Ayache D, El Kihel M, Betsch C, Bou Malhab F, Elbaz P
Service ORL, Fondation Adolphe de Rothschild, 25-29 rue Manin, 75019 Paris.
Ann Otolaryngol Chir Cervicofac. 2000 Nov;117(5):281-90.
The aim of this study was to identify causes of primary stapedectomy failures and to evaluate hearing results in revision stapes surgery.
We retrospectively reviewed a series of 26 revision stapedectomies. Patient characteristics, preoperative findings, causes of failure and complication of primary stapedectomy and postoperative hearing results were noted.
Conductive hearing loss was the most common reason for revision surgery (77 %). Leading causes of stapedectomy failure included prosthesis malfunction (42 %), fibrous adhesions (37,5 %), incus erosion (12,5 %) and otosclerotic regrowth (12,5 %). When revision was indicated because of cochleo-vestibular complication, middle ear exploration revealed 3 problems: oval window granuloma or excessively long prosthesis or perilymphatic fistula. In this series, postoperative air-bone gap was closed to less than 10 dB in 57 % of cases, to less than 20 dB in 71 % of cases and we did not observed any sensorineural hearing loss.
The results of this series are comparable with previously published studies. Revision stapes surgery is not as successful as primary stapedectomy, but the risk of sensorineural hearing loss does not appear to be higher than in primary surgery. Revision surgery is a challenging problem that must be performed by an experienced surgeon.
本研究旨在确定初次镫骨切除术失败的原因，并评估再次镫骨手术的听力结果。
我们回顾性分析了26例再次镫骨切除术病例。记录患者特征、术前检查结果、初次镫骨切除术失败原因及并发症以及术后听力结果。
传导性听力损失是再次手术最常见的原因（77%）。镫骨切除术失败的主要原因包括假体故障（42%）、纤维粘连（37.5%）、砧骨侵蚀（12.5%）和耳硬化再生（12.5%）。当因耳蜗 - 前庭并发症而进行再次手术时，中耳探查发现3个问题：卵圆窗肉芽肿、假体过长或外淋巴瘘。在本系列中，57%的病例术后气骨导差缩小至小于10 dB，71%的病例缩小至小于20 dB，且未观察到任何感音神经性听力损失。
本系列结果与先前发表的研究结果相当。再次镫骨手术不如初次镫骨切除术成功，但感音神经性听力损失的风险似乎并不高于初次手术。再次手术是一个具有挑战性的问题，必须由经验丰富的外科医生进行操作。
