本文選題：鼓室硬化　切入點(diǎn)：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(zhǎng)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(jìn)行詳細(xì)描述并提出“硬化(sclerosis)'”一詞。1956年,Zollner在進(jìn)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(guó)內(nèi)外關(guān)于鼓室硬化發(fā)病率的報(bào)道不一,國(guó)外為20-43%[2,3],國(guó)內(nèi)為3.7-11.7%。 目前,鼓室硬化的病因及發(fā)病機(jī)制仍不清楚。隨著鼓室成形術(shù)的廣泛開(kāi)展和手術(shù)顯微鏡的普遍應(yīng)用,該病越來(lái)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(bào)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(tīng)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(jìn)行術(shù)前溝通,是目前耳科臨床尚待解決的問(wèn)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(diǎn),探討HRCT對(duì)鼓室硬化的診斷及其病變范圍和聽(tīng)骨鏈狀態(tài)的判斷價(jià)值。 2.研究鼓室硬化純音聽(tīng)閩測(cè)定的聽(tīng)力學(xué)特點(diǎn),探討純音測(cè)聽(tīng)對(duì)鼓室硬化聽(tīng)骨鏈功能狀態(tài)評(píng)估的術(shù)前判定價(jià)值。 3.研究并探討耳內(nèi)窺鏡對(duì)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(tīng)骨鏈狀態(tài)的診斷價(jià)值。 4.研究聯(lián)合應(yīng)用HRCT、純音測(cè)聽(tīng)和耳內(nèi)窺鏡三種術(shù)前檢查方法,對(duì)鼓室硬化病例的確診及漏診結(jié)果進(jìn)行綜合分析,探討聯(lián)合診斷對(duì)鼓室硬化的確診、病變性質(zhì)、病變范圍和聽(tīng)骨鏈狀態(tài)的判定價(jià)值及對(duì)術(shù)前手術(shù)方案制定和預(yù)后評(píng)估的指導(dǎo)意義。 研究對(duì)象和方法1.研究對(duì)象： 納入標(biāo)準(zhǔn)：①臨床診斷需手術(shù)探查鼓室或開(kāi)放乳突的鼓室硬化病例；②臨床、聽(tīng)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(guó)GE64排Lightspeed VCT掃描儀進(jìn)行軸位掃描和冠位重建。軸位掃描基線為聽(tīng)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(tīng)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(tīng)骨及鼓室壁破壞等為非特征性改變。 純音測(cè)聽(tīng)：術(shù)前純音聽(tīng)閾測(cè)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(tīng)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(tīng)骨鏈固定或中斷的判斷標(biāo)準(zhǔn)。 耳內(nèi)窺鏡檢查：對(duì)伴有鼓膜穿孔的病例進(jìn)行耳內(nèi)窺鏡檢查,記錄病變情況。以鼓膜、鼓室腔及聽(tīng)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(kāi)放乳突。根據(jù)病變范圍和聽(tīng)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(dòng)良好且結(jié)構(gòu)完整;Ⅲ型,上中鼓室硬化病灶累及聽(tīng)骨鏈致鐙骨固定；Ⅳ型,鼓室及鼓竇充滿硬化組織致聽(tīng)骨鏈包裹固定,部分聽(tīng)骨破壞吸收。 4.對(duì)比研究和統(tǒng)計(jì)分析 ①顳骨HRCT表現(xiàn)與手術(shù)探查結(jié)果進(jìn)行對(duì)比分析,統(tǒng)計(jì)各型診斷符合率 ②純音測(cè)聽(tīng)結(jié)果與術(shù)中病變分型和聽(tīng)骨鏈狀態(tài)的統(tǒng)計(jì)分析。 ③耳內(nèi)窺鏡檢查與術(shù)中探查結(jié)果進(jìn)行對(duì)比研究。 ④分析顳骨HRCT診斷后的漏診病例的純音測(cè)聽(tīng)特點(diǎn)和耳內(nèi)窺鏡檢查結(jié)果,對(duì)該類病例進(jìn)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(jiàn)軟組織影7耳；③乳突腔：軟組織影6耳；④聽(tīng)骨鏈：鈣化包裹21耳,蟲(chóng)蝕樣改變或以骨質(zhì)破壞為主且未見(jiàn)中斷15耳,骨質(zhì)破壞且中斷6耳；⑤鼓室腔及聽(tīng)骨鏈未見(jiàn)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(jiàn)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(jiàn)異常11耳；③乳突腔肉芽組織6耳；④聽(tīng)骨鏈：周圍硬化灶致聽(tīng)骨固定,其中錘砧骨固定21耳,鐙骨固定14耳,全聽(tīng)骨鏈包埋10耳；僅見(jiàn)聽(tīng)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(tīng)骨鏈未見(jiàn)異常11耳。 高分辨CT未見(jiàn)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(jiàn)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(tīng)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(tīng)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(cè)聽(tīng)特點(diǎn)與術(shù)中病變分型 術(shù)前測(cè)聽(tīng)結(jié)果：①氣導(dǎo)聽(tīng)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(tīng)力圖出現(xiàn)類Carchart切跡改變。 術(shù)中探查聽(tīng)骨鏈功能：完整并活動(dòng)良好11耳,錘砧骨固定14耳,鐙骨固定21耳,全聽(tīng)骨鏈固定10耳；聽(tīng)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(tīng)骨鏈無(wú)異常11耳。 術(shù)中病變分型及各型測(cè)聽(tīng)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(tīng)骨鏈周圍出現(xiàn)鈣化灶包裹17耳,聽(tīng)骨鏈合并骨質(zhì)破壞未見(jiàn)中斷7耳,聽(tīng)骨鏈合并骨質(zhì)破壞并中斷4耳,聽(tīng)骨鏈未見(jiàn)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(tīng)骨鏈周圍硬化灶致錘砧骨固定16耳,鐙骨固定11耳,全聽(tīng)骨鏈包埋10耳；聽(tīng)骨破壞但尚未中斷12耳,破壞且中斷7耳,聽(tīng)骨鏈未見(jiàn)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(duì)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(duì)于其中鼓膜穿孔者進(jìn)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(tīng)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(duì)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(guò)耳內(nèi)窺鏡并沒(méi)有做出硬化的診斷,經(jīng)手術(shù)探查確診為鼓室硬化;而對(duì)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(cè)聽(tīng)結(jié)果和術(shù)中探查聽(tīng)骨鏈情況,Ⅱ——Ⅳ型鼓室硬化,即硬化灶波及聽(tīng)骨鏈者,純音測(cè)聽(tīng)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(cè)聽(tīng)結(jié)果ABG均≥30dBHL,推測(cè)其聽(tīng)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(diǎn)或鈣化斑塊,聽(tīng)骨鏈及其周圍結(jié)構(gòu)紊亂和鈣化包裹。HRCT對(duì)鼓室硬化診斷、術(shù)前病變范圍和聽(tīng)骨鏈?zhǔn)芮智闆r預(yù)估有較高價(jià)值,但存在較高漏診現(xiàn)象。 2.鼓室硬化累及聽(tīng)骨鏈者純音聽(tīng)閾測(cè)定聽(tīng)力學(xué)特點(diǎn)為ABG≥30dBHL,可有類Carchart切跡出現(xiàn)。純音測(cè)聽(tīng)可較好地評(píng)估聽(tīng)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(tīng)骨。耳內(nèi)窺鏡檢查對(duì)明確鼓室硬化診斷,了解部分聽(tīng)骨受累情況有幫助,但對(duì)有合并癥及鼓膜完整病例的術(shù)前評(píng)估有限。 4. HRCT、純音測(cè)聽(tīng)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(tīng)骨鏈的功能狀態(tài),為手術(shù)方案的制定和聽(tīng)功能的預(yù)后評(píng)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(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R764

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