Gristwood Ronald Edward, Venables William Norman
Department of Otolaryngology, Royal Adelaide Hospital, Adelaide, Australia.
Ann Otol Rhinol Laryngol. 2011 Jun;120(6):363-71. doi: 10.1177/000348941112000603.
We determined the effect of piston diameter (0.8 or 0.6 mm) and fenestra size (total, three-quarter, or half removal or calibrated stapedotomy) on hearing gains after stapes surgery for clinical otosclerosis.
We analyzed the mean air conduction hearing gains at various frequencies in a sample of 911 strictly consecutive patients who underwent 1,168 stapes procedures with piston reconstruction carried out by the same surgeon between 1963 and 1979. Assiduous follow-up of patients was attempted for at least 10 years, and in some cases for 20 years. Results over time at the various audiometric frequencies were stored for computer analysis.
There is no apparent advantage of one piston diameter (0.8 or 0.6 mm) over another for hearing gains at 0.25, 0.5, 1,2, 3, and 4 kHz. The slim piston appeared to have a significant advantage for 6 and 8 kHz at 5 to 10 years after operation, but interpretation here requires caution, because the slim piston was usually chosen for cases with a small fenestra. Of the various sizes of footplate fenestras, total removal of the stapes footplate had significantly worse air conduction results, most clearly demonstrated at higher frequencies. Below 2 kHz, there is only weak evidence that the means differ significantly at all for the different sizes of fenestra. Small fenestras (stapedotomies) appear to offer advantages for hearing gains, particularly at the higher frequencies of 3 to 8 kHz, and for at least 10 years.
The diameter (0.6 or 0.8 mm) of the pistons selected for reconstruction after stapes surgery appears to have little effect on the outcome, except perhaps at 6 and 8 kHz, where the slim piston appeared to have a significant advantage. The size of the footplate fenestra is of paramount importance to the outcome. A small footplate fenestra has statistically significant advantages for hearing gain over all other sizes of fenestra (ie, total, three-quarter, or half removal of the footplate), at least for the first 10 years after surgery, at frequencies of 2 kHz and above. Total stapedectomy has given the worst results for hearing gain at frequencies above 2 kHz, and the rate of deterioration of gain over time seems to be more rapid than after small-fenestra techniques. Small fenestras are recommended as the preferred technique in all cases of surgically treatable otosclerosis.
我们确定了活塞直径（0.8或0.6毫米）和开窗大小（完全切除、四分之三切除、二分之一切除或校准镫骨切除术）对临床耳硬化症镫骨手术后听力改善的影响。
我们分析了1963年至1979年间由同一位外科医生进行的1168例活塞重建镫骨手术的911例连续患者样本在不同频率下的平均气导听力改善情况。我们试图对患者进行至少10年的认真随访，在某些情况下随访20年。将不同听力测定频率随时间的结果存储起来用于计算机分析。
在0.25、0.5、1、2、3和4千赫的听力改善方面，一种活塞直径（0.8或0.6毫米）相对于另一种并无明显优势。较细的活塞在术后5至10年的6和8千赫频率上似乎具有显著优势，但在此处的解读需谨慎，因为较细的活塞通常用于开窗较小的病例。在各种大小的镫骨足板开窗中，完全切除镫骨足板的气导结果明显更差，在较高频率时最为明显。在2千赫以下，仅有微弱证据表明不同大小开窗的均值存在显著差异。小开窗（镫骨切除术）似乎对听力改善有优势，特别是在3至8千赫的较高频率，且至少持续10年。
镫骨手术后选择用于重建的活塞直径（0.6或0.8毫米）似乎对结果影响不大，可能除了在6和8千赫频率，此时较细的活塞似乎具有显著优势。镫骨足板开窗大小对结果至关重要。至少在术后头10年，在2千赫及以上频率，小的镫骨足板开窗在听力改善方面比所有其他大小的开窗（即完全切除、四分之三切除或二分之一切除足板）具有统计学上的显著优势。在2千赫以上频率，全镫骨切除术的听力改善结果最差，且随着时间推移改善程度恶化的速度似乎比小开窗技术更快。在所有可手术治疗的耳硬化症病例中，建议将小开窗作为首选技术。
