中文摘要：

目的 分析总结鼓膜完整的单耳传导性聋的临床表现、听力学特点、影像学特点以及听力重建后的疗效.方法 回顾性分析解放军总医院耳鼻咽喉头颈外科2011年4月至2013年9月手术治疗的82例鼓膜完整的单耳传导性聋患者的临床资料,其中男41例,女41例;年龄7～ 66岁,平均（26.5±13.7）岁,病史1个月至50年.总结分析其病史、临床表现、听力学评估、颞骨CT、术中探查及手术听力重建结果.结果 经手术探查发现,82例患者中,先天性中耳畸形43例（52.4％）、耳硬化症22例（26.8％）、先天性中耳胆脂瘤8例（9.8％）、先天性中耳胆脂瘤合并听骨链畸形3例（3.7％）、外伤致传导性聋6例（7.3％）.耳硬化症和先天性胆脂瘤患者常表现为渐进性听力下降,先天性中耳畸形者多自幼听力下降.高分辨率颞骨CT对先天性中耳畸形、外伤致传导性聋、先天性中耳胆脂瘤的诊断率分别为40.0％、50.0％及83.3％.3例前庭窗闭锁患者语言频率平均气导听阈升高至（66.9±1.1） dBHL,2000 Hz骨导阈值升高至（28.3±10.4） dBHL.32例镫骨固定患者与47例听骨链中断患者2000 Hz骨导阈值分别升高至（27.2±9.7）dBHL和（17.8±8.8） dBHL,差异具有统计学意义（P=0.000）.耳内切口显微镜下鼓室探查,根据术中所见病变情况采用相应的听骨链重建技术.术后随访2年以上、资料完整的52例患者,语言频率平均气导听阈由术前的（60.0±11.4） dBHL恢复至术后（32.2±12.1）dBHL（P =0.000）,平均气骨导差由（43.2±12.0） dB缩减为（16.3±9.4）dB（P =0.000）.结论 鼓膜完整的单耳传导性聋患者,以先天性中耳畸形、耳硬化症、先天性中耳胆脂瘤最常见,术前可根据病史、影像学检查及听力学特点进行初步鉴别,通过鼓室探查及听力重建手术,可明确诊断并获得满意的听力恢复效果.

英文摘要：

Objective To analyze the clinical characteristics of unilateral conductive hearing loss with intact tympanic membrane,and summarize the key diagnostic points,differential diagnosis and observe the effects of surgical treatment.Methods We reviewed data from 82 patients with unilateral conductive hearing loss with intact tympanic membranes who accepted the exploratory tympanotomy from April 2011 to September 2013.There were 41 males and 41 females,aged from 7 to 66（averaged 26.5 ± 13.7）years,with a history of one month to 50 years.The history,clinical symptoms,audiological evaluation,high resolution temporal bone CT,the results of surgical exploration and hearing reconstruction were analyzed.Results The exploratory tympanotomy revealed 43 cases of congenital middle ear malformations （52.4%）,22 cases of otosclerosis （26.8%）,eight cases of congenital cholesteatoma （9.8%）,six cases of trauma induced conductive hearing loss （7.3%）,three cases of congenital ossicular malformations with congenital cholesteatoma （3.7%）.Progressive hearing loss was common in patients with otosclerosis and congenital cholesteatoma,and patients with congenital middle ear malformations described their hearing loss since childhood.High resolution temporal bone CT of congenital middle ear malformation,trauma induced conductive hearing loss,congenital cholesteatoma diagnosis rate was 40.0%,50.0%,and 83.3%respectively.The preoperative air-conductive threshold of patients with absence of the oval window were increased to （66.9 ± 1.1） dBHL,the preoperative bone-conductive threshold achieved （28.3 ± 10.4） dBHL at 2 000 Hz.While patients with stapes fixation and that with ossicular chain discontinuity were （27.2 ±9.7） dBHL and （17.8 ± 8.8） dBHL （P =0.000） respectively.Through the tympanic exploration with endaural incision under the microscope,different hearing reconstruction were applied according to different lesions.After the operation,the hearing level of 52 patients with return visit were improved