【摘要】： 目的中耳術(shù)后感音神經(jīng)性耳聾的發(fā)生是其嚴(yán)重并發(fā)癥之一,近兩年受到人們的重視。本課題通過(guò)新型ER-7C聲級(jí)計(jì)分別在尸頭顳骨和活體上針對(duì)電鉆和吸引器產(chǎn)生噪聲進(jìn)行描述,分析噪聲的影響因素,探究中耳術(shù)后感音神經(jīng)性耳聾的發(fā)生機(jī)制,為臨床治療提供了理論依據(jù)。 方法采用ER-7c型聲級(jí)計(jì),對(duì)耳顯微手術(shù)中不同種類和不同規(guī)格的電鉆及吸引器在9具尸頭的12側(cè)顳骨中產(chǎn)生的噪聲進(jìn)行測(cè)量,并以噪聲的等效聲壓級(jí)的峰值(MAX)和RMS(均方根)為指標(biāo),分析噪聲影響因素,以前瞻性研究隨訪20例單側(cè)中耳手術(shù)者非手術(shù)耳聽(tīng)力變化,探究中耳術(shù)后感音神經(jīng)性耳聾發(fā)生機(jī)制。 結(jié)果1.在9具尸頭的12側(cè)顳骨中測(cè)量噪聲值如下:⑴不同直徑的切割鉆在乳突骨皮質(zhì)產(chǎn)生噪聲峰值的均值為120.4dB SPL～121.7dB SPL,RMS值為108.3dB SPL～110.6 dB SPL;⑵在乳突腔,不同直徑的切割鉆和金剛鉆產(chǎn)生噪聲峰值為116.8dB SPL～121.5dB SPL, RMS為105.4dB SPL～110.1dB SPL,其差別無(wú)統(tǒng)計(jì)學(xué)意義;(3)耳蝸開(kāi)窗術(shù)記錄噪聲峰值在116.0dB SPL～131.5dB SPL,噪聲RMS值為108.6dB SPL～124.9dB SPL,并且在3具尸頭的3側(cè)顳骨中記錄到轉(zhuǎn)動(dòng)的金剛鉆接觸鼓階內(nèi)骨膜時(shí)噪聲值超過(guò)130 dB SPL。(4)吸引器產(chǎn)生的噪聲峰值在99.9dB SPL～128.7dB SPL,RMS在84.8dB SPL～117.2dB SPL;隨著吸引器直徑增大,噪聲值也增加;但當(dāng)吸引器直徑超過(guò)2 mm后,其噪聲值的差異無(wú)統(tǒng)計(jì)學(xué)意義。2.20例手術(shù)患者隨訪中發(fā)現(xiàn)7例(35.0%)患者非手術(shù)耳術(shù)后兩周或一個(gè)月骨導(dǎo)閾值提高陽(yáng)性,術(shù)后3個(gè)月骨導(dǎo)閾值基本恢復(fù)正常。 結(jié)論1.耳顯微手術(shù)中電鉆轉(zhuǎn)動(dòng)所產(chǎn)生的噪聲值較大,尤其在耳蝸開(kāi)窗時(shí)轉(zhuǎn)動(dòng)的金剛鉆接觸鼓階內(nèi)骨膜時(shí)噪聲值更大,足以引起噪聲性耳聾。因此改進(jìn)耳顯微手術(shù)的技術(shù)、縮短內(nèi)耳受噪聲暴露的時(shí)間對(duì)降低噪聲性耳聾的發(fā)生率至關(guān)重要。2.耳顯微手術(shù)中吸引器產(chǎn)生的噪聲值較大,因此應(yīng)選擇合適的吸引器,盡量縮短噪聲暴露時(shí)間,在靠近耳蝸時(shí)應(yīng)選用直徑1 mm的吸引器,以避免噪聲性耳聾的發(fā)生。3.耳顯微手術(shù)中電鉆和吸引器噪音可引起非手術(shù)耳聽(tīng)力短暫閾值漂移,三個(gè)月后聽(tīng)力基恢復(fù)術(shù)前水平。
[Abstract]:Objective the occurrence of sensorineural deafness after middle ear operation is one of the serious complications, which has been paid more attention in recent two years. This paper describes the noise produced by electric drill and attractor on the temporal bone of cadaveric head and in vivo by a new type of ER-7C sound level meter, analyzes the influencing factors of noise, and probes into the mechanism of sensorineural deafness after middle ear operation. It provides a theoretical basis for clinical treatment. Methods the noise from 12 temporal bones of 9 cadavers was measured by using ER-7c type sound level meter, which was produced by different types and specifications of electric drill and attractor in 9 cadavers. Based on the (MAX) and RMS (root mean square) of the equivalent sound pressure level of noise, the factors influencing noise were analyzed. The hearing changes of 20 cases of unilateral middle ear surgery were followed up, and the mechanism of sensorineural hearing loss after middle ear operation was explored. Result 1. The noise values were measured in 12 sides of temporal bone of 9 cadaver heads as follows: (1) the mean value of noise peak in mastoid bone cortex by cutting drill of different diameters was 120.4dB SPL~121.7dB SPL,RMS value of 108.3dB SPL~110.6 dB SPL;2 in mastoid cavity. There was no significant difference between the noise peak of 116.8dB SPL~121.5dB SPL, RMS and that of diamond with different diameters. (3) the peak noise of cochlear fenestration was 108.6dB SPL~124.9dB SPL, and the RMS value of 116.0dB SPL~131.5dB SPL, was 108.6dB SPL~124.9dB SPL,. In three temporal bones of cadaveric heads, the noise value of the rotating diamond in contact with the periosteum of the inner drum step was over 130mol / 4) the peak noise produced by the attractor in 99.9dB SPL~128.7dB SPL,RMS increased with the diameter of the attractor at 84.8dB SPL~117.2dB SPL;. The noise value also increased, but there was no significant difference when the diameter of the attractor was more than 2 mm. 2. 7 patients (35.0%) had increased bone conduction threshold after 2 weeks or one month of non-operative ear surgery. The bone conduction threshold returned to normal 3 months after operation. Conclusion 1. The noise produced by electric drill rotation in ear microsurgery is larger especially when the diamond rotates in the cochlea fenestration and touches the periosteum in the drum step which is enough to cause noise deafness. Therefore, it is very important to improve the technique of microsurgery and shorten the time of noise exposure to the inner ear in order to reduce the incidence of noise-induced deafness. 2. In order to avoid noise-induced deafness, we should select suitable attractor to shorten the time of noise exposure and 1 mm diameter attractor near cochlea in order to avoid noise-induced deafness. The noise of electric drill and attractor can cause transient threshold shift of hearing in non-operative ears during microsurgery, and the level of hearing base recovers after 3 months.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R764

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