Clinic of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
Otol Neurotol. 2011 Jun;32(4):520-8. doi: 10.1097/MAO.0b013e318216795b.
To analyze the influence of stapes prosthesis diameter on postoperative hearing results after stapedotomy without interposition in otosclerotic patients.
PubMed search from 1970 to 2009 using the key words stapedotomy or stapedectomy or otosclerosis or stapesplasty.
Inclusion criteria to select articles and patient groups for meta-analysis and statistical analyses were as follows: otosclerosis as diagnosis, clear description of technique and prosthesis size, calibrated stapedotomy, and complete report of functional results.
Five controlled studies were found analyzing the influence of prosthesis diameter and reporting the results in a comparable way for meta-analysis (n = 590). Sixty-two studies not analyzing the influence of prosthesis diameter contained comparable subgroups with a total of 9,536 cases. These cases were pooled according to their diameter (0.3, 0.4, 0.5, 0.6,and 0.8 mm). The results of air conduction, bone conduction, air-bone gap (ABG), and success rate (closure of the ABG within 10 dB as percentage of the total cases) for all groups and frequency-specific ABG results were gathered. Furthermore, 12 clinical and experimental studies were reviewed that did not contribute to the statistical analysis.
A meta-analysis performed for success rate of the 5 controlled studies showed favorable results for 0.6-mm over 0.4-mm prostheses (success rate, 67% versus 58%, p = 0.05). In the statistical analysis of the pooled data, the 0.6-mm prosthesis showed better results compared with 0.4 mm (p < 0.001) in the postoperative air conduction threshold (29 dB versus 35 dB), postoperative ABG (7 dB versus 11 dB), ABG improvement (25 dB versus 21 dB), and success rate (81.1% versus 75.1%). The frequency-specific analysis of the postoperative ABG showed no advantage for the small prosthesis in the high frequencies. There was no difference in postoperative change of bone conduction in the 0.6- and 0.4-mm groups. Statistically significant results could not be assessed for other prosthesis diameters because of the small number of cases reported.
A 0.6-mm diameter piston prosthesis is associated with significantly better results than a 0.4-mm prosthesis and should be used if the surgical conditions allow it.
分析在耳硬化症患者中行镫骨切除术时不使用移植物的情况下，镫骨假体直径对术后听力结果的影响。
1970 年至 2009 年在 PubMed 上使用“镫骨切除术或镫骨成形术或耳硬化症或镫骨切除术”关键词进行检索。
纳入标准为选择文章和患者群体进行荟萃分析和统计分析如下：耳硬化症作为诊断，明确描述技术和假体大小，校准的镫骨切除术，并完整报告功能结果。
共发现 5 项对照研究分析了假体直径的影响，并以可进行荟萃分析的可比方式报告了结果（n=590）。62 项未分析假体直径影响的研究包含了具有总共有 9536 例的可比亚组。根据直径（0.3、0.4、0.5、0.6 和 0.8 毫米）对这些病例进行了汇总。收集了所有组的空气传导、骨传导、气骨间隙（ABG）和成功率（ABG 闭合率作为总病例的百分比）以及特定频率的 ABG 结果。此外，还回顾了 12 项未对统计分析做出贡献的临床和实验研究。
对 5 项对照研究的成功率进行的荟萃分析显示，0.6 毫米假体优于 0.4 毫米假体（成功率为 67%对 58%，p=0.05）。在汇总数据的统计分析中，0.6 毫米假体在术后空气传导阈值（29dB 对 35dB）、术后 ABG（7dB 对 11dB）、ABG 改善（25dB 对 21dB）和成功率（81.1%对 75.1%）方面的结果优于 0.4 毫米假体。术后 ABG 的特定频率分析显示，在高频下小假体没有优势。在 0.6 和 0.4 毫米组中，骨导术后的变化没有差异。由于报道的病例数量较少，因此无法对其他假体直径的统计学显著结果进行评估。
与 0.4 毫米假体相比，0.6 毫米直径活塞假体的效果显著更好，如果手术条件允许，应使用该假体。
