耳内镜下CO2激光打孔人工镫骨植入术治疗耳硬化症的临床疗效观察

Clinical efficacy observation of endoscopic artificial stapes implantation assisted by CO2 laser in the treatment for otosclerosis

摘要:

目的 探讨耳内镜下CO₂激光打孔辅助下人工镫骨植入术治疗耳硬化症的安全性和治疗效果。方法 选取2017年1月－2023年12月该院收治的耳硬化症患者21例（22耳）为研究对象，在耳内镜下结合CO₂激光行镫骨底板开窗植入人工镫骨，观察术后听力恢复情况，以及面瘫、味觉障碍、眩晕、鼓膜穿孔和耳鸣等并发症发生情况。结果 术后气导阈值为（47.49±13.56）dB HL，较术前的（59.20±9.95）dB HL，降低了（11.72±13.42）dB HL，差异有统计学意义（P < 0.01）；术后骨导阈值为（28.45±10.70）dB HL，与术前的（28.77±8.39）dB HL比较，降低了（0.31±7.44）dB HL，差异无统计学意义（P > 0.05）；术后气骨导间距（A-B gap）为（19.03±8.76）dB HL，较术前的（30.44±8.60）dB HL，降低了（11.40±9.74）dB HL，差异有统计学意义（P < 0.01）。术后出现感音神经性听力下降1例，未出现面瘫、味觉障碍和术后感染等并发症。结论 耳内镜下CO₂激光打孔辅助下人工镫骨植入术治疗耳硬化症安全可靠，可明显改善患者听力指标，且并发症发生率低，值得临床推广。

Abstract:

Objective To explore the method of treating otosclerosis with endoscopic artificial stapes implantation assisted by CO₂ laser perforation, then verify its safety and observe the therapeutic effect.Methods From January 2017 to December 2023, 21 patients (22 ears) with otosclerosis who met the inclusion criteria were selected for the study. Under endoscopy, CO₂ laser was used to punch the stapes floor plate and perform artificial stapes implantation. Postoperative hearing recovery and complications such as facial paralysis, dysgeusia, vertigo, tympanic membrane perforation, and tinnitus were observed.Results The postoperative air conduction threshold was (47.49 ± 13.56) dB HL, which was a reduction of (11.72 ± 13.42) dB HL compared to the preoperative air conduction threshold of (59.20 ± 9.95) dB HL.The difference was statistically significant (P < 0.01). The postoperative bone conduction threshold was (28.45 ± 10.70) dB HL, which decreased by (0.31 ± 7.44) dB HL compared to the preoperative bone conduction threshold of (28.77 ± 8.39) dB HL. The difference was not statistically significant (P > 0.05).The postoperative air-bone gap (A-B gap) was (19.03 ± 8.76) dB HL, which was a significant decrease compared to the preoperative A-B gap of (30.44 ± 8.60) dB HL, showing an improvement of (11.40 ± 9.74) dB HL. The difference was statistically significant (P < 0.01). One case of sensorineural hearing loss occurred postoperatively, but no cases of facial paralysis, dysgeusia, or postoperative infection complications were observed.Conclusion The treatment of otosclerosis with artificial stapedial implantation assisted by CO₂ laser perforation under endoscopy is safe and reliable, significantly improving patients' hearing indicators, with a low incidence of complications, and is worth promoting in clinical practice.