目的:分析该病的病因,诊断,以及用完整的鼓膜治疗无法解释的传导性听力损失(UCHL)。方法:根据系统评价和荟萃分析(PRISMA)指南的首选报告项目进行系统评价。从PubMed、Embase,WebofScience,还有Cochrane.根据纳入和排除标准筛选出54篇研究文章和21例病例报告,分析UCHL的病因。选择7篇进行鼓室探查的UCHL研究文章进行数据提取和临床特征分析。结果:UCHL是多种疾病的常见表现,包括先天性听骨异常(COA),耳硬化症(OTS),先天性中耳胆脂瘤(CMEC),椭圆形窗户闭锁,上半规管裂开,先天性髌骨足板固定术,中耳骨瘤或腺瘤,先天性骨肌腱骨化,等等。共有522例患者被纳入7篇文章;其中OTS表现出随着年龄增长而增加的趋势。主要症状是听力损失,接着是耳鸣,头晕,耳朵丰满,耳朵疼痛,面瘫.共有87.5%至93.0%的COA患者表现为非进行性耳聋,自幼发生,耳鸣发生率为15.6%至30.2%,86.4%至96.4%的OTS患者出现进行性听力损失,耳鸣发生率为60.1%~90.9%。高分辨率CT(HRCT)诊断阳性率为33.8%~87.1%,CMEC高于COA(83.3%-100%vs28.6%-64%)。所有文章都报告了良好的听力恢复。最常见的手术并发症包括味觉异常,耳鸣,和头晕。结论:UCHL具有相似的临床表现,在术前诊断中存在挑战。鼓室探查术是诊断和治疗的主要方法,手术切除病灶并重建听力后预后良好。儿童也可以安全地接受手术。
Objective: To analyze the etiology, diagnosis, and treatment of unexplained conductive hearing loss (UCHL) with intact tympanic membrane. Methods: A systematic
review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 642 articles were retrieved from databases such as PubMed, Embase, Web of Science, and Cochrane. Fifty-four research articles and 21 case reports were screened out according to the inclusion and exclusion criteria for analysis of the etiology of UCHL. Seven research articles with UCHL who underwent exploratory tympanotomy were selected for data extraction and analysis of clinical characteristics. Results: UCHL is a common manifestation of various diseases, including congenital ossicular anomalies (COA),
otosclerosis (OTS), congenital middle ear cholesteatoma (CMEC), oval window atresia, superior semicircular-canal dehiscence, congenital stapedial footplate fixation, middle ear osteoma or adenoma, congenital ossification of stapedial tendon, and so on. A total of 522 patients were included in the 7 articles; among whom OTS showed a tendency to increase with age. The main symptoms were hearing loss, followed by tinnitus, dizziness, ear fullness, ear pain, facial paralysis. A total of 87.5% to 93.0% patients with COA manifested as nonprogressive deafness that occurred since childhood, with tinnitus incidence of 15.6% to 30.2%, and 86.4% to 96.4% patients with OTS presented with progressive hearing loss, with tinnitus incidence of 60.1% to 90.9%. The diagnosis positive rate of high-resolution computed tomography (HRCT) was 33.8% to 87.1%, and CMEC was higher than that of COA (83.3%-100% vs 28.6%-64%). All the articles reported good hearing recovery. The most common surgical complications included taste abnormalities, tinnitus, and dizziness. Conclusion: UCHL presents with similar clinical manifestations and poses challenges in preoperative diagnosis. Exploratory tympanotomy is the primary method for diagnosis and treatment, with good prognosis after removing the lesion and reconstructing hearing during the operation. Children can also safely undergo the surgery.