘤4耳；乳突腔肉芽組織4耳；③聽骨鏈周圍硬化灶致錘砧骨固定16耳,鐙骨固定11耳,全聽骨鏈包埋10耳；聽骨破壞但尚未中斷12耳,破壞且中斷7耳,聽骨鏈未見明顯異常11耳。 4.聯(lián)合診斷 根據(jù)術(shù)前讀片與術(shù)中探查結(jié)果的對比研究,具鼓室硬化特征性CT表現(xiàn)的38耳的診斷率為100%,占全部鼓室硬化病例的67.86%(38/56)。 CT診斷漏診18耳,其中鼓膜穿孔12耳,鼓膜完整6耳。對于其中鼓膜穿孔者進行耳內(nèi)窺鏡檢查。鼓膜穿孔的12耳病例中,7耳經(jīng)耳內(nèi)鏡擬診為鼓室硬化：鼓膜有鈣化者4耳,鼓岬表面珊瑚樣鈣化灶7耳；聽骨被鈣化包裹4耳；5耳未作出診斷,經(jīng)手術(shù)探查合并肉芽1耳、合并膽脂瘤4耳。對于合并肉芽和膽脂瘤的5耳病例,由于受到合并癥的影響通過耳內(nèi)窺鏡并沒有做出硬化的診斷,經(jīng)手術(shù)探查確診為鼓室硬化;而對于其他6耳鼓膜完整的漏診病例,經(jīng)手術(shù)探查得出4耳為錘、砧骨固定型,2耳為鐙骨固定型。漏診病例中,7耳經(jīng)耳內(nèi)窺鏡檢查能確定診斷,二者的聯(lián)合診斷率為38+7/56=80.36%。 根據(jù)術(shù)前純音測聽結(jié)果和術(shù)中探查聽骨鏈情況,Ⅱ——Ⅳ型鼓室硬化,即硬化灶波及聽骨鏈者,純音測聽結(jié)果ABG均≥30dBHL。分析CT及耳內(nèi)窺鏡檢查仍不能確診的11耳病例,其純音測聽結(jié)果ABG均≥30dBHL,推測其聽骨鏈存在固定或中斷,應(yīng)將鼓室硬化列入可能診斷之一 結(jié)論 1.鼓室硬化特征性HRCT表現(xiàn)為鼓膜或中耳腔內(nèi)出現(xiàn)骨化斑點或鈣化斑塊,聽骨鏈及其周圍結(jié)構(gòu)紊亂和鈣化包裹。HRCT對鼓室硬化診斷、術(shù)前病變范圍和聽骨鏈?zhǔn)芮智闆r預(yù)估有較高價值,但存在較高漏診現(xiàn)象。 2.鼓室硬化累及聽骨鏈者純音聽閾測定聽力學(xué)特點為ABG≥30dBHL,可有類Carchart切跡出現(xiàn)。純音測聽可較好地評估聽骨鏈功能狀態(tài)。 3.合并鼓膜穿孔的鼓室硬化病例,術(shù)前耳內(nèi)窺鏡檢查表現(xiàn)為鼓室腔內(nèi)白色硬化斑塊,可包裹聽骨。耳內(nèi)窺鏡檢查對明確鼓室硬化診斷,了解部分聽骨受累情況有幫助,但對有合并癥及鼓膜完整病例的術(shù)前評估有限。 4. HRCT、純音測聽和耳內(nèi)窺鏡檢查的聯(lián)合診斷,可提高鼓室硬化的術(shù)前診斷率,更好地了解聽骨鏈的功能狀態(tài),為手術(shù)方案的制定和聽功能的預(yù)后評估提供依據(jù)。
[Abstract]:Research background
Tympanosclerosis (Tympanosclerosis) also known as tympanosclerosis, refers to the middle ear in long-term chronic inflammation after healing, middle ear connective tissue from degenerative changes, is one of the important causes of conductive hearing loss; the main pathological changes in middle ear submucosa and lamina propria of the tympanic membrane appeared hyaline degeneration and calcinosis of tympanosclerosis. By Von Troltsch in 1869 for the first time are described in detail and put forward the "hardening" (sclerosis) "is a term of.1956 years, Zollner wrote a paper called" tympanosclerosis "in a large number of tympanoplasty, so hard to tympanic officially named. At home and abroad on the incidence of tympanosclerosis is reported in a foreign 20-43%[2,3] domestic, 3.7-11.7%.
At present, the etiology and pathogenesis of tympanosclerosis remains unclear. With the widely application and extensive surgical microscope tympanoplasty, the disease has attracted more and more attention and research reports on tympanosclerosis and treatment effect gradually increased, and the diagnosis is less. The tympanosclerosis usually relies on surgical exploration and pathological to be diagnosed tympanosclerosis. How to improve the level of preoperative diagnosis, the preoperative diagnosis, diagnosis the nature and scope of understanding the situation of ossicular chain, in order to develop appropriate operation scheme, and with better preoperative communication, is currently the clinical otology problem yet to be solved.
objective
1., we studied the characteristics of CT High Resolution computed tomography (HRCT) in tympanosclerosis, and discussed the diagnostic value of HRCT for tympanosclerosis, the range of lesions and the state of ossicular chain.
2. of tympanosclerosis pure tone auditory characteristics of Fujian were discussed, pure tone audiometry value assessment of the state of the chain of tympanosclerosis ossicular before operation.
3. to study and explore the diagnostic value of ear endoscopy in cases of tympanic sclerosis with tympanic membrane perforation, the scope of the lesion and the state of the ossicular chain.
4. of the combined use of HRCT and pure tone test three mirror preoperative examination method of endoscope and ear to listen to, tympanosclerosis diagnosis and misdiagnosis were analyzed, to explore the diagnosis of tympanosclerosis confirmed, the nature of the lesions, the lesion and ossicular chain state and determine the value of preoperative surgical planning and prognostic significance.
Research object and method 1. research object:
Inclusion criteria: (1) clinical diagnosis requires surgical exploration of tympanosclerosis cases of tympanum or open mastoid; second, clinical hearing and imaging data (HRCT data) are complete; 3. First operation, non revision multiple operations; fourth, operation is completed by the same treatment group members.
From August 2006 to 2010 8 completed by the same treatment group tympanosclerosis resident surgery in 52 cases 56 ears studies met the inclusion criteria. There were 35 male and 17 female, age 12-64 years, average 35.74 years old. The history of 1-40 years, an average of 16.48 years. With 34 cases, 18 cases of single ear, the ears are surgery in 4 cases. The intact tympanic membrane perforation of tympanic membrane with 8 ears, 48 ears, of which the edge of perforation in 39 ears, 9 ears. All the slack perforation cases were confirmed by surgery and pathology diagnosed tympanosclerosis.
2. examination method and result judgment
HRCT: using the GE64 Lightspeed row VCT scanner scanning Wacom reconstruction. Axial scanning baseline to orbital line, scan range from arcuate eminence to the external auditory canal. Target scan, bone algorithm reconstruction and 512 * 512 matrix, slice thickness, layer spacing is 1mm, the width of the window window 4000Hu. 700Hu, FOV=32. to the tympanic membrane, around the tympanum and ossicular appeared high density calcification or ossification image characteristic changes of tympanosclerosis, the tympanic membrane tympanic and mastoid thickening, soft tissue density, and the destruction of ossicular tympanic wall for non characteristic changes.
Pure tone audiometry: preoperative pure tone audiometry variables: mean 500100020004000Hz air conduction and bone conduction as the average pure tone of Fujian PTA (pure-tone audiometry) ABG air bone gap (air bone gap) for the same period (air conduction) AC air conduction minus bone conduction (bone conduction) BC value to ABG30dB. As a standard to judge the fixation or disruption of the ossicular chain.
Ear endoscopy: Patients with perforation of tympanic membrane were examined by ear endoscopy. The lesions were recorded. Calcified or sclerotic lesions around tympanic membrane, tympanic cavity and auditory ossicles were used as diagnostic criteria for tympanosclerosis.
3. surgical exploration and pathological classification
General anesthesia, routine tympanic exploration or / and mastoidectomy. According to the extent of the lesion and the situation of ossicular chain were divided into 4 types: type I, sclerosis lesions involving only the tympanic membrane; type II, hardening lesions in the attic by hammer incus fixed or fused with the shield plate, good structural integrity and activity of stapes; type III, in tympanosclerosis lesions involving the ossicular chain by fixation of the stapes; type IV, tympanic cavity and tympanic sinus with sclerotic tissue ossicular chain wrapped fixation, partial ossicular resorption.
4. comparative study and statistical analysis
(1) comparison and analysis of the HRCT findings of the temporal bone and the results of the surgical exploration, and statistics the coincidence rate of each type of diagnosis
(2) the statistical analysis of the results of pure tone audiometry and the classification of the lesions and the state of the ossicular chain during the operation.
A comparative study of the results of ear endoscopy and intraoperative exploration.
The characteristics of pure tone audiometry and the results of ear endoscopy after HRCT diagnosis of temporal bone were analyzed, and the cases were analyzed.
Result
HRCT findings of the 1. temporal bone and the results of surgical exploration
Preoperative CT findings: the tympanic membrane thickening calcification in 20 ears, 29 ears, 44 ears with perforated; II antrum and tympanic cavity: calcification or ossification were found in 23 ears with high density, high density calcification or ossification image and soft tissue image coexist in 9 ears, only the shadow of soft tissue in 7 ears; the mastoid cavity: soft tissue shadow in 6 ears; listen to the bone chain: calcification wrapped in 21 ears, wormhole like changes or main and no interrupt 15 ears with bone destruction, bone destruction and disruption in 6 ears; the tympanum and ossicular chain had no obvious abnormalities in 14 ears.
Intraoperative examination results: tympanic membrane thickening: 24 ears, 33 ears calcified, perforation in 48 ears; the tympanic antrum and tympanic cavity: only calcification or sclerosis plaques in 20 ears, and 19 ears with cholesteatoma granulation, 4 ears with chronic otitis media in 2 ears, antrum and tympanic were normal in 11 ears; the mastoid granulation tissue in 6 ears; the ossicular chain: surrounding sclerosis foci of ossicular fixation, the hammer incus stapes fixation in 21 ears, 14 ears, 10 ears full of ossicular chain embedding; 14 cases of calcification were wrapped ossicular, calcification package and bone destruction but have not yet been interrupted in 22 ears, bone destruction and calcification of the package and interrupt 9 ears; no abnormal ossicular chain in 11 ears.
High resolution CT (11+7) showed no calcification in 18 ears, the ear 1L imaging findings of tympanic membrane perforation no other abnormality, the 11 ears after surgical exploration there eardrum calcification in 4 ears, antrum and tympanic calcification in 9 ears, 5 ears with promontory surface calcification, calcification of the ossicular chain was wrapped in 7 ears in 5 ears, hammer incus, fixed type, 2 ears of the stapes; the other 7 ear imaging soft tissue showed only surgical exploration showed calcification in 1 ear tympanic membrane, antrum attic calcification in 2 ears, 3 ears promontory surface calcification, calcification of the ossicular chain wrapped in 1 ears.
Intraoperative pathological type and CT type quasi coincidence rate of diagnosis: type 11 ears, the coincidence rate of 9//11=81.82%; type II in 21 ears, the coincidence rate of 14/21=66.67%; type III in 14 ears, with the rate of 6/14=42.86%; 10 ears with type IV, the coincidence rate of 3/10=30%; differential diagnosis and surgical exploration consistent with only 32 ears which image fitting the diagnosis of cases, the diagnosis of the I rate is high, the other is not high, the total diagnostic coincidence rate was 57.14%.
The total diagnostic rate of CT was 67.86%, and the rate of missed diagnosis was 18/56=32.14%
2. characteristics of pure tone audiometry and intraoperative pathological classification
Preoperative audiometric results: the air conduction threshold range of 35-65dBHL, the bone conduction spacing is greater than or equal to 30dBHL51 less than 30dBHL5 ear, ear; type I outside of all cases of bone conduction interval greater than or equal to 30dBHL. the 34 hearing figure Carchart notch.
Functional exploration of ossicular chain operation: complete and good activity in 11 ears, 14 ears fixed hammer incus stapes, 21 ear, the fixation of the ossicular chain in 10 ears; calcification of ossicular chain wrapped in 22 ears, 16 ears but not interrupt bone destruction, bone destruction and disruption of the ossicular chain in 7 ears, 11 ears without exception.
Intraoperative lesion classification and audiometric ABG mean of each type: type 11 ears, ABG=2.60 + 6.33dBHL; type II 21 ears, ABG=35.70 + 8.43dBHL; type III 14 ears, ABG=41.33 + 9.87dBHL; IV 10 ears, ABG=39.23+8.75dBHL..
3. ear endoscopy
Preoperative endoscopy results of 48 ears with ear tympanic membrane perforation: 24 ear tympanic membrane thickening, calcification in 32 ears, 48 ears with perforated promontory; the surface like coral reef or onion like calcification in 14 ears, 10 ears with cholesteatoma and granulation, calcification in 4 ears; 17 ears around the parcel of ossicular chain, listen with no interruption of bone chain bone destruction in 7 ears, with bone destruction and disruption of the ossicular chain in 4 ears, 11 ears showed no abnormalities of ossicular chain.
That same group of patients: the tympanic membrane thickening calcification in 24 ears, 32 ears, 48 ears of the tympanic membrane perforation; tympanic sinus and mesotympanum calcification or sclerosis plaques in 17 ears, with granulation in 10 ears, 4 ears with cholesteatoma; mastoid granulation tissue in 4 ears; the ossicular chain around the lesion induced by hammer hardening fixed incus in 16 ears, 11 ears with stapes, the ossicular chain embedded in 10 ears; but not interrupt 12 ear ossicular destruction, damage and disruption of the ossicular chain in 7 ears, 11 ears had no obvious abnormalities.
4. joint diagnosis
According to the results of preoperative reading and intraoperative exploration, the diagnosis rate of 38 ears with tympanosclerosis characteristic CT is 100%, accounting for 67.86% of all cases of tympanosclerosis (38/56).
CT missed diagnosis in 18 ears, 12 ears of the tympanic membrane perforation of tympanic membrane, complete 6 ear. Ear endoscopy for the tympanic membrane perforation. 12 cases of perforation of the tympanic membrane in the ear, 7 ears with ear endoscopy diagnosed tympanosclerosis: the tympanic membrane calcification in 4 ears, promontory surface coral calcification foci in 7 ears; listen to bone is wrapped calcification in 4 ears; 5 ears did not make the diagnosis, surgical exploration with granulation in 1 ears, 4 ears with cholesteatoma. For patients with granulation and cholesteatoma 5 ears were affected by the complications through the ear endoscope does not make diagnosis of MS, diagnosed by surgical exploration and tympanic sclerosis; for the other 6 eardrum complete cases of misdiagnosis, surgical exploration in 4 ears that hammer incus fixed type, 2 ears of the stapes. Misdiagnosis cases, 7 ears with ear endoscopy can confirm the diagnosis, diagnosis rate for 38+7/56=80.36%. two
According to the preoperative pure tone audiometry exploration situation of ossicular chain and surgery, II type IV tympanosclerosis, namely sclerosis lesion of ossicular chain spread, the results of pure tone audiometry ABG greater than or equal to 30dBHL. and CT analysis of ear endoscopy is still not confirmed 11 cases of ear, the pure tone audiometry results of ABG were more than 30dBHL, the ossicular there is a fixed chain or interrupted, should be included in the possible diagnosis of tympanosclerosis
conclusion
1. TS HRCT features of the tympanic membrane or middle ear cavity ossification spots or calcified plaque, ossicular chain and its surrounding structure disorder and calcification encapsulated.HRCT on tympanosclerosis diagnosis, preoperative lesion and ossicular chain invasion prediction has high value, but there is a high misdiagnosis phenomenon.
2. tympanosclerosis involving the ossicular chain were pure tone audiometry audiology features for the ABG is larger than 30dBHL, with Carchart notch. Pure tone audiometry can better assess the state of the ossicular chain function.
Tympanosclerosis 3. with tympanic membrane perforation, preoperative ear endoscopy showed a white plaque within the tympanic cavity, can be wrapped to clear ear ossicle. Endoscopy diagnosis of tympanosclerosis, understand partial ossicular involvement helps, but the complications and the tympanic membrane complete cases preoperative evaluation is limited.
4. HRCT, combined diagnosis of pure tone audiometry and ear endoscopy can improve the preoperative diagnostic rate of tympanosclerosis, and better understand the functional state of ossicular chain, so as to provide evidence for the formulation of operation plan and prognosis of auditory function.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R764

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王燕玲;秦兆冰;李素娟;陳秀蘭;;鼓室硬化的高分辨CT表現(xiàn)與手術(shù)對比[J];中國耳鼻咽喉頭頸外科;2011年06期

2 吳倩;龔樹生;;中耳植入的振動聲橋在患有年齡相關(guān)性聽力損失的狗中的治療作用:3只狗短期的結(jié)果[J];聽力學(xué)及言語疾病雜志;2011年05期

3 郭宏偉;;老年性耳聾的飲食調(diào)理[J];食品與健康;2002年12期

4 許為青;孫敬武;;耳后帶蒂肌筋膜瓣和耳屏軟骨-軟骨膜復(fù)合體在伴有開放式乳突根治Ⅲa型鼓室成形術(shù)中的應(yīng)用[J];中國臨床保健雜志;2011年04期

5 韓月臣;樊兆民;;鼓室硬化癥[J];中國耳鼻咽喉頭頸外科;2011年07期

6 王詠峰;張勇;;皮瓣加外置技術(shù)鼓膜成形在鼓膜穿孔中的應(yīng)用[J];中國眼耳鼻喉科雜志;2011年01期

7 柯嘉;馬芙蓉;杜晨;潘滔;張珂;;兒童及青少年慢性化膿性中耳炎臨床特點[J];中國耳鼻咽喉頭頸外科;2011年07期

8 謝光云;;耳顯微外科手術(shù)治療慢性化膿性中耳炎36例護理體會[J];貴州醫(yī)藥;2011年05期

9 白育青;郭會平;李軍;唐海芳;;慢性化膿性中耳炎膽固醇肉芽腫的手術(shù)治療[J];中國藥物與臨床;2011年07期

10 劉后廣;塔娜;饒柱石;;新型人工中耳壓電振子設(shè)計[J];振動與沖擊;2011年07期

相關(guān)會議論文 前10條

1 柴亮;毛永軍;王鋒;張志利;汪審清;;鼓室硬化的診斷與治療[A];浙江省醫(yī)學(xué)會耳鼻咽喉科學(xué)分會成立60周年慶典暨2011年浙江省醫(yī)學(xué)會耳鼻咽喉頭頸外科學(xué)學(xué)術(shù)年會論文匯編[C];2011年

2 陳永正;康厚庸;張?zhí)煊?;全植入式人工耳蝸壓電感受器對聽骨鏈振動影響[A];2010全國耳鼻咽喉頭頸外科中青年學(xué)術(shù)會議論文匯編[C];2010年

3 張全安;;中耳炎以聽骨鏈區(qū)為中心診治理念的理論和臨床研究[A];中華醫(yī)學(xué)會全國中耳炎專題學(xué)術(shù)會議論文匯編[C];2004年

4 董季平;寧文德;楊想春;楊軍樂;閻銳;;聽骨鏈多排螺旋CT曲面重建及臨床應(yīng)用[A];中華醫(yī)學(xué)會第十三屆全國放射學(xué)大會論文匯編（上冊）[C];2006年

5 楊琳;戴培東;張?zhí)煊?謝友舟;王克強;王正敏;;全聽骨假體及部分聽骨假體重建術(shù)的生物力學(xué)分析[A];2010全國耳鼻咽喉頭頸外科中青年學(xué)術(shù)會議論文匯編[C];2010年

6 楊智云;劉春玲;;64排螺旋CT中耳仿真內(nèi)鏡和聽骨鏈的三維重建[A];中華醫(yī)學(xué)會第十三屆全國放射學(xué)大會論文匯編（下冊）[C];2006年

7 謝友舟;戴培東;朱翌洲;陳力奮;張?zhí)煊?王正敏;;聽骨鏈三維有限元建模與初步分析[A];中華醫(yī)學(xué)會第十次全國耳鼻咽喉-頭頸外科學(xué)術(shù)會議論文匯編（上）[C];2007年

8 邱建華;;傳導(dǎo)性耳聾聽力重建中的有關(guān)問題[A];中華醫(yī)學(xué)會全國中耳炎專題學(xué)術(shù)會議論文匯編[C];2004年

9 謝友舟;張?zhí)煊?戴培東;王正敏;;基于微型CT成像的聽骨鏈有限元建模方法[A];第十屆中國科協(xié)年會論文集（三）[C];2008年

10 朱翊洲;陳力奮;張?zhí)煊?戴培東;謝友舟;楊琳;王克強;王正敏;;基于混合單元的中耳聽骨鏈系統(tǒng)有限元分析[A];中國力學(xué)學(xué)會學(xué)術(shù)大會'2009論文摘要集[C];2009年

相關(guān)重要報紙文章 前10條

1 歐陽軍;耳鳴——疾病的信號[N];中國老年報;2004年

2 馬贊森（廣東工業(yè)大學(xué)退休教授）;懷念姜泗長院士[N];光明日報;2001年

3 北京市石景山區(qū)八角中里 徐恩生;老人說話“緩則圓”[N];健康時報;2009年

4 李新萍;國內(nèi)首例振動聲橋植入術(shù)成功實施[N];中國醫(yī)藥報;2010年

5 馮大夫;噪聲對人體有何影響？[N];人民日報海外版;2002年

6 馬紅;顯微外科治中耳畸形[N];健康報;2002年

7 特約記者 李新萍;國內(nèi)首例振動聲橋植入術(shù)成功[N];健康報;2010年

8 邱吉芬;及早發(fā)現(xiàn)嬰幼兒聽力障礙[N];中國石油報;2002年

9 聶松義;徐勁松;胡月飛;小耳畸形兒童再造耳道獲成功[N];中國醫(yī)藥報;2004年

10 廖皓磊;何謂倒掛懸垂綜合征[N];中國中醫(yī)藥報;2000年

相關(guān)博士學(xué)位論文 前4條

1 謝友舟;聽骨鏈系統(tǒng)在聲波傳導(dǎo)過程中的相關(guān)生物力學(xué)研究[D];復(fù)旦大學(xué);2009年

2 吳擁真;微型壓電陶瓷傳感器拾取聲學(xué)信號的實驗研究[D];復(fù)旦大學(xué);2009年

3 夏明;開放式乳突手術(shù)后復(fù)發(fā)性耳漏的基礎(chǔ)研究和臨床治療[D];山東大學(xué);2008年

4 馮紅云;EGF、TGF-α、HRG對中耳粘膜生長和分化的影響及在慢性中耳炎中的表達(dá)[D];山東大學(xué);2005年

相關(guān)碩士學(xué)位論文 前10條

1 王燕玲;鼓室硬化的術(shù)前診斷[D];鄭州大學(xué);2011年

2 羅冬;虛擬耳鏡對中耳聽骨鏈病變的診斷與應(yīng)用研究[D];暨南大學(xué);2009年

3 孫捷;聽骨鏈仿真內(nèi)鏡成像的臨床應(yīng)用研究[D];新疆醫(yī)科大學(xué);2006年

4 劉怡;多層螺旋CT三維重建技術(shù)在耳部疾病診斷中的綜合應(yīng)用[D];第二軍醫(yī)大學(xué);2008年

5 王節(jié);Ki-67和c-fos在中耳膽脂瘤增殖活性中的研究[D];安徽醫(yī)科大學(xué);2009年

6 孫曉衛(wèi);HRCT在慢性化膿性中耳炎術(shù)前評估的價值[D];山東大學(xué);2006年

7 何敏;螺旋CT在慢性化膿性中耳炎中的臨床應(yīng)用[D];新疆醫(yī)科大學(xué);2008年

8 史長征;螺旋CT后處理技術(shù)在中耳疾病診斷中的應(yīng)用[D];暨南大學(xué);2006年

9 盧智慧;顳骨高分辨率CT在小耳畸形手術(shù)中的應(yīng)用[D];安徽醫(yī)科大學(xué);2008年

10 汪昌學(xué);聽骨鏈和耳蝸的應(yīng)用解剖學(xué)研究[D];汕頭大學(xué);2008年

，

本文編號：1685230