The Research On The Damage Of Auditory Ossicles In Chronic Suppurative Otitis Media And The Evaluation Of The Destruction Of The Ossicles By HRCT

The first part:Research on the damage of ossicules in chronic suppurative otitis media (CSOM)Objective:To abserve the parts and extent of the damage of ossicles in200cases of CSOM during operation and explore the differences in different types of CSOM, provide theoretical basis for clinical work.Methods:200cases of CSOM, who were treated in The First Affiliated Hospital of Zhengzhou University during2009.10-2012.06, were slected and divided into cholesteatoma type and granuloma type. In100cases of CSOM of granuloma type(100ear), male40cases, female60cases; Age10-66years old, the average age39.9years old, duration from3months to60years old, left ear53cases, right ear47; In100cases of cholesteatoma type (100ear), male69cases, female31cases age5-75years old, the average age33.7years old, duration from1month to65years old, left ear53, right ear47. According to the history, symptom, signs, audiology examination and temporal bone CT of high resolution(high resolution computed tomography, HRCT), After discussion of at least three senior doctor,200affected ears were in accordance with the operation indications, and underwent open radical mastoidectomy and one-stage tympanoplasty, during operation we observed the damage of ossicles parts with a high-powered microscope.According to literature and observation during the operation, the ossicle chain was divided into ten parts:head of malleus, handle of malleus, body of incus, long limb of incus, short limb of incus, lenticular process, head of stapes, anterior crus of stapes, posterior crus of stapes and footplate of stapes. According to each part and the extent of the damage we statisticsed the number of the damage of ossicles in200cases, calculated every part damage rate, two groups of independent samples using SAS9.1software of χ2test or Fisher’s exact probability test and group classification of χ2test analysis, independent sample with p<0.05as the difference was statistically significant,p<0.01for significantly statistical differences,p>0.05for no significantly statistical differences.Result:1. The comparison of the damage parts of ossicles between the two types of CSOMIn cases of CSOM of cholesteatoma type, the sites which had a higher rate of damage, were long limb of incus (63%) and body of incus(57%), followed by head of malleus (47%), short limb of incus (42%), handle of malleus (13%), anterior crus of stapes (12%), lenticular process (12%), and posterior crus of stapes (13%) had a lower rate of damage, but footplate of stapes had no obvious damage; In cases of CSOM of granuloma type, the sites which had a highest rate of damage were long limb of incus (79%),body of incus (79%),short limb of incus (72%) followed by head of malleus (66%),lenticular process (32%), and head of stapes (31%) had a higher rate of damage, and footplate of stapes (6%) lowest.Compared between the two types, the disappearance rates of head of malleus, body of incus and lenticular process were obvious statistically significant (p<0.01); the disappearance rates of long limb of incus, anterior crus of stapes, posterior crus of stapes and footplate of stapes were statistically significant (p<0.05); the disappearance rates of handle of malleus and head of stapes were no statistically significant (p>0.05).2. The comparison of the extent of the damage of ossicles between the two types of otitis media auditory ossicles Compared between the two types, the extent of damage of head of malleus, body of incus, short limb of incus had significant statistical difference (p<0.05); the extent of damage of long limb of incus and handle of malleus had not statistical difference (p<0.05); The rest parts which didn’t performed statistical analysis, were all damage disappearence and had not significant morphological differences.In cholesteatoma type, the disappearance rate of head of malleus, body of incus, hort limb of incus was higher; Comparing the disappearance rate of handle of malleus and long limb of incus, there was no statistically significant difference between the two (p>0.05); footplate of stapes in cholesteatoma type had significant difference (p<0.01); But the disappearance rate of lenticular process, head of stapes, anterior crus of stapes and posterior crus of stapes had not significant difference between the two (p>0.05).Conclusion:1. In different types of CSOM, the parts and extent of damage of ossicles are different. In granuloma type, the most common parts are body of incus and long limb of incus. In cholesteatoma type, the most common parts are body of incus, long limb of incus and short limb of incus.2. Compared with the granuloma type, the extent of damage of ossicles in cholesteatoma type is more serious.The second part:Diagnosis value of damage of ossicles in chronic suppurative otitis media (CSOM) using HRCTObjective:To discuss the chronic suppurative otitis media (CSOM) patients’scan the temporal bone of HRCT before operation and explore the diagnosis value of damage of ossicles in CSOM using HRCT.Methods:200cases of patients (the first part) with chronic suppurative otitis media who underwent the temporal bone of HRCT were collected. The ossicular chain was divided into seven parts:head of malleus, handle of malleus, body of incus, long limb of incus, short limb of incus, lenticular process and stapes. Routine preoperative temporal bone HRCT axial check choose coronal reconstruction, to the destruction of parts of the diagnosis of ossicular chain and the extent of the damage. We observed the condition of ossicles during operation and evaluate the diagnostic value of HRCT. Classification data with independent sample groups classification rank sum test or2test for paired samples, the difference was statistically significant at p<0.05, p<0.01as statistically significant difference,p>0.05for no significantly statistical differences. To calculated the sensitivity, specificity, coincidence rate and Youden value.Results:The comparison of the HRCT results and observed results during operation:In cases of CSOM of granuloma type, the extent of damage of seven parts of ossicles was no statistically significant difference(p>0.05); In cases of CSOM of cholesteatoma type, the extent of damage of head of malleus, handle of malleus, body of incus, long limb of incus was no statistically significant difference(p>0.05); the extent of damage of short legs incus lenticular process and the extent of damage of short limb of incus, lenticular process, and the structure of the stapes was statistically significant(p<0.05).Compared with the two in cases of CSOM of granuloma type, the rate of damage of stapes had difference (p<0.05), the rate of damage of long limb of incus had obviously significant difference(p<0.01);In cases of CSOM of cholesteatoma type, the rate of damage of head of malleus, long limb of incus, short limb of incus, lenticular process and stapes had significant difference(p<0.01), body of incus had difference(p<0.05), the handle of malleus had not significant difference (p>0.05).HRCT for the cases of CSOM of granuloma type, handle of malleus had the highest sensitivity(100%), followed by hammer bones(92.50%), lenticular process lowest(30.00%); head of malleus, handle of malleus had the highest specificity (100%), followed by lenticular process(92.05%) and long feet of incus (91.89%), short limb of incus lowest(72.41%); handle of malleus had the highest coincidence rate (100%), handle of malleus had the highest Youden value (1.000), the lenticular process had the lowest Youden value(0.221). HRCT for the cases of CSOM of cholesteatoma type, the ohandle of malleus had the highest sensitivity(100%), followed by the head of the malleus(89.02%), the lenticular process lowest(34.38%); handle of malleus had the highest specificity (100%), the stapes lowest(62.32%); handle of malleus had the highest coincidence rate(100%), the short limb of incus lowest(71%); handle of malleus had the highest Youden value(1.000), lenticular process lowest(0.270).Conclusion:HRCT has different sensitivity and specificity for different parts of the ossicular chain in cases of the two. Compared with CSOM of cholesteatoma type, HRCT has higher diagnosis value for the extent and parts of ossicular chain in CSOM of granuloma type.