title: [Analyses of the clinical characteristics of unilateral conductive hearing loss with intact tympanic membrane].
abstract: OBJECTIVE
  To analyze the clinical characteristics of unilateral conductive hearing loss with intact tympanic membrane, and summarize the key diagnostic points, differential diagnosis and observe the effects of surgical treatment.
  
  
  METHODS
  We reviewed data from 82 patients with unilateral conductive hearing loss with intact tympanic membranes who accepted the exploratory tympanotomy from April 2011 to September 2013. There were 41 males and 41 females, aged from 7 to 66( averaged 26.5±13.7)years, with a history of one month to 50 years. The history, clinical symptoms, audiological evaluation, high resolution temporal bone CT, the results of surgical exploration and hearing reconstruction were analyzed.
  
  
  RESULTS
  The exploratory tympanotomy revealed 43 cases of congenital middle ear malformations (52.4%), 22 cases of otosclerosis (26.8%), eight cases of congenital cholesteatoma (9.8%), six cases of trauma induced conductive hearing loss (7.3%), three cases of congenital ossicular malformations with congenital cholesteatoma (3.7%). Progressive hearing loss was common in patients with otosclerosis and congenital cholesteatoma, and patients with congenital middle ear malformations described their hearing loss since childhood. High resolution temporal bone CT of congenital middle ear malformation, trauma induced conductive hearing loss, congenital cholesteatoma diagnosis rate was 40.0%, 50.0%, and 83.3% respectively. The preoperative air-conductive threshold of patients with absence of the oval window were increased to (66.9±1.1)dBHL, the preoperative bone-conductive threshold achieved (28.3±10.4)dBHL at 2 000 Hz. While patients with stapes fixation and that with ossicular chain discontinuity were (27.2±9.7)dBHL and (17.8±8.8)dBHL(P=0.000)respectively. Through the tympanic exploration with endaural incision under the microscope, different hearing reconstruction were applied according to different lesions. After the operation, the hearing level of 52 patients with return visit were improved, the mean air-conductive threshold were decreased from (60.0±11.4)dBHL to (32.2±12.1)dBHL(P=0.000); and the mean ABG were decreased from (43.2±12.0)dB to (16.3±9.4)dB(P=0.000).
  
  
  CONCLUSIONS
  Congenital middle ear malformations, otosclerosis, congenital cholesteatoma are the most common causes in unilateral conductive hearing loss with an intact tympanic membrane. The diagnosis rate can be improved by analyzing the clinical features. Through exploratory tympanotomy and hearing reconstruction, we can clarify the diagnosis and achieve a satisfying hearing recover.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Chaoying
authors.initials: C
authors.lastname: Tang
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Jishuai
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Weiju
authors.initials: W
authors.lastname: Han
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Weidong
authors.initials: W
authors.lastname: Shen
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: Hou
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Pu
authors.initials: P
authors.lastname: Dai
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Shiming
authors.initials: S
authors.lastname: Yang
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Dongyi
authors.initials: D
authors.lastname: Han
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001299:Audiometry; D002648:Child; D002781:Cholesteatoma / Q000151:congenital / Q000473:pathology; D003937:Diagnosis, Differential; D004429:Ear Ossicles / Q000473:pathology; D004432:Ear, Middle / Q000002:abnormalities; D005260:Female; D006314:Hearing Loss, Conductive / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008876:Middle Ear Ventilation; D010040:Otosclerosis / Q000473:pathology; D014432:Tympanic Membrane; D055815:Young Adult