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Effects of Hearing Reconstruction by Teflon Prothesis in Chronic Otitis Media

【摘要】 目的 评价聚四氟乙烯人工听骨在慢性中耳炎听力重建中的应用效果。 方法 回顾性分析2008年8月〖CD3/5〗2009年12月慢性中耳炎手术中接受聚四氟乙烯部分/全人工听骨赝复物(Partial/Total ossicular replacement prostheses,PORP/TORP,美国美敦力公司)行听骨链重建的50例患者50只耳的临床资料及随访结果。比较听力学资料完整的39例39只耳手术前及手术后3～6个月语言频率(05、1.0、2.0 kHz)气导平均听力及气骨导差(airbonecap,ABG)。 结果 随访3～16个月,50只耳手术后1～3个月均干耳,手术后1个月鼓膜愈合良好。9只耳手术中人工听骨表面未置入耳屏软骨,其中1只耳手术后3个月人工听骨脱出,1只耳手术后2个月鼓膜内陷,人工听骨外端盘面外突。39只耳手术前气导听力为3667～9500 dB,平均为(5970±1433) dB;骨导听力为330～5170 dB,平均为(2278±1161) dB;手术后气导听力平均为(4660±1703) dB,与手术前比较,差异有统计学意义(Plt;001)。手术前ABG为10～60 dB,平均为(3700±1212) dB。手术后ABG平均为(2620±1156) dB,与手术前比较,差异有统计学意义(Plt;001)。手术后气导听力提高1000～3000 dB者(手术后听力提高有效)共24只耳,有效率为615%(24/39)。 结论 聚四氟乙烯人工听骨是慢性中耳炎体重建听骨的理想材料,手术后取得良好的听力结果,远期疗效需进一步观察。【Abstract】 Objective To evaluate the effects of hearing reconstruction in chronic otitis meadia with prothesis. Methods Retrospective reviews were performed in 50 patients(50 ears)who had undergone Teflon Partial/Total ossicular replacement prostheses (PORP/TORP) implants from August 2008 to December 2009. Audiometric measurements (the average hearing threshold at 05, 10, 20 kHz) were taken in 39 patients (39 ears) preoperatively and postoperatively. Comparisons of preoperative and postoperative mean air condition and air bone gap (ABG) were performed. Results All patients were followed up for three to 16 months, and the surgery resulted in a dry ear and a healing drum without perforation in all 50 patients. Of the nine patients without tragus cartilage interposed between the drum and the prosthesis, one patient occured prothesis extrusion, and one patient had retraction of the eardrum. The mean air conduction of the 39 patients before and after surgery were (5970±1433) dB and (4660±1703) dB. The mean air bone gap (ABG) was (3700±1212) dB before operation, while it was elevated to (2620±1156) dB when followed up (Plt;001). The surgical treatments were found to be successful (postoperative mean air condition improved 10.0030.00 dB) in 24 ears (615%). The effectiveness was 615%. Conclution Teflon could be an ideal material for ossicular reconstruction in chronic otitis media, and the hearing improvement is obtained after operation, but the problem of extrusion has not been solved at present, and the longterm effects should be surveyed.