Oeken J
Klinik für HNO-Heilkunde, Kopf- und Halschirurgie, Klinikum Chemnitz gGmbH, Flemmingstr. 2, 09116, Chemnitz, Deutschland.
HNO. 2013 Jun;61(6):504-9. doi: 10.1007/s00106-012-2646-3.
It is recommended that a stapedotomy be performed under local anaesthesia to enable intraoperative monitoring of hearing and vestibular function. In contrast, we prefer to carry out stapedotomies under general anesthesia. The aim of this study was to investigate whether this practice has an adverse effect on hearing results.
All stapedotomies performed in our department between May 2003 and February 2012 were included in the analysis. Revision surgery was excluded. All interventions were performed under general anesthesia with an endotracheal tube by the same surgeon using the same technique. Pure tone and speech audiometry, acoustic reflex testing and Schüller radiology were performed preoperatively. Follow-up examinations (pure tone and speech audiometry) took place 4-6 weeks following surgery.
A total of 262 stapedotomies were carried out on 228 patients. Follow-up examinations could not be performed on six patients. Of the remaining 256 cases, closure of the air-bone gap to less than 10 dB was achieved in 220 patients (86%) and in 29 patients (11%) it was closed to less than 20 dB. Conductive hearing loss persisted in seven cases (3%). A mild sensorineural hearing loss with complete closure of the air-bone gap was experienced by two patients (0.8%). There was no instance of postoperative deafness.
Performing stapedotomies under general rather than local anesthesia has no adverse effects on audiological results.
建议在局部麻醉下进行镫骨切除术，以便术中监测听力和前庭功能。相比之下，我们更倾向于在全身麻醉下进行镫骨切除术。本研究的目的是调查这种做法是否会对听力结果产生不利影响。
分析纳入了2003年5月至2012年2月在我科进行的所有镫骨切除术。翻修手术被排除在外。所有干预措施均由同一位外科医生采用相同技术在全身麻醉下经气管插管进行。术前进行纯音和言语听力测定、声反射测试以及许勒位放射检查。术后4 - 6周进行随访检查（纯音和言语听力测定）。
共对228例患者实施了262次镫骨切除术。6例患者未能进行随访检查。在其余256例病例中，220例患者（86%）的气骨导差缩小至小于10 dB，29例患者（11%）缩小至小于20 dB。7例患者（3%）仍存在传导性听力损失。2例患者（0.8%）出现轻度感音神经性听力损失且气骨导差完全闭合。无术后耳聋病例。
在全身麻醉而非局部麻醉下进行镫骨切除术对听力学结果无不利影响。
