House Howard P, Hansen Marlan R, Al Dakhail Abdul Aziz A, House John W
House Ear Clinic, Los Angeles, California 90057, USA.
Laryngoscope. 2002 Nov;112(11):2046-50. doi: 10.1097/00005537-200211000-00025.
OBJECTIVE/HYPOTHESIS: To compare the effectiveness and long-term stability of hearing results between stapedectomy and small fenestra stapedotomy in patients with conductive hearing loss due to otosclerosis.
Retrospective review of prospectively collected audiometric data.
The hearing results and complication rates of 209 ears with long-term follow-up that underwent either stapedectomy or stapedotomy by the senior author (h.p.h.) between 1961 and 1989 were compared. Forty-two patients underwent stapedectomy in one ear and stapedotomy in the opposite ear, permitting a paired case review of the results in these patients. The techniques were compared with respect to initial and late hearing results and change of the results over time.
Patients undergoing stapedectomy and stapedotomy were followed for an average of 11.5 and 6.0 years, respectively. There were no statistically significant differences in initial or late postoperative pure-tone average (PTA), PTA air-bone gap, speech discrimination scores, or incidence of sensorineural hearing loss between the two groups. Ears treated by stapedotomy showed statistically better initial and late postoperative 4-kHz air-conduction threshold and initial 4-kHz air-bone gap, but the gap difference was not significant with late follow-up. There was no significant difference in the percentage of patients with air-bone gap closure within 10 dB for any frequency other than 4 kHz at the initial postoperative test. Importantly, the successful outcomes in both groups were stable over long-term follow-up. Results were the same when comparing the two procedures in patients having undergone both.
These results show that, in the hands of an experienced surgeon, either technique provides satisfactory and stable long-term results.
目的/假设：比较镫骨切除术与小开窗镫骨手术治疗耳硬化症所致传导性听力损失患者的听力效果及长期稳定性。
对前瞻性收集的听力测定数据进行回顾性分析。
比较1961年至1989年间由资深作者（h.p.h.）实施镫骨切除术或镫骨手术的209只长期随访耳朵的听力结果和并发症发生率。42例患者一侧耳朵接受镫骨切除术，另一侧耳朵接受镫骨手术，从而对这些患者的结果进行配对病例分析。比较两种技术在初始和晚期听力结果以及结果随时间的变化。
接受镫骨切除术和镫骨手术的患者平均随访时间分别为11.5年和6.0年。两组在术后初始或晚期纯音平均听阈（PTA）、PTA气骨导差、言语辨别得分或感音神经性听力损失发生率方面无统计学显著差异。接受镫骨手术治疗的耳朵在术后初始和晚期4kHz气导阈值以及初始4kHz气骨导差方面在统计学上表现更好，但在后期随访中气骨导差差异不显著。术后初始测试时，除4kHz外其他任何频率气骨导差缩小至10dB以内的患者百分比无显著差异。重要的是，两组的成功结果在长期随访中均保持稳定。对接受过两种手术的患者进行两种手术比较时结果相同。
这些结果表明，在经验丰富的外科医生手中, 两种技术都能提供令人满意且稳定的长期效果。
