De la Cruz A, Angeli S, Slattery W H
Clinical Studies Department, House Ear Institute, Los Angeles, CA 90057-9927, USA.
Otolaryngol Head Neck Surg. 1999 Apr;120(4):487-92. doi: 10.1053/hn.1999.v120.a89626.
Stapes surgery for correction of conductive hearing loss in adults with otosclerosis is a well-established procedure. Its effectiveness in children, however, has received less scrutiny in the literature. Previous studies from our and other institutions demonstrated similar results in children and adults. Between 1980 and 1994 stapedectomies were done on 95 ears of 81 patients younger than 18 years (83 primary and 12 revisions). Data regarding age of onset, family history, associated anomalies, surgical findings, technique, hearing results, and complications were reviewed. Two groups were identified: congenital stapedial fixation and juvenile otosclerosis. Patients with congenital stapedial fixation had an earlier onset of hearing loss (3 vs 10 years, P < 0.001), a greater incidence of abnormalities of the malleus and incus (25% vs 3%, P < 0.001), and a slightly greater preoperative air-bone gap (35.2 +/- 12.9 vs 27.8 +/- 8.9, P = 0.002). Patients with otosclerosis had a greater frequency of a positive family history of deafness (53% vs 10%, P < 0.001). Overall, 79% of primary cases and 89% of revision cases had an improvement in hearing, with mean postoperative air-bone gaps of 15 dB and 22 dB, respectively. The gap did not widen significantly during the entire length of follow-up (mean 72 months). In primary cases, 59.1% obtained a postoperative air-bone gap of 10 dB or less. Eighty-two percent of children operated on for otosclerosis obtained excellent results (postoperative air-bone gap < or = 10 dB), compared with only 44% of children with congenital stapedial ankylosis (P = 0.02). In revision surgery, 29% of children obtained excellent results. Poorer results in both cases of congenital stapedial fixation and revision stapedectomy appear to be related to the greater incidence of associated anomalies of the malleus and incus. Indications, technique, complications, and considerations pertinent to childhood stapedectomy are discussed.
镫骨手术用于矫正成人耳硬化症所致的传导性听力损失是一种成熟的手术方法。然而，其在儿童中的有效性在文献中受到的关注较少。我们机构和其他机构之前的研究表明，儿童和成人的结果相似。1980年至1994年期间，对81例18岁以下患者的95只耳朵进行了镫骨切除术（83例初次手术和12例翻修手术）。回顾了有关发病年龄、家族史、相关异常、手术发现、技术、听力结果和并发症的数据。确定了两组：先天性镫骨固定和青少年耳硬化症。先天性镫骨固定患者的听力损失发病年龄更早（3岁对10岁，P<0.001），锤骨和砧骨异常的发生率更高（25%对3%，P<0.001），术前气骨导差略大（35.2±12.9对27.8±8.9，P=0.002）。耳硬化症患者耳聋家族史阳性的频率更高（53%对10%，P<0.001）。总体而言，79%的初次手术病例和89%的翻修手术病例听力得到改善，术后平均气骨导差分别为15 dB和22 dB。在整个随访期间（平均72个月），气骨导差没有明显扩大。在初次手术病例中，59.1%的患者术后气骨导差为10 dB或更小。接受耳硬化症手术的儿童中有82%获得了优异的结果（术后气骨导差≤10 dB），相比之下，先天性镫骨强直的儿童中只有44%（P=0.02）。在翻修手术中，29%的儿童获得了优异的结果。先天性镫骨固定和翻修镫骨切除术的结果较差似乎与锤骨和砧骨相关异常的发生率较高有关。讨论了与儿童镫骨切除术相关的适应证、技术、并发症和注意事项。
