高分辨率CT在耳硬化症诊断中的应用价值

High Resolution Computed Tomography in the Diagnosis of Otosclerosis

谢立;刘爱国;Tejvansh Shenoy Imrit;周良强;刘磊;

1:华中科技大学同济医学院附属同济医院耳鼻咽喉头颈外科

2:武汉科技大学附属天佑医院耳鼻咽喉头颈外科

摘要
目的评估高分辨率CT(HRCT)检查在耳硬化症诊断中的价值。方法回顾性分析经手术确诊且资料完整的21例(31耳)耳硬化症患者的临床资料,年龄21~62岁,平均38.2±11.4岁。所有患者术前接受0.625 mm薄层HRCT检查,依据HRCT检查结果分为三组(因拟单侧手术,故以单侧21耳分组):HRCT阴性组(4耳)、窗前型组(11耳)和混合型组(6耳),与术中确诊比较HRCT诊断耳硬化症的检出率,比较各组术前和术后3个月的纯音气导(air conduction,AC)、骨导(bone conduction,BC)阈值和气骨导差(air bone gap,ABG)值。结果手术确诊为耳硬化症的21例患者中有17例患者术前HRCT检查发现耳硬化病变,检出率80.95%(17/21),其中10例(10/17,58.82%)为双侧耳硬化症。CT阴性组、窗前型组和混合型组术前平均AC阈值分别为52.8±13.9、57.7±10.0和62.7±16.7 dB HL,差异无统计学意义(P>0.05);三组术后3个月平均AC阈值分别为26.6±11.6、40.3±27.0和58.8±8.8 dB HL,差异有统计学意义(P<0.05);三组术前平均BC阈值分别为25.6±10.1、30.5±6.5和37.1±14.4 dB HL,术后分别为25.3±10.7、29.9±17.6和45.0±13.0 dB HL,均无统计学差异(P>0.05)。术前三组间ABG差异无统计学意义(P>0.05),术后HRCT阴性组ABG明显小于混合型组(P<0.05),与CT阴性组和窗前型组相比,混合型组患者术前和术后气、骨导阈值均较高;CT阴性组(P=0.014)和窗前型组(P=0.044)术后的AC听力较混合型组明显提高。术后混合型组和窗前型组中各有1耳发生感音神经性听力损失。结论 HRCT对于耳硬化症的诊断有较高的阳性率,尤其是窗前型;HCRT诊断为混合型耳硬化症者听力下降严重,术后听力改善不如CT阴性及窗前型者。
关键词
耳硬化症;高分辨率CT;气导;骨导;气骨导差
基金项目(Foundation):
作者
谢立;刘爱国;Tejvansh Shenoy Imrit;周良强;刘磊;
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