Objective: To analyze the surgical efficacy of patients with mixed hearing loss and otosclerosis with different air bone gap (ABG) before surgery, and to provide reference for the prognosis evaluation of otosclerosis surgery. Methods: The clinical data of 108 cases(116 ears) of otosclerosis who had undergone stapes fenestration technique artificial stapes implantation in Xiangya Hospital of Central South University from November 2013 to May 2020 and had mixed hearing loss before surgery were collected, including 71 women(76 ears)and 37 men (40 ears), with an average age of 38.5 years. According to preoperative pure tone audiometry ABG, they were divided into three groups: group S, 15 dB≤ABG<31 dB, a total of 39 ears; group M, 31 dB≤ABG<46 dB, a total of 58 ears; and group L, ABG≥46 dB, 19 ears in total. The hearing outcomes of three groups of patients at 6-12 months after surgery were compared and analyzed using SPSS 24.0 statistical software. Results: A total of 3 patients (group S: 2 cases; group L: 1 case) experienced severe sensorineural hearing loss after surgery and were not included in the statistical analysis. After surgery, the pure tone hearing threshold of patients with otosclerosis in each group was significantly improved compared to before surgery, with an average air conduction threshold improvement of(21.6±13.4) dB. The difference between before and after surgery was statistically significant(t=17.13, P<0.01). The average bone conduction threshold improved by(3.7±7.6) dB, and the difference was statistically significant before and after surgery(t=5.20, P<0.01). The postoperative ABG was(18.3±9.3) dB, which was significantly reduced compared to preoperative(36.2±8.6)dB. Among the three groups of patients, the L group had the highest improvement in air conduction threshold[(29.9±10.8)dB], while the S group had the lowest improvement[(15.7±11.4)dB]. There was no statistically significant difference in post operative pure tone hearing thresholds between the three groups(P>0.05). The postoperative ABG in group S was the smallest[(16.5±9.0)dB], while in group L, the postoperative ABG was the largest[(20.5±10.0)dB]. Compared with group S, group M and group L still had a large residual ABG at 2 000 Hz after surgery. The bone conduction threshold of both S and M groups improved to some extent after surgery compared to before (P<0.01). Conclusions: Surgery can benefit patients with mixed hearing loss and otosclerosis with different preoperative ABG. Patients with small preoperative ABG have better surgical results and ideal ABG closure at all frequencies after surgery. Patients with large preoperative ABG can significantly increase the gas conduction threshold during surgery, but certain frequencies of ABG may still be left behind after surgery. The improvement effect of surgery on bone conduction threshold is not significant. Patients should be informed of treatment methods such as hearing aids based on their actual situation for selection.
目的： 分析术前不同气骨导差（air-bone gap，ABG）混合性听力损失耳硬化症患者的手术疗效，为耳硬化症手术的预后评估提供参考。 方法： 收集2013年11月至2020年5月在中南大学湘雅医院接受镫骨小窗技术人工镫骨植入手术、术前表现为混合性听力损失的耳硬化症患者的临床资料，共108例（116耳），其中女性71例（76耳），男性37例（40耳），平均年龄38.5岁。根据术前纯音测听ABG将其分为三组：S组，15 dB≤ABG<31 dB，共39耳；M组，31 dB≤ABG<46 dB，共58耳；L组，ABG≥46 dB，共19耳。采用SPSS 24.0统计软件比较分析三组患者术后6~12个月时的听力结果。 结果： 术后有3耳（S组2耳，L组1耳）出现严重的感音神经性听力损失，未纳入统计分析。各组耳硬化症患者术后纯音听阈较术前均有明显改善，平均气导阈值改善（21.6±13.4）dB，术前、术后比较，差异具有统计学意义（t=17.13，P<0.01）；平均骨导阈值改善（3.7±7.6）dB，术前、术后比较，差异具有统计学意义（t=5.20，P<0.01）；术后ABG为（18.3±9.3）dB，较术前（36.2±8.6）dB明显缩小。三组患者中L组气导阈值改善量最大［（29.9±10.8）dB］，S组的改善量最小［（15.7±11.4）dB］。术后气导和骨导纯音听阈三组间比较，差异均无统计学意义（P值均>0.05）。S组术后ABG最小［（16.5±9.0）dB］，L组术后ABG最大［（20.5±10.0）dB］。与S组相比，M组和L组术后在2 000 Hz处仍遗留较大的ABG。S组和M组术后骨导阈值较术前均有一定改善（P值均<0.01）。 结论： 手术能使不同术前ABG的混合性听力损失耳硬化症患者获益：术前ABG小的患者手术效果较好，术后各频率ABG闭合理想；术前ABG大的患者手术能明显提升气导阈值，但某些频率术后仍可能遗留一定的ABG。手术对骨导阈值的改善效果不明显。应结合患者实际情况，告知其助听器等治疗方法以供患者选择。.