摘要
目的分析外伤所致听力损失的临床特点及预后,以便更好地指导临床诊断和医学鉴定,早期确定有效治疗方案。方法对外伤后主诉听力损失的84例(96耳)患者的初诊和随访临床资料进行对比分析。分别将听力损失程度和鼓膜穿孔程度进行分级,统计分析其在患耳中的分布,归纳总结其临床特点及预后。结果外伤后初诊听力正常34耳(35.4%),听力下降62耳(64.6%),其中传导性聋33耳(53.2%),感音神经性聋25耳(40.3%),混合性聋4耳(6.5%)。随访时传导性聋患者气导平均听阈从(45.77±4.28)dB HL降低至(34.48±4.53)dB HL(t=2.906,P<0.05),骨导平均听阈从(23.45±2.31)dB HL降低至(19.63±2.20)dB HL(t=2.329,P<0.05)。感音神经性聋和混合性聋患者平均听阈变化无显著性差异(P>0.05)。外伤后鼓膜完整39耳(40.6%),鼓膜穿孔57耳(59.4%)。鼓膜穿孔者自愈40耳(70.2%),鼓膜修补术后愈合12耳(21.1%),未愈5耳(8.8%)。Ⅰ级鼓膜穿孔自愈率83.0%,Ⅱ级鼓膜穿孔自愈率16.7%,Ⅲ级、Ⅳ级鼓膜穿孔自愈率为0。结论外伤可引起听觉器官不同程度的损害,主要表现为传导性聋,严重者可表现为感音神经性聋、混合性聋。传导性聋患者预后好,感音神经性聋和混合性聋患者预后差。外伤可导致不同程度鼓膜穿孔,随穿孔程度加重,自愈率逐渐降低,Ⅲ级、Ⅳ级鼓膜穿孔难以自愈,需行手术治疗。
Objective The clinical characteristics and prognosis of post traumatic hearing loss were retrospectively evaluated to aid further diagnosis,medical evaluation,early identification,and effective treatment.Methods We recruited 84 patients(96 ears)and obtained their clinical examination findings,hearing test results,and audiograms from a single-institution otolaryngology service with comparative data generated from their first and follow-up visits.Results Among all the recruited patients,34 ears(35.4%)had normal hearing,while 62 ears(64.6%)had hearing loss after trauma,at their first visit.Among 62 ears with hearing loss,33 ears(53.2%)had conductive hearing loss,25 ears(40.3%)had sensorineural hearing loss,and four ears(6.5%)had a mixture of conductive and sensorineural hearing loss.At the follow-up visit,the air conduction threshold of ears with conductive hearing loss had significantly decreased from 45.77±4.28 dB HL to 34.48±4.53 dB HL(t=2.906,P<0.05),while the bone conduction threshold decreased from 23.45±2.31 dB HL to 19.63±2.20 dB HL(t=2.906,P<0.05).However,no significant differences between the first and follow-up visits were observed in ears with sensorineural hearing loss or ears with mixed hearing loss.Of all the 96 ears,39(40.6%)had intact tympanic membrane,while 57(59.4%)had traumatic tympanic membrane perforation.At follow-up,40 ears(70.2%)with traumatic tympanic membrane perforation had healed spontaneously,while 12 ears(21.1%)had healed after tympanoplasty.However,five ears(8.8%)did not heal.Among the ears that spontaneously healed,83.0%had grade I and 16.7%had grade II tympanic membrane perforation.Ears with grade III and grade IV tympanic membrane perforations did not heal spontaneously.Conclusions Hearing impairment is a common clinical presentation in patients with traumatic injury.In most patients,this manifests as conductive hearing loss,while severely affected patients may have sensorineural or mixed hearing loss.Patients with conductive hearing loss have a favorable prognosis,while patients with sensorineural or mixed hearing loss have a poor prognosis.Trauma could cause different degrees of tympanic membrane perforation.With gradually aggravated tympanic membrane perforation,the spontaneous healing rate decreases.Therefore,for patients with large tympanic membrane perforations,which rarely heal spontaneously,tympanoplasty is warranted.
作者
丁玉静
兰兰
王秋菊
冀飞
熊芬
谢林怡
丁海娜
夏寅
赵辉
DING Yujing;LAN Lan;WANG Qiuju;JI Fei;XIONG Fen;XIE Linyi;DING Haina;XIA Yin;ZHAO Hui(ColIege of Otolaryngology Head and Neck Surgery,Chinese PLA General Hospital/National Clinical Research Center for Otolaryngologic Diseases/Key Lab of Hearing Science,Ministry of Education/Beijing Key Lab of Hearing Impairment for Prevention and Treatment,Beijing 100853,China;Department of Otolaryngology Head and Neck Surgery,Beijing Tian tan Hospital,Capital Medical University,Beijing 100070,China)
出处
《山东大学耳鼻喉眼学报》
CAS
2020年第1期9-14,共6页
Journal of Otolaryngology and Ophthalmology of Shandong University
基金
国家重点研发计划(2017YFA0104702).
关键词
外伤
听力损失
鼓膜穿孔
预后
Trauma
Hearing loss
Tympanic membrane perforation
Prognosis
