Fisch U, Acar G O, Huber A M
Ear, Nose and Throat Center, Hirslanden Clinic, Witellikerstrasse 40, CH-8029 Zurich, Switzerland.
Otol Neurotol. 2001 Nov;22(6):776-85. doi: 10.1097/00129492-200111000-00011.
The purpose of this study was to analyze the results of malleostapedotomy and to compare them with those of a conventional incus stapedotomy in a series of 82 consecutive surgical revisions in otosclerotic patients.
82 consecutive revision stapes surgery cases over 5 years were evaluated. The preoperative and postoperative audiometric data of 80 (97.5%) of the patients were obtained.
71 of the patients underwent a functional revision procedure as malleostapedotomy (56, 79%) or as incus stapedotomy (15, 21%). The most common cause of failure of primary surgery was a displaced or malfunctioning prosthesis (86.2%). Pathologic changes of the oval window were found in 80% of the cases. Problems of the incus were identified in 80% and abnormality of the malleus in 48.6% of the cases. The functional success rate of malleostapedotomy (closure within 10 dB) was found to be higher than that of traditional incus stapedotomy (p < 0.05). Overclosure was seen in 12 patients (17%) and a significant sensorineural hearing loss in 2 patients (3%). There were no dead ears in this series. The postoperative hearing results after first revision surgery were better than those after multiple surgical procedures (p < 0.05).
Malleostapedotomy yields better functional hearing results than incus stapedotomy in revision surgery for otosclerosis. The detection of many malleus fixations was the result of the systematic exposure of the anterior malleal process and ligament through an endaural approach with superior canaloplasty.
本研究旨在分析镫骨-砧骨切除术的结果，并将其与传统砧骨-镫骨切除术的结果进行比较，该研究纳入了82例连续接受手术翻修的耳硬化症患者。
对5年内连续82例镫骨手术翻修病例进行评估。获取了80例（97.5%）患者的术前和术后听力数据。
71例患者接受了功能性翻修手术，其中镫骨-砧骨切除术56例（79%），砧骨-镫骨切除术15例（21%）。初次手术失败的最常见原因是假体移位或功能异常（86.2%）。80%的病例发现卵圆窗有病理改变。80%的病例发现砧骨问题，48.6%的病例发现锤骨异常。镫骨-砧骨切除术的功能成功率（听力改善10dB以内）高于传统砧骨-镫骨切除术（p<0.05）。12例患者（17%）出现听力过改善，2例患者（3%）出现明显的感音神经性听力损失。本系列病例中无全聋病例。首次翻修手术后的听力结果优于多次手术后的结果（p<0.05）。
在耳硬化症的翻修手术中，镫骨-砧骨切除术比砧骨-镫骨切除术能产生更好的功能性听力结果。通过外耳道入路和上半规管成形术系统暴露锤骨前突和韧带，发现了许多锤骨固定病例。
