Relationship Between Facial Nerve Damage And Ossicular Chain And Hearing Loss In Chronic Inflammatory Disease Of Middle Ear

Objective:To compare the injury of facial nerve canal between chronic suppurative otitis media(CSOM)and cholesteatoma of the middle ear(Chol),and to explore the relationship between the injury of facial nerve canal and auditory chain and hearing loss,so as to provide certain reference for the evaluation of complications of middle ear surgery and postoperative efficacy of otitis media patients.Methods:A total of 237 patients with chronic suppurative otitis media and cholesteatoma of the middle ear who were admitted to the otolaryngology head and neck surgery department of our hospital from June 2016 to December 2019 for middle ear surgery were retrospectively analyzed,including 148 cases of chronic suppurative otitis media(CSOM)and 89 cases of cholesteatoma of the middle ear(Chol).According to the preoperative examination and the intraoperative records of patients with facial nerve canal damage(the tympanum paragraph,taper and mastoid segment),listening(gas,bone conduction and bones guidance),according to the damage degree of the patient’s ear ossicular chain can be divided into 1-5,to study the incidence and location of facial canal damage in patients with CSOM and Chol,the relationship between facial canal damage and ossicular chain injury,and the relationship between facial canal damage and hearing loss.Results:(1)There were 107 cases(45.1%)of facial canal damage in 237 patients,including 50 cases(33.8%)of CSOM and 57 cases(64.0%)of Chol.The incidence of facial canal damage in patients with CSOM and Chol is statistically significant(χ2=20.552,P<0.001).(2)The most common site of facial nerve canal damage is the tympanum segment(70.5%),and the damage of CSOM in the tympanum segment of facial nerve canal is more common(84.0%)than in the Chol(57.9%)(P<0.05),and the mixed damage of two or more sites(6.0%)is less common than that in Chol patients(24.6%)(P<0.05).(3)In the patients with CSOM,the degree of facial nerve canal damage and ossicular chain injury is statistically significant(Z=-2.366,P=0.018).In patients with Chol,there is no statistically significant difference between the degree of damage of facial nerve canal and ossicular chain(P>0.05).(4)When the facial nerve canal is complete,the degree of ossicular chain damage in patients with CSOM and Chol is statistically significant(Z=-6.669,P<0.001).(5)When accompanied by facial nerve canal damage,the degree of ossicular chain injury in patients with CSOM and Chol is statistically significant(Z=-5.524,P<0.001).(6)In the patients with CSOM,the comparison between the air conduction auditory threshold(Z=-2.583,P=0.004)and bone conduction auditory threshold(Z=-2.497,P=0.013)in the patients with accompanied facial nerve canal damage and those with intact facial nerve canal is statistically significant,while the difference between the air conduction auditory threshold and bone conduction auditory threshold in the patients with and without facial nerve canal damage is not statistically significant(P>0.05).In patients with Chol,there is no significant difference between the hearing value and the facial nerve canal damage(P>0.05).When the facial nerve canal is complete,the comparison of the air conduction hearing threshold(Z=-3.771,P<0.001),bone conduction hearing threshold(Z=-2.850,P=0.004)and the difference value of the air and bone conduction hearing threshold(Z=-2.663,P=0.008)between the patients with CSOM and the patients with Chol is statistically significant.When accompanied by facial nerve canal damage,there is no statistical significance in the comparison between air conduction auditory threshold,bone conduction auditory threshold and difference value of air conduction auditory threshold between CSOM and Chol(P>0.05).Conclusions:(1)The incidence of facial nerve canal damage in CSOM patients is lower than that in Chol patients,and the degree of damage is less severe.(2)In CSOM patients,the degree of ossicular chain injury with facial nerve canal damage is more serious than that with facial nerve canal integrity.In Chol patients,there is no significant correlation between facial nerve canal damage and ossicular chain injury.