Aslan Felek Sevim, Islam Ahmet, Celik Hatice, Demirci Munir, Samim Erdal, Kose S Kenan
2nd ENT Department, Ankara University School of Medicine, Ankara, Turkey.
Acta Otolaryngol. 2009 Dec;129(12):1388-94. doi: 10.3109/00016480902856596.
Although we have shown that malleus handle and mucosal factors were important prognostic factors for hearing, we were unable to show the positive effect of the stapes superstructure on hearing results. The positive effect of the presence of the stapes superstructure on hearing results is closely related to the quality of the mucosa.
The aim of this study was to investigate the impact of ossicular and mucosal factors on hearing in primary canal wall down (CWD) surgery with ossicular chain reconstruction (OCR) performed for extensive acquired cholesteatoma.
A total of 134 adults who had CWD surgery with OCR for extensive acquired cholesteatoma between January 1996 and May 2007 were retrospectively analyzed.
The graft insufficiency was 13%, chronic infection without cholesteatoma was 6% and cholesteatoma recurrence was 8% after the first operations. The rate of anatomic failure was 10% after a follow-up period of 46.3 months. In this study, we present the anatomic results for 136 ears and functional results for 135 ears. The hearing gain was significantly higher in the cholesteatoma-only group when compared with the mucosal-cholesteatoma disease group. Forty-three ears (54%) in the cholesteatoma-only group and 23 ears (42%) in the mucosal-cholesteatoma disease group had postoperative ABG within 20 dB. The best hearing results were obtained in Austin group B, while the worst hearing results were evident in Austin group C (p=0.017). Postoperative ABG was within 20 dB in 44% (n=31) of the patients with an intact stapes superstructure, while this ratio was 54% (n=35) when the stapes superstructure was absent.
尽管我们已表明锤骨柄和黏膜因素是听力的重要预后因素，但我们未能证明镫骨上部结构对听力结果有积极影响。镫骨上部结构的存在对听力结果的积极影响与黏膜质量密切相关。
本研究的目的是调查在为广泛获得性胆脂瘤施行的一期外耳道壁下翻（CWD）手术并进行听骨链重建（OCR）中，听骨和黏膜因素对听力的影响。
回顾性分析了1996年1月至2007年5月期间因广泛获得性胆脂瘤接受CWD手术并进行OCR的134例成人患者。
首次手术后移植物不足率为13%，无胆脂瘤的慢性感染率为6%，胆脂瘤复发率为8%。随访46.3个月后解剖失败率为10%。在本研究中，我们展示了136耳的解剖结果和135耳的功能结果。仅胆脂瘤组的听力增益明显高于黏膜 - 胆脂瘤疾病组。仅胆脂瘤组的43耳（54%）和黏膜 - 胆脂瘤疾病组的23耳（42%）术后气骨导差在20 dB以内。奥斯汀B组听力结果最佳，而奥斯汀C组听力结果最差（p = 0.017）。镫骨上部结构完整的患者中44%（n = 31）术后气骨导差在20 dB以内，而镫骨上部结构缺失时该比例为54%（n = 35）。
