Agrawal Sumit, Parnes Lorne
Department of Otolaryngology, University of Western Ontario, London.
J Otolaryngol. 2002 Apr;31(2):112-7. doi: 10.2310/7070.2002.19069.
This study reports the results of 112 primary stapedotomies and 13 revision stapedotomies performed by the senior author.
Retrospective case review of all primary and revision stapedotomies performed at University Hospital between 1994 and 1999. All patients in this series had otosclerosis and underwent stapedotomy using a 0.6-mm diameter platinum wire/Teflon piston prosthesis. The air-bone gap was calculated as the difference between the preoperative boneconduction and the postoperative air-conduction thresholds. The average follow-up time post-stapedotomy to audiometric testing was approximately 2.5 months.
An average air-bone gap closure at 500, 1000, and 2000 Hz to 10 dB or less was used as the criterion for success. The effects of stapedotomy on speech reception thresholds (SRTs), speech discrimination scores (SDSs), and airconduction thresholds are also reported.
In primary stapedotomy, an air-bone gap closure of 10 dB or less was achieved in 85.7% of patients. A significant hearing gain was achieved at all frequencies (250-8000 Hz), with the greatest benefit being achieved at the lower frequencies. The SRT was significantly improved post-stapedotomy by an average of 26.7 dB, and no significant change was found in the SDS. In revision stapedotomy, 38.5% of patients had a significant hearing gain at 250 to 4000 Hz. The SRT was significantly improved postoperatively by an average of 12.7 dB, and no significant change was found in SDS. Overall complication rates were similar to other series with two cases of partial hearing loss (1.6%), one incus fracture (0.8%), one large tympanic membrane perforation (0.8%), and one perilymphatic fistula (0.8%), which was successfully repaired. No patients in this series experienced complete sensorineural hearing loss, facial nerve injury, worsened tinnitus, or reparative granuloma.
The results of this study are comparable to other similar studies examining the use of stapedotomy in patients with otosclerosis. The high success rate and low incidence of serious complications support stapedotomy, without a laser but with resident involvement, as a highly effective treatment for otosclerosis.
本研究报告了资深作者所进行的112例初次镫骨切除术和13例翻修镫骨切除术的结果。
对1994年至1999年在大学医院进行的所有初次和翻修镫骨切除术进行回顾性病例分析。本系列所有患者均患有耳硬化症，并使用直径0.6毫米的铂丝/聚四氟乙烯活塞假体进行镫骨切除术。气骨导差计算为术前骨导阈值与术后气导阈值之差。镫骨切除术后至听力测试的平均随访时间约为2.5个月。
以500、1000和2000赫兹处平均气骨导差缩小至10分贝或更低作为成功标准。还报告了镫骨切除术对言语接受阈值（SRT）、言语辨别得分（SDS）和气导阈值的影响。
在初次镫骨切除术中，85.7%的患者气骨导差缩小至10分贝或更低。所有频率（250 - 8000赫兹）均实现了显著的听力改善，低频改善最为明显。镫骨切除术后SRT平均显著改善26.7分贝，SDS无显著变化。在翻修镫骨切除术中，38.5%的患者在250至4000赫兹处有显著的听力改善。术后SRT平均显著改善12.7分贝，SDS无显著变化。总体并发症发生率与其他系列相似，有2例部分听力损失（1.6%）、1例砧骨骨折（0.8%）、1例大的鼓膜穿孔（0.8%）和1例外淋巴瘘（0.8%），外淋巴瘘已成功修复。本系列中无患者出现完全性感音神经性听力损失、面神经损伤、耳鸣加重或修复性肉芽肿。
本研究结果与其他关于耳硬化症患者镫骨切除术应用的类似研究相当。高成功率和低严重并发症发生率支持在无激光但有住院医生参与的情况下，镫骨切除术作为耳硬化症的一种高效治疗方法。
