Folia M, Abedipour D, Naiman N, Truy E
Hopital Edouard Herriot, Service d'ORL et de Chirurgie Cervico-Faciale et d'Audiophonologie, Lyon, France.
Rev Laryngol Otol Rhinol (Bord). 2006;127(3):121-5.
To analyse the anatomical and functional results after second-look ossiculoplasty using Titanium (TI) and Hydroxyapatite (HA) prosthesis and to study the prognostic factors for good functional results.
Forty nine patients (19 men and 30 women) with an average age of 36 years were included in this study. The patients presented with anatomical and/or functional failures after a first ossiculoplasty and had a second-look intervention. The status of the first prosthesis and also the anatomical status of the middle ear and the remaining ossicular chain were described intra operatively. The functional and anatomical results were assessed 2 months after the second ossiculoplasty and during the most recent out patient clinic. Postoperative air conduction gain (ACG) and air bone gap (ABG) were calculated in average values using four frequencies: 0.5, 1, 2 and 4 kHz. The variables used in statistical analysis were the following: Tympanic membrane and preoperative middle ear status, the type of prosthesis (partial or total) and its material (TI and HA).
The average time to second-look operation was 18 months. The postoperative ABG did not show any significant statistic improvement and in several patients auditory function deteriorated in the operated ear The predictive factors for good functional results were: The integrity of the tympanic membrane, chronic otitis media without cholesteatoma, total prosthesis and HA prosthesis. If three of these factors were present, the postoperative ABG would always be less than 20 dB.
When selecting patients for second look ossibuloplasty it is important to understand the predictive facctors for good results. This will allow a full discussion of options, risks and morbidity with the patient.
分析使用钛（TI）和羟基磷灰石（HA）假体进行二次听骨成形术后的解剖学和功能结果，并研究功能良好结果的预后因素。
本研究纳入了49例患者（19例男性和30例女性），平均年龄36岁。这些患者在首次听骨成形术后出现解剖学和/或功能失败，并接受了二次手术。术中描述了第一个假体的状态以及中耳和剩余听骨链的解剖状态。在二次听骨成形术后2个月以及最近的门诊期间评估功能和解剖结果。使用0.5、1、2和4kHz四个频率计算术后气导增益（ACG）和气骨导间距（ABG）的平均值。统计分析中使用的变量如下：鼓膜和术前中耳状态、假体类型（部分或全部）及其材料（TI和HA）。
二次手术的平均时间为18个月。术后ABG没有显示出任何显著的统计学改善，并且在一些患者中，患耳的听觉功能恶化。功能良好结果的预测因素为：鼓膜完整、无胆脂瘤的慢性中耳炎、全假体和HA假体。如果存在这三个因素中的三个，术后ABG将始终小于20dB。
在选择进行二次听骨成形术的患者时，了解良好结果的预测因素很重要。这将有助于与患者充分讨论各种选择、风险和发病率。
