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腭裂修复术对婴幼儿听力和中耳功能的短期影响
Short-term Impact of Cleft Palate Repair on Hearing and Middle Ear Function in Infants
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摘要:目的 探讨单纯腭裂修复术对腭裂婴幼儿听力和中耳功能的短期影响。方法 2013年1月至2014年11月在北京协和医院行手术治疗的先天性腭裂婴幼儿33例, 其中男22例, 女11例, 在腭裂修复术前、术后1~24个月对患儿进行畸变产物耳声发射(distortion product otoacoustic emission, DPOAE)、听性脑干反应(auditory brainstem response, ABR)和226 Hz鼓室声导抗图检测, 观察腭裂修复术后患儿听力和中耳功能的短期变化。结果 33例(66耳)腭裂婴幼儿手术时平均年龄为17个月(8.5~25个月)。64耳接受术前DPOAE测试, 7耳(10.9%)通过; 56耳接受术后DPOAE测试, 19耳(33.9%)通过, 手术前后通过率比较差异具有统计学意义(P < 0.01);术前术后均接受DPOAE测试的54耳中, 16耳(29.6%)听力改善。63耳接受术前ABR检查, 其中Ⅴ波反应阈平均值为(43.73±13.65)dB nHL; 62耳接受术后ABR检查, 其中Ⅴ波反应阈平均值为(35.65±13.75)dB nHL, 手术前后反应阈值比较差异具有统计学意义(P < 0.01);术前术后均接受ABR检测的53耳中, 29耳(54.7%)术后V波反应阈降低, 听力改善。手术前后226 Hz鼓室声导抗图分型比较差异无统计学意义(P>0.05)。结论 单纯腭裂修复术术后患儿短期听力得到改善, 但中耳功能改善不明显。Abstract:Objective To study the short-term impact of cleft palate repair surgery on hearing and middle ear function in infants.Methods Thirty-three infants with cleft palate who received cleft palate repair surgery from January 2013 to November 2014 in Peking Union Medical College Hospital were included in this study, including 22 male infants and 11 female infants. They were examined using distortion product otoacoustic emission (DPOAE), auditory brainstem response (ABR), 226 Hz probe-tone tympanometry before surgery and 1-24 months after surgery.Results The mean age of the 33 infants (66 ears) at the time of surgery was 17 months (8.5-25 months). Sixty-four ears were examined with preoperative DPOAE, with 7 ears (10.9%) passed; postoperative DPOAE was performed in 56 ears, with 19 ears (33.9%) passed. The passing rate was significantly improved after operation (P < 0.01). In the 54 ears for which both preoperative and postoperative DPOAE were conducted, 16 ears (29.6%) showed improved hearing. Sixty-three ears were examined with preoperative ABR, showing a mean hearing threshold of (43.73±13.65)dB nHL; 62 ears were examined with postoperative ABR, showing a mean hearing threshold of (35.65±13.75)dB nHL, significantly improved compared with the preoperative threshold (P < 0.01). In the 53 ears which received both preoperative and postoperative ABR, 29 ears(54.7%) showed reduced hearing thresholds. There was no significant difference in 226 Hz probe-tone tympanometry between preoperative and postoperative examinations(P>0.05).Conclusion In infants with cleft palate, short-term hearing improvement may be observed after repair surgery, while middle ear function may show no obvious improvement.
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