目的通过对比术前纯音测听结果与术中所见听骨链的情况，探讨鼓室硬化症患者纯音听阈特征。方法回顾分析2008年～2011年31例鼓室硬化住院手术病例，分析患者气、骨导听力，气骨导差（ABG），中耳病变情况。结果31例中，混合性听力损失20例，传导性HL10例，感音神经性HL1例；手术探查钙斑散在分布，听骨链有不同程度的固定，听骨链完整20例，破坏11例。结论鼓室硬化病人听力损失主要为混合性及传导性，平行曲线者鼓室硬多较重，横V曲线鼓室硬化多较轻，ABG>30dBHL提示听骨链固定或破坏，但ABG<30dBHL不能轻易否定听骨链固定或破坏。

Objective By comparing the preoperative pure tone audiometry and intraoperative auditory ossicle chain, seen on patients with middle ear sclerosis pure tone hearing threshold characteristic. Methods Retrospective analysis of 2008~ 2011, 31 cases of tympanic cavity hardening hospital surgery cases, analysis of patients with air and bone conduction hearing, bones guide (ABG), middle ear disease. Results 31 patients, 20 patients with mixed hearing loss, and conductivity HL10 example, sensorineural HL1 cases; Ploration calcium spots scattered distribution, auditory ossicle chain have different degree of fixed, auditory ossicle chain of 20 patients with complete destruction in 11 cases. Conclusion Middle ear sclerosis patients mainly combination, and conductive hearing losses, parallel curve of drum-type hard much heavier, cross V curve drum-type hardening much lighter, ABG > 30 DBHL prompt auditory ossicle chain fixed or damage, but the ABG < 30 DBHL cannot easily deny auditory ossicle cha

目的：回顾性分析钛人工听骨（宾格牌）在植入术后假体脱出的原因，以期进一步提高人工听骨植入手术的成功率。方法自2007年2月到2013年7月间，共完成一期钛金属人工听骨植入听骨链重建术206耳。其中， POP164耳，TOP42耳。结果206例中，共计脱出12个，占5.8%。分别是术后3周感染脱出3耳；随访中钛听骨渐外露至完全排出9耳。致钛听骨渐外露的因素有：1）钛听骨高度过高。2）钛听骨歪斜。3）软骨片过小、薄、移位。4）含气腔渐变小。结论植入材料选择、手术技巧、术后中耳含气腔的变化均是影响假体脱出的因素。其中，就宾格牌钛听骨而言，其支撑面的平面形态设计和锐利的切缘可能是导致术后远期假体脱出的一个潜在因素。

[Abstrcut]Objective To understand the cause of extrusion of Spigger titanium prosthesis following ossicular chain re-construction to improve treatment outcomes. Methods Two hundred and six cases of ossicular chain reconstruction using the Spigger titanium prosthesis by a single ear surgeon from February of 2007 to July of 2013 were reviewed. Both PORP (n=157 cases) and TORP (n=49 cases) prostheses were used in the 206 cases. Results Of the 206 cases, extrusion occurred in 12 cases (5.8%). Inflammation during the first three weeks after the surgery caused extrusion in 3 cases. In 9 cases the Titanium prosthesis extruded gradually over six months after the surgery. The extrusion from the middle ear after surgery appeared to be related to the following factors:1) excessively high prosthesis positioning, 2) slanting prosthesis placement, 3) gradual car-tilage displacement from being too small or too thin, 4) gradual decrease in middle ear air cells size, and 5) design defects in

目的分析中耳畸形的临床和听力学特征,手术探查明确中耳畸形具体形式,观察重建听骨链改善听力的效果。方法 10例中耳畸形患者均行鼓室探查术。8例同时行听骨链重建(2例放弃),其中5例采用植入部分人工听骨(PORP)的鼓室成形术,2例采用植入全人工听骨(TORP)的鼓室成形术,1例采用镫骨足板开窗+人工镫骨植入术,1例行鼓岬开窗+人工听骨植入。结果术中发现砧骨畸形最多见,共9例,表现为砧骨长脚发育不全、豆状突缺失;其次是镫骨结构畸形并固定1例,镫骨仅存底板但可正常活动2例,镫骨畸形伴面神经畸形2例,另有1例前庭窗及面神经不能辨认。听力重建后患者听力满意,言语频率气导平均提高27.79 d B。结论中耳畸形的明确诊断依靠鼓室探查术,一定条件下植入PORP的手术效果最为理想。

Objective To analyze the diagnosis and treatment of malformation of middle ear .Methods Ten patients were involved in the study .Exploratory tympanotomy was undergone in all patients and 8 patients of which accepted the reconstruction of ossicular chain .Partial replacement prosthesis ( PORP) was used in 5 patients, total replacement prosthesis(TORP) was used in 2 patients, fenestration of stapes footplate with stapes prosthesis in 1 patient and fenestration of promontory of tympanum with prosthesis in 1 patient.Results Exploratory tympanotomy showed a variety of abnormalities of the middle ear which were difficult to identify preoperatively , despite of the modern imaging techniques.Hearing thresholds were obtained without severe complication occurrence . Conclusions Exploratory tympanotomy is essential to identify congenital conductive hearing loss and PORP implantation provides the optimal way for reconstruction of ossicular chain .

目的：探讨鼓膜完整的传导性或混合性聋患者的听力学特征。方法回顾性分析资料完整并经手术确诊的30例（42耳）传导性或混合性聋患者的临床资料，结合鼓室探查结果分析其术前纯音测听、静态声导抗、中耳共振频率及CT结果。结果42耳中术前CT显示3耳耳硬化，2耳听骨链畸形，而鼓室探查结果显示耳硬化症30耳、听骨链中断12耳；所有患者纯音测听示0．5、1、2kHz平均骨导阈值为27．5±1．3dBHL，平均气导阈值为67．0±1．8dBHL，平均气骨导差为39．5±1．1dB；42耳中，鼓室A型导抗图占50．0％（21/42），As型占42．9％（18/42），Ad型占7．1％（3/42）；耳硬化症患者的平均中耳共振频率为1079．0±67．4Hz，比听骨链中断患者的平均中耳共振频率（633．3±43．6Hz）高，差异有统计学意义（P＝0．0002）。结论鼓膜完整的传导性或混合性聋患者中耳硬化症最常见，耳硬化症患者的中耳共振频率高于听骨链中断患者。

Objective To investigate audiological characteristics of patients with intact tympanic membranes and conductive or mixed hearing loss .Methods A retrospective study was carried out among 30 patients (42 ears) with intact tympanic membranes and conductive or mixed hearing loss who underwent exploratory tympanotomy . The preoperative outcomes of pure tone audiometry ,tympanometry ,resonant frequency of middle ear and temporal bone CT scan were analyzed .Results Among 42 ears ,30 ears with otosclerosis and 12 ears with ossicular chain dis-ruption were confirmed in exploratory tympanotomy ,but only 5 ears showed positive findings in CT scan .The mean thresholds of bone conduction ,air conduction and air -bone gap at frequencies of 0 .5 ,1 and 2 kHz were 27 .5 ± 1 .3 dB HL ,67 .0 ± 1 .8 dB HL ,39 .5 ± 1 .1 dB HL ,respectively .An analysis of tympanometric data of all patients re-vealed that 50% of all ears (21/42) were type A tympanograms ,42 .9% (18/42) were type As tympanogra

目的探索先天性中外耳畸形患者耳道再造与鼓室成形术后听力改善情况,为此类患者方案选择提供参考。方法回顾性分析2006年6月~2012年12月我们进行外耳道再造与鼓室成形患者中有术前术后听力的41例(41耳)的情况。结果手术采用听骨链松解41.5%(17/41),Porp植入46.3%(19/41),Torp植入7.3%(3/41),内耳开窗4.9%(2/41)。术前术后0.5k、1k、2k、4k平均气导听阈值分别为(58 d B/53d B),(64 d B/52d B),(73 d B/73d B),(62 d B/46d B).结论听骨链松解与Torp植入术后听力改善不明显,Porp植入和内耳开窗术后听力有明显改善,但未能达到正常听阈水平。

Objective To explore the hearing improvement after reconstruction of external auditory meatus (Re-EAMs) and tympanoplasty for patients with congenital deformation of the middle and outer ears, and provide reference for later treat?ment to these kinds of patients. Methods a retrospective analysis of 41 cases (41 ears) with preoperative and postoperative hearing findings undergone Re-EAMs and tympanoplasty patients with congenital deformation of the middle and outer ears in General Hospital of PLA during 2006.7-2012.12. Results The methods for operations were Ossicular chain loosening 41.5%(17/41),Porp implantation 46.3%(19/41), Torp implantation 7.3%(3/41) and inner ear fenestration 4.9%(2/41),with average air conduction hearing threshold pre-and post-operation for 0.5k、1k、2k、4k (58 dB/53dB),(64 dB/52dB),(73 dB/73dB)and (62 dB/46dB)respectively. Conclusion Hearing improvement is not obvious after ossicular chain loosening and Torp implan?tation, while significant for Porp i