Massey Becky L, Hillman Todd A, Shelton Clough
Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, UT 84132, USA.
Otolaryngol Head Neck Surg. 2006 May;134(5):816-8. doi: 10.1016/j.otohns.2005.10.063.
To evaluate outcomes of stapedectomy surgery for congenital stapes fixation.
Retrospective chart review.
The charts of 463 stapedectomies performed by 1 surgeon from 1996 to 2003 were reviewed. Patients with a history of childhood hearing loss and operative findings consistent with congenital fixation of the stapes were included. Patients with a history of trauma or chronic otitis media and those with otosclerosis were excluded. Thirty-six patients underwent stapedectomy for congenital fixation. Revision cases and those with inadequate postoperative bone or air conduction data were excluded. Inclusion criteria were met for 25 patients. Operative findings and hearing outcomes were evaluated.
The study group was comprised of 25 stapedectomies. Closure of the air-bone gap to less than 10 dB was achieved in 48% of cases, and 80% had closure within 20 dB. A gap of more than 30 dB remained in 3 cases. There were 2 cases of sensorineural hearing loss with worsening of the bone conduction thresholds by 15 dB and 30 dB. There were no instances of perilymph gusher. In addition to an excluded case that was not reconstructed because of facial nerve position, 3 of the included patients were found to have a dehiscent facial nerve at surgery. There were no facial nerve injuries, and fixation of the malleus or incus was not found in any of the included patients. When hearing outcomes were compared with our results for otosclerosis over the same time period, rates of closure to within 10 dB and 20 dB were significantly worse in the congenital group.
Closure of the air-bone gap in this population differs from our results in stapedectomy done for otosclerosis. This difference likely reflects subtle anatomic variations in the congenital group that affect the effectiveness of the prosthesis. Despite the difference in results, stapedectomy for congenital fixation remains an effective method to achieve significant hearing improvement in the majority of patients.
B-3b.
评估镫骨切除术治疗先天性镫骨固定的效果。
回顾性病历审查。
回顾了1996年至2003年由1名外科医生实施的463例镫骨切除术的病历。纳入有儿童期听力损失病史且手术结果符合先天性镫骨固定的患者。排除有创伤或慢性中耳炎病史的患者以及耳硬化症患者。36例患者因先天性固定接受镫骨切除术。排除翻修病例以及术后骨导或气导数据不充分的病例。25例患者符合纳入标准。评估手术结果和听力情况。
研究组包括25例镫骨切除术。48%的病例气骨导间距缩小至10 dB以内，80%的病例在20 dB以内。3例患者气骨导间距仍大于30 dB。有2例感音神经性听力损失，骨导阈值分别恶化了15 dB和30 dB。未发生外淋巴瘘。除1例因面神经位置未重建而排除的病例外，纳入的患者中有3例在手术中发现面神经裂缺。未发生面神经损伤，纳入的患者中均未发现锤骨或砧骨固定。将听力结果与同期我们治疗耳硬化症的结果进行比较时，先天性组气骨导间距缩小至10 dB和20 dB以内的比例明显更低。
该人群中气骨导间距的缩小情况与我们治疗耳硬化症的镫骨切除术结果不同。这种差异可能反映了先天性组中影响假体效果的细微解剖变异。尽管结果存在差异，但先天性固定镫骨切除术仍是大多数患者实现显著听力改善的有效方法。
B - 3b。
