Department of Otolaryngology-Head and Neck Surgery, Miyazaki University, 5200 Kihara, Kiyotake-cho, Miyazaki 889-1692, Japan.
Eur Arch Otorhinolaryngol. 2010 Jun;267(6):875-9. doi: 10.1007/s00405-009-1142-1. Epub 2009 Nov 10.
Many cases of tympanosclerotic stapes fixation are accompanied by fixation or erosion of malleus and/or incus. This status of the ossicular chain is one of the reasons that ossiculoplasty for tympanosclerotic stapes fixation is more difficult than that for otosclerosis. We conducted a retrospective review of seven patients who were operated on for tympanosclerotic stapes fixation between 2002 and 2006. All of the patients had abnormal conditions of the malleus and/or incus and underwent stapedectomy and total ossiculoplasty with hydroxyapatite prosthesis (Apaceram T-7 type), which has a planar-like head portion that contacts a piece of cartilage. Postoperative hearing results were assessed in all seven patients after at least 1 year. The postoperative air-bone gap (ABG) was closed within 10 dB in two of seven patients, and was less than 20 dB in six of seven patients. The mean postoperative ABG was closed within 10 dB at 1 and 2 kHz and less than 20 dB at low frequencies (0.25 and 0.5 Hz). There was almost no hearing improvement at high frequencies (4 and 8 kHz). There were no patients with postoperative sensorineural hearing loss. The present study shows that stapedectomy and total ossiculoplasty with cartilage-connecting hydroxyapatite prosthesis is effective and safe for stapes fixation accompanied by fixation or erosion of the malleus and/or incus.
许多鼓室硬化镫骨固定病例伴有砧骨和/或镫骨固定或侵蚀。听小骨链的这种状态是镫骨硬化症患者行镫骨成形术比鼓室硬化症患者更困难的原因之一。我们回顾性分析了 2002 年至 2006 年间行鼓室硬化镫骨固定手术的 7 例患者。所有患者的砧骨和/或镫骨均有异常，行镫骨切除术和羟基磷灰石人工听骨（Apaceram T-7 型）全听骨成形术，该人工听骨的头部呈平面状，与软骨接触。7 例患者术后至少 1 年均进行了听力评估。7 例患者中，有 2 例术后气骨导差（ABG）缩小至 10dB 以内，6 例术后 ABG 小于 20dB。术后 1 和 2kHz 时平均 ABG 缩小至 10dB 以内，低频（0.25 和 0.5Hz）时 ABG 小于 20dB。高频（4 和 8kHz）时听力几乎无提高。无术后感音神经性听力损失患者。本研究表明，对于伴有砧骨和/或镫骨固定或侵蚀的镫骨固定患者，行软骨连接羟基磷灰石人工听骨的镫骨切除术和全听骨成形术是有效且安全的。
