腭裂修复术对婴幼儿听力和中耳功能的短期影响

摘要

Objective To study the short-term impact of cleft palate repair surgery on hearing and middle ear function in infants .Methods Thirty-three infants with cleft palate who received cleft palate repair surgery from January 2013 to November 2014 in Peking Union Medical College Hospital were included in this study , in-cluding 22 male infants and 11 female infants .They were examined using distortion product otoacoustic emission (DPOAE), auditory brainstem response (ABR), 226 Hz probe-tone tympanometry before surgery and 1 -24 months after surgery .Results The mean age of the 33 infants (66 ears) at the time of surgery was 17 months (8.5-25 months).Sixty-four ears were examined with preoperative DPOAE , with 7 ears (10.9%) passed;postoperative DPOAE was performed in 56 ears, with 19 ears (33.9%) passed.The passing rate was significant-ly improved after operation ( P<0.01 ) .In the 54 ears for which both preoperative and postoperative DPOAE were conducted , 16 ears ( 29.6%) showed improved hearing .Sixty-three ears were examined with preoperative ABR, showing a mean hearing threshold of (43.73 ±13.65 ) dB nHL;62 ears were examined with postoperative ABR, showing a mean hearing threshold of (35.65 ±13.75 ) dB nHL, significantly improved compared with the preoperative threshold ( P<0.01 ) .In the 53 ears which received both preoperative and postoperative ABR , 29 ears (54.7%) showed reduced hearing thresholds .There was no significant difference in 226 Hz probe-tone tympanometry between preoperative and postoperative examinations ( P>0.05 ) .Conclusion In infants with cleft palate , short-term hearing improvement may be observed after repair surgery , while middle ear function may show no obvious improvement .%目的：探讨单纯腭裂修复术对腭裂婴幼儿听力和中耳功能的短期影响。方法2013年1月至2014年11月在北京协和医院行手术治疗的先天性腭裂婴幼儿33例，其中男22例，女11例，在腭裂修复术前、术后1～24个月对患儿进行畸变产物耳声发射（distortion product otoacoustic emission， DPOAE）、听性脑干反应（auditory brainstem response， ABR）和226Hz鼓室声导抗图检测，观察腭裂修复术后患儿听力和中耳功能的短期变化。结果33例（66耳）腭裂婴幼儿手术时平均年龄为17个月（8．5～25个月）。64耳接受术前DPOAE测试，7耳（10．9％）通过；56耳接受术后DPOAE测试，19耳（33．9％）通过，手术前后通过率比较差异具有统计学意义（ P＜0．01）；术前术后均接受DPOAE 测试的54耳中，16耳（29．6％）听力改善。63耳接受术前ABR检查，其中Ⅴ波反应阈平均值为（43．73±13．65） dB nHL；62耳接受术后ABR检查，其中Ⅴ波反应阈平均值为（35．65±13．75） dB nHL，手术前后反应阈值比较差异具有统计学意义（ P＜0．01）；术前术后均接受ABR检测的53耳中，29耳（54．7％）术后V波反应阈降低，听力改善。手术前后226 Hz鼓室声导抗图分型比较差异无统计学意义（ P＞0．05）。结论单纯腭裂修复术术后患儿短期听力得到改善，但中耳功能改善不明显。