Møller P
Bergen University Hospital, ENT dept., Haukeland Hospital, Norway.
Rev Laryngol Otol Rhinol (Bord). 1992;113(5):397-400.
Two hundred and fifty consecutively operated stapes procedures operated by the author for otosclerosis are presented. A fat-wire stapedectomy prostheses (Schuknecht) was used in 152 cases and a Fisch teflon-wire piston was used in 98 ears. Of the 250 procedures 33 patients had bilateral surgery. The operations were done in local anaesthesia in most cases and with endomeatal incision. The fat-wire prostheses gave in 95% a closure within 10 dB and the rest 5% closed within 11-20 dB. The Fisch teflon-wire piston gave a closure within 10 dB in 87%, within 11-20 dB in 12% and within 21-30 dB in 1%. The speech reception was better after operation in 97% of patients operated with the fat-wire prostheses and in 99% of patients having the teflon-wire piston. It was a significant difference at 20 dB level of speech improvement (p < 02) in favour of the teflon-wire piston. The surgery for otosclerosis is a special procedure seeking refinements in surgical techniques to increase safety and maintain acceptable results. Our results show that the small fenestra technique with 4 mm piston will give better speech reception and better hearing in the high frequencies. To achieve a high standard the operations for otosclerosis should probably be centralised to let the surgeon do a minimum of 8 to 10 procedures every year.
本文介绍了作者连续进行的250例耳硬化镫骨手术。其中152例使用了脂肪丝镫骨切除术假体（舒克内希特），98耳使用了菲施特氟龙丝活塞。在这250例手术中，33例患者接受了双侧手术。大多数手术在局部麻醉下进行，采用耳道内切口。脂肪丝假体在95%的病例中听力改善在10分贝以内，其余5%在11 - 20分贝以内。菲施特氟龙丝活塞在87%的病例中听力改善在10分贝以内，12%在11 - 20分贝以内，1%在21 - 30分贝以内。使用脂肪丝假体手术的患者中97%术后言语接受能力改善，使用特氟龙丝活塞的患者中99%改善。在言语改善20分贝水平上，特氟龙丝活塞有显著差异（p < 0.02）。耳硬化手术是一种特殊手术，需要不断改进手术技术以提高安全性并保持可接受的效果。我们的结果表明，采用4毫米活塞的小开窗技术能带来更好的言语接受能力和高频听力。为达到高标准，耳硬化手术可能应集中进行，让外科医生每年至少进行8至10例手术。
