目的:评估和比较单侧先天性耳道闭锁(UCAA)患者的闭锁成形术和Bonebridge(BB)植入的听力学结果,指导临床决策。
方法:本研究包括27名诊断为UCAA的受试者。十三人植入了BB,14人接受了闭锁成形术。所有患者都接受了手术前后的检查,包括纯音测听法,声场阈值(SFT),语音接收阈值(SRT),单词识别得分(WRS),和水平声源定位测试。
结果:(1)术后,闭锁成形术组SFT平均下降11.79±5.93dBHL,BB组下降24.46±9.36dBHL,与闭锁成形术组相比,BB组的下降幅度明显更大(P<0.05)。(2)两组在正常耳罩条件下,术后平均双音节WRS显着改善。BB组的改善程度明显高于闭锁成形术组。(3)当语音信号从CAA侧出现时,噪声来自正常听力侧,与术前水平相比,两个手术组术后信噪比均显著下降,闭锁组信噪比提高2.14±2.95dB,BB组信噪比提高4.92±5.83dB(P<0.05)。(4)术前平均最小听觉角为29.71±18.42°,术后6个月降至18.1±10.07°,改善有统计学意义(P<0.05)。
结论:我们得出的结论是,在安静和嘈杂的条件下,闭锁成形术和Bonebridge植入术都可以显着改善UCAA儿童的言语感知。BoneBridge植入似乎比闭锁成形术提供更好的听力学结果。闭锁成形术可以显著提高声音定位的准确性。在Bonebridge植入后的短时间内未观察到声音定位精度的显着改善。应以更大的样本量和更长的随访时间进行进一步的研究。
OBJECTIVE: To evaluate and compare audiological outcomes of atresiaplasty and Bonebridge (BB) implantation in patients with unilateral congenital aural atresia (UCAA), to guide clinical decision-making.
METHODS: Twenty-seven subjects diagnosed with UCAA were included in the
study. Thirteen were implanted with the BB, while 14 undergone atresiaplasty. All patients underwent pre-and post-surgery examinations, including pure-tone audiometry, sound field threshold (SFT), speech reception threshold (SRT), word recognition score (WRS), and horizontal sound source localization tests.
RESULTS: (1) Postoperatively, the average SFT decreased by 11.79 ± 5.93 dB HL in the atresiaplasty group and by 24.46 ± 9.36 dB HL in the BB group, with a significantly greater decrease in the BB group compared to the atresiaplasty group (P < 0.05). (2) Both groups demonstrated a significant improvement in average disyllabic WRS postoperatively under normal ear-masking conditions, with the BB group showing a significantly higher improvement than the atresiaplasty group. (3) When the speech signal was presented from the CAA side with noise from the normal hearing side, both surgical groups exhibited a significant decrease in postoperative signal-to-noise ratio compared to preoperative levels, with improvements of 2.14 ± 2.95 dB SNR in the atresiaplasty group and 4.92 ± 5.83 dB SNR in the BB group (P < 0.05). (4) The average minimum audible angle preoperative in the atresiaplasty group was 29.71 ± 18.42°, which decreased to 18.1 ± 10.07° at 6 months postoperatively, showing a statistically significant improvement (P < 0.05).
CONCLUSIONS: We concluded that both atresiaplasty and Bonebridge implantation can significantly improve speech perception under both quiet and noisy conditions in children with UCAA. BoneBridge implantation appears to provide better audiological outcomes than atresiaplasty. Atresiaplasty can significantly improve the accuracy of sound localization. No significant improvement in sound localization accuracy was observed in the short period after Bonebridge implantation. Further research should be conducted with a larger sample size and longer follow-up time.