Objective:To investigate the risk factors of wet ear status and its impact on the efficacy of endoscopic type Ⅰ tympanoplasty. Methods:A retrospective analysis was conducted at the Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Chinese People's Liberation Army（PLA）Air Force Medical University, on 160 ears that underwent endoscopic type Ⅰ tympanoplasty; these were assigned to a dry-ear group （n= 118） and a wet-ear group （n= 42）.Univariate analysis and binary logistic regression were used to identify risk factors for wet ear status. Postoperative outcomes, including tympanic meoombrane healing rate and hearing improvement across frequencies, were compared between groups. Results:①Significant intergroup differences were observed in age, residual tympanic membrane status, external auditory canal condition, mastoid pneumatization（MC0）, and middle ear ventilation dysfunction（P<0.05）; ②The degree of mastoid pneumatization being MC0 is an independent risk factor for wet ear（P<0.05）; ③No significant difference in tympanic membrane healing rates was found（P>0.05）; ④The wet ear group showed significantly higher pre-and postoperative air-conduction（AC） and bone-conduction（BC） thresholds at 2 kHz and 4 kHz compared to the dry ear group（P<0.05）, though the postoperative air-bone gap（ABG） improvement was comparable. Conclusion:Poor mastoid pneumatization is a risk factor for wet ears. The wet ear state has no effect on tympanic membrane healing and air-bone conduction gap, but patients in the wet ear group may have more severe inner ear or auditory nerve pathway damage.

Objective:Retrospective analysis of clinical data of 123 patients with atticotomy, exploring the clinical characteristics of patients undergoing atticotomy and the efficacy of hearing reconstruction methods. Methods:123 patients with atticotomy were divided into three groups according to the ossicular chain treatment method: preservation of the ossicular chain group（37 cases）, cartilage elevation of stapes group（49 cases）, and PORP group（37 cases）. The clinical characteristics of patients with atticotomy, preoperative and postoperative hearing levels of the three groups of patients, and postoperative complications were analyzed. Results:①89.43%（110/123） of patients who underwent atticotomy were pars flaccida cholesteatomas, while 10.57%（13/123） of patients were secondary cholesteatoma, adhesive otitis media, pars tensa cholesteatomas, congenital cholesteatoma, and external auditory canal cholesteatoma; ②The group with preserved ossicular chain had a shorter medical history compared to the other two groups, and the difference was statistically significant（P<0.001）. The group with preserved ossicular chain had smaller inter group ABG values and average ABG values at frequencies of 500 Hz, 1 000 Hz, 2 000 Hz and 4 000 Hz before surgery compared to the other two groups, and the difference was statistically significant（P<0.001）; The differences in ABG frequencies and average ABG between the three groups of patients before and after surgery were statistically significant（P<0.05）; Postoperative ABG: The group preserving the ossicular chain had a smaller difference compared to the other two groups, with a statistically significant difference（P<0.05）. There was no statistically significant difference between the cartilage plus high stapes group and the PORP group（P>0.05）; ③At 3 months post surgery, all patients achieved ear dryness. Two patients experienced delayed facial paralysis after conservative treatment, and all recovered. One patient had a slight decrease in bone conductivity due to the influence of grinding during hammer anvil fixation surgery, and one patient experienced a recurrence after 4 years due to residual surgery. 81 patients（65.85%） experienced non cartilage repair area invagination during postoperative follow-up, of which 5 patients（4.07%, 5/123） underwent a second surgery. Although the rest of the patients had local invagination, they could still self clean and did not form a cholesteatoma. The total recurrence rate was 4.88%（6/123）, with an average recurrence time of 4 years. Conclusion:Atticotomy surgery is most commonly used for pars flaccida cholesteatomas with limited scope. The incidence of postoperative retraction is high, and regular follow-up is necessary; When conditions permit during surgery, priority can be given to preserving the ossicular chain for better postoperative hearing. Both cartilage elevation of stapes and PORP implantation can effectively improve hearing, and there is no difference in postoperative hearing between the two methods. However, there is a risk of detachment and high cost after PORP surgery, and cartilage elevation of stapes is limited by insufficient height and stapes head erosion. Therefore, it is necessary to choose a comprehensive hearing reconstruction method based on the patient's condition.

Objective:To investigate the safety and efficacy of regional parotid gland resection with small incision under microscope.Methods:The data of patients who underwent parotid tumor resection with small incision under microscope from January 2017 to November 2022 were retrospectively collected. The patients′ basic information, preoperative imaging data, intraoperative relevant information, and follow-up data were evaluated, and the occurrence of complications was analyzed.Results:A total of 78 patients were enrolled, including 36 males and 42 females, with a median age of 37 (28, 48) years. The operation time was (88.5±24.6) minutes. The amount of bleeding was (16.2±7.2) ml. The maximum diameter of tumors was less than 3.5 cm, and all the tumor was located in the superficial lobe of the parotid gland. The pathological results were all benign. The follow-up time was 3-60 months. There was no tumor recurrence and permanent facial nerve injury, and no other complications such as salivary leakage and infection occurred.Conclusions:Regional parotid resection with small incision under microscope is feasible, and its safety and efficacy need more cases and long-term follow-up studies.

目的 探讨语前聋患儿双模式(一侧人工耳蜗植入,对侧配戴助听器)干预与双侧人工耳蜗植入(co-chlear implantation,CI)后早期听觉言语康复效果以及生活质量,为语前聋患儿双侧干预模式的选择提供参考.方法 回顾性分析2016～2019年行双侧CI 28例(双侧CI组)和双模式干预28例(双模式组)语前聋患儿的临床资料,双侧CI组的平均植入年龄和术前助听器使用时长低于双模式组.所有患儿均于开机时、开机1、3、6和12个月时完成听觉行为分级标准(CAP)、婴幼儿有意义听觉整合量表(IT-MAIS)、言语可懂度分级标准(SIR)、有意义使用言语量表(MUSS)问卷填写,并于术后2±0.76年完成中文版CI儿童家长观点调查问卷(MPP),比较两组结果.结果 双模式组IT-MAIS得分在开机时(F=16.52,P<0.001)、开机1个月(F=12.02,P=0.001)、开机3个月(F=4.27,P=0.043)高于双侧CI组,之后两组间IT-MAIS得分无统计学差异(P>0.05).双模式组CAP分级在开机时(F=9.50,P=0.003)、开机1个月(F=8.70,P=0.005)高于双侧CI组,随后两组间CAP分级无统计学差异(P>0.05).双模式组术后MUSS得分高于双侧CI组(F=5.46,P=0.023).在开机时、开机1个月两组间SIR分级无统计学差异(P>0.05),在开机3个月(F=4.50,P=0.039)、6个月(F=10.89,P=0.002)和12个月时(F=5.46,P=0.023)双模式组SIR分级高于双侧CI组.MPP问卷的幸福感(F=9.15,P=0.004)、社会关系(F=5.03,P=0.029)和教育(F=7.97,P=0.007)维度得分双模式组高于双侧CI组,在交流、基本功能、自立能力、CI的效果和影响以及对患儿的支持维度两组间得分无统计学差异(P>0.05).结论 双侧CI与双模式干预患儿术后听觉言语能力均能取得较大进步;尽管术后早期双模式干预患儿的听觉言语能力进步更明显,但考虑到植入年龄、术前助听器使用时间等因素的影响,尚不能认为双模式干预的效果优于双侧CI.

目的 探讨儿童慢性化脓性中耳炎行鼓室成形术的疗效.方法 回顾性分析51例(51耳)行鼓室成形术的慢性化脓性中耳炎儿童年龄、手术方法、鼓膜愈合率、术后听力疗效.结果 51例患儿年龄7～17岁,平均12.98±3岁,51耳的鼓膜愈合率为90.2％(46/51);将患者分为≤13岁(26例)及>13岁(25例)两组,鼓膜愈合率分别为88.46％(23/26)、92.0％(23/25),差异无统计学意义(P>0.05);完成Ⅰ型鼓室成形术者35耳(68.63％),Ⅱ型鼓室成形术者16耳(31.37％),Ⅰ型和Ⅱ型鼓室成形术者术后术耳气骨导差较术前均有显著缩小(P<0.05);听力改善总有效率为78.43％(40/51),Ⅰ型和Ⅱ型鼓室成形术者听力改善的有效率分别为80％(28/35),75％(12/16).结论 7岁以上慢性化脓性中耳炎儿童的年龄可能不是影响鼓室成形术成功率的关键因素,但手术仍需谨慎.

目的 通过锥形束CT评估感音神经性耳聋患者人工耳蜗植入术(cochlear implantation,CI)后电极位置与植入损伤,为CBCT的应用提供参考.方法 选取在我科行人工耳蜗植入术的35名成人重度或极重度感音神经性耳聋患者为研究对象,年龄13-73岁,在术后3-4天均行植入侧颞骨CBCT扫描.使用NNT Viewer软件对扫描所得的DICOM数据进行后处理.观察电极位置以及植入后内耳损伤程度.结果 两款直电极植入耳蜗后均贴于耳蜗管外侧壁,81％(17/21)诺尔康CS-10A标准电极完全植入,75％(12/16)MED-EL SONATATI100标准电极完全植入.诺尔康CS-10A标准电极的平均植入深度角为366.46°±46.24°,平均植入长度为19.85mm±1.56mm,MED-EL SONATATI100标准电极的平均植入深度角为575.72°±100.33°,平均植入长度为26.66mm±4.02mm.诺尔康CS-10A标准电极植入后有1例发生骨螺旋板升高,1例发生电极从鼓阶进入前庭阶,MED-EL SONATATI100标准电极植入后有2例发生电极从鼓阶进入前庭阶.结论 CBCT具有高空间分辨率、低金属伪影、低辐射量以及成像时间短的优势,可用来评估人工耳蜗术后电极植入深度角、植入长度、电极位置、显示电极与周围结构的关系及植入后内耳损伤程度,具有较大的临床应用价值.

Objective:To compare the effect on hearing of different reconstruction material in type Ⅱ tympanoplasty. Methods:Retrospectively analysis of 286 patients who accepted type Ⅱ tympanoplasty. The air-bone gap of 0.5, 1, 2, 4 kHz was analyzed before and after operation. We compared the hearing change and the complications between each group. Results:In incus group, the manubrium mallei and the head of stapes were connected with shaped incus, PORP group were implanted with PORP during operation, and cartilage group used auricular cartilage to cover the head of stapes. There was no significant difference in 4 kHz air-bone gap（ABG） between the cartilage group and PORP group either before or after the operation （P>0.05）. Air-bone gap of 0.5, 1, 2, 4 kHz of the incus group, and the 0.5, 1, 2 kHz of the cartilage and PORP group were significantly reducedafter the operation（P<0.05）. One patient got severe sensorineural hearing loss in incus group after the operation. The high frequency of bone conduction decreased in 1 patient（2, 4 kHz）.In the incus group, 3 patients had temporary facial paralysis after operation. Incus and cartilage group each have 1 patient with dizziness after the operation. Incus, cartilage and PORP group had 5, 3 and 11 patients with perforation again respectively. There was extrusion occurred in 1 patient of PORP group. Conclusion:Self incus, cartilage and PORP can be used in typeⅡ tympanoplasty, the effect of hearing reconstruction is similar. The first two are more economical, PORP implantation has the lowest technical difficulty and the most widely application, but there is a certain risk of extrusion .

Objective:To evaluate hearing outcome and complications of one-stage tympanoplasty in patients with stapes fixation due to tympanosclerosis. Method:59 patients（sixty-one ears） underwent one-stage tympanoplasty for stapes fixation due to tympanosclerosis were retrospectively analyzed. Stapes fixation due to tympanosclerosis were proved during the surgery in these patients diagnosed with chronic otitis media. For all the patients, tympanosclerotic plaques around stapes were removed for stapes mobilization. Then the ossicular chain was rebuilt by autogenous incus or PORP. The pre-and post-operative audiometric results（500 Hz, 1 kHz, 2 kHz and 4 kHz） were evaluated for each patient. Improvement of pure-tone average more than 10 dB postoperatively were accepted as success criteria. Result:Complications included temporary facial paralysis（1/61）, temporary vertigo（2/61）, mild elevation in bone conduction thresholds（2/61） and delayed healing of tympanic membrane（1/61）. Postoperative（1 and 3 months） bone conduction thresholds improved at frequencies of 1 and 2 kHz（P<0.01）. Postoperative（1 and 2 years） air conduction thresholds improved at all frequencies（P<0.01 or P<0.05）. A gain ≥10 dB in pure-tone average was found in 44（72.13%） patients at 1 year after surgery. The air conduction levels were significantly improved in both autogenous incus and PORP groups（P<0.01）. There was no difference about success rate between these two groups（P>0.05）. Conclusion:For patients with stapes fixation due to tympanosclerosis, one-stage tympanoplasty can improve hearing threshold though ossicular chain reconstruction and stapes release. The major complications such as facial paralysis and sensorineural hearing loss should be avoided by delicate surgical operation.

目的 分析鼓室硬化患者在Ⅱ型鼓室成形术中采用自体砧骨或部分人工听骨(partial ossicular replacement prostheses,PORP)重建听骨链后的听力疗效.方法 对106例累及听骨链的鼓室硬化患者在Ⅱ型鼓室成形术中分别采用自体砧骨(自体砧骨组,55例)或PORP(PORP组,51例)重建听骨链,随访1～22个月,比较两组500、1 000、2 000和4 000 Hz各频率的气骨导差及平均气骨导差.结果 自体砧骨组术后0.5～4 kHz各频率听力均较术前显著提高,气骨导差显著减小;PORP组术后除4 000 Hz外,其它频率听力亦较术前显著提高,气骨导差显著减小;两组间术前、术后各频率气骨导差及平均气骨导差比较差异均无统计学意义(P＞0.05),听力提高的有效率比较差异也无统计学意义(P＞0.05).结论 鼓室硬化患者Ⅱ型鼓室成形术中选择自体砧骨或PORP重建听骨链均可有效改善听力,且两种材料的效果相同,术后远期听力疗效还需随访研究.

Objective:Retrospctive analysed the Characteristics and outcomes of surgical treatment of 18 patients who were diagnosed as secondary acquired cholesteatoma (SAC).Method:Patients with SAC accepted operations were enrolled in this study. Then the factors such as sex, age, cource of history, otorrhea before operation, the size of perforation of tympanic membrane, entry site of epithelium, extension direction, ossicular destruction, tympanosclerosis, tympanum tympani tendon involvement, stage of cholesteatoma（JOS, 2015, Japan），degree of gasification of mastoid（JOS，2015，Japan），air conductive threshold, bone conductive threshold, air-bone gap, the healing of tympanic membrane and the auditory improvement were analyzed.Result:Eighteen patients were enrolled in this study, with course of history range from 2 months to 50 years (average: 20.20±16.31) years. There were 14 cases with wet ear before operation. All patients were conformed with perforation of membranal tensa by otoendoscopic photography before operation, with nearly total in 5 ears,large size in 10 ears,medium size in 2 ears and small size in 1 ear. Ossicular erosion were found in 13 patients (malleus involved in 6, incus involved in 12 and stapes involved in 4). Thirteen patients with tendon of tensor tympani involved and 9 patients with tympanosclerosis were conformed during operation. The epithelium entered through the malleus manubrium to the promontory in 13 cases, through the edge of the perforation in 3 cases and through the incus long process to around stapes in 1 case. Cholesteatoma invasion extend to anterosuperior area in 3 cases, posterosuperior area in 3 cases,both in anterosuperior and posterosuperior area in 12 cases. The cholesteatomas classified: stage Ⅰ in 11 cases, stage Ⅱ in 7 cases. Mastoid gasification classified MC0 in 6 cases, MC1 in 10 cases and MC2 in 2 cases. The average air conductive threshold was (56.32±10.15) dB, bone conductive threshold was (20.76±6.22) dB and air-bone gap (35.56±9.84) dB.Tympanic membrane healed in all patients during following up, without recurrent of cholesteatoma, and the post-operative air conductive threshold (43.02±14.96) dB and air-bone gap (21.04±12.90)dB were improved significantly(P<0.05).Conclusion:Most of SAC were secondary to nearly total or large perforation of membranal tensa (83.33%), with relative long history of chronic otitis media (average 20.20 ± 16.31) years and otorrhea before operation. The epithelium entered mainly through the malleus manubrium to the promontory，then through edge of the perforation，by extending anterosuperior and posterosuperior area and usually accompanied with tendon of tensor tympani involved, ossicular destruction, and poor mastoid gasification and tympanosclerosis. The characteristics of SAC were different from other type of cholesteatoma which need further researches.

目的：分析2型糖尿病并冠心病患者行护理干预对血糖血脂的影响。方法回顾性分析2012年12月～2014年12月本院收治的2型糖尿病合并冠心病患者69例的临床资料，按不同护理方案分为对照组33例和研究组36例，对照组行常规护理，研究组在其基础上行护理干预，观察两组血糖血脂及并发症。结果对照组空腹、三餐后2 h的血糖水平均显著高于研究组，对照组总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）的水平均显著高于研究组，高密度脂蛋白胆固醇（HDL-C）水平低于研究组，对照组并发症的发生率为39.4%，显著高于研究组的13.9%，差异均具统计学意义（P＜0.05）。结论2型糖尿病合并冠心病患者行护理干预对血糖血脂的影响效果显著。

目的 探讨高龄心绞痛患者护理安全的影响因素及对策.方法 随机抽取我院在2011--2012年期间收治的150例高龄心绞痛患者的临床资料进行回顾性分析,通过对高龄心绞痛患者安全的影响因素进行评估,做好高龄心绞痛患者护理安全的有效预防.结果 采取积极高龄心绞痛患者护理安全措施,既增强了护理人员及家属、患者的防范意识,又避免和减少了潜在危险因素的发生,提高了患者护理安全水平.结论 做好高龄心绞痛患者的安全护理,为患者治疗创造良好安全的就医环境,全面控制危险因素,降低危险发生率,提高高龄心绞痛患者治愈率,改善高龄心绞痛患者的生活质量.