A New Tool for Testing Ossicular Mobility During Middle Ear Surgery: Preliminary Report of Four Cases
A New Tool for Testing Ossicular Mobility During Middle Ear Surgery: Preliminary Report of Four Cases
复制标题
中耳手术中测试听骨活动性的新工具：四例初步报告
作者：
N. Hato;H. Kohno;Masahiro Okada;N. Hakuba;K. Gyo;T. Iwakura;M. Tateno
目的：研制一种听骨振动测试仪，对影响鼓室成形术术后听力的最关键因素之一听骨活动性进行客观定量的评估。方法：我们的装置由三个部分组成：一个带有弯曲尖端的探头轴连接到目标小骨上，一个振动激励器来激活探头，一个压电传感器来检测探头的振动。这些部件被封装在一个不锈钢支架中，在耳部手术中可以很容易地用手操作。探测器被大约1600赫兹的电信号激活。该系统由笔记本电脑控制，结果以听骨电阻（ROR）与参考值的百分比之比表示。一次测量需要10毫秒。该装置被应用于4例耳部手术患者。结果：两例人工耳蜗植入者的几项测量显示镫骨的RORs差异较大（病例1为15-20%，病例2为35-45%），而锤骨和镫骨的RORs在同一范围内。这被认为与病例2的部分耳蜗钙化相对应。病例3因耳硬化接受手术，镫骨的ROR很高，在70 - 80%之间。当测量踝-砧骨固定异常（病例4）时，踝和砧骨的ROR在60 - 70%之间。由于手术视野有限，无法测量镫骨的ROR。没有注意到与此设备测量相关的问题。结论：本文报道了我们用于测试听骨活动性的新工具的设计、原理、测量过程和初步结果。在手术中测量听骨活动度可以为决定手术方法提供重要信息。
Objective: We developed an ossicular vibration tester for the objective and quantitative assessment of ossicular mobility, which is one of the most critical factors affecting postoperative hearing after tympanoplasty. Methods: Our device consists of three components: a probe shaft with a curved tip to be attached to the target ossicle, a vibration exciter to activate the probe, and a piezoelectric sensor to detect vibrations of the probe. These components are encased in a stainless steel holder, allowing easy hand manipulation during ear surgery. The probe is activated with an electric signal at around 1,600 Hz. The system is controlled with a laptop computer, and the results are presented as the ratio of the ossicular resistance (ROR) to a reference value as a percentage. One measurement takes 10 ms. The device was applied in four selected patients during ear surgery. Results: Several measurements in two of the cochlear implantees showed a greater difference in the RORs of the stapes (15-20% in Case 1 and 35-45% in Case 2), whereas the RORs of the malleus and incus were within the same range. This was thought to correspond to the partial cochlear calcification noted in Case 2. In Case 3, who underwent surgery because of otosclerosis, the ROR of the stapes was high, ranging from 70 to 80%. When measured for the malleus-incus fixation anomaly (Case 4), the ROR of the malleus and incus was in the range of 60 to 70%. Owing to the limited surgical view, the ROR of the stapes could not be measured. No problems related to the measurements with this device were noted. Conclusion: The design, principles, measuring procedures, and preliminary results of our new tool for testing ossicular mobility are reported. Measuring the ossicular mobility during surgery may provide important information for deciding the surgical procedures.