Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan,
Eur Arch Otorhinolaryngol. 2014 May;271(5):1007-14. doi: 10.1007/s00405-013-2529-6. Epub 2013 Apr 30.
The aim of this study was to analyze the impact of clinical factors on the outcomes of otosclerosis surgery and support patients' access to evidence-based information in pre-operative counseling to optimize their choices. A total of 109 ears in 93 patients undergoing stapes surgery in a tertiary referral center were included. Variables with a potential impact on hearing outcomes were recorded, with an emphasis on factors that were readily available pre-operatively. Hearing success was defined as a post-operative air-bone gap ≤10 dB. Logistic regression analysis was used to determine the factors independently contributing to the prediction of hearing success. The mean follow-up period was 18.0 months. Univariate and multivariate analyses indicated that none of the pre-operative factors (piston type, age, sex, affected side, tinnitus, vertigo, and pre-operative hearing thresholds) affected hearing success significantly (all p > 0.05). In conclusion, self-crimping Nitinol piston provides comparable hearing outcomes with conventional manual-crimping prostheses. However, Nitinol piston offers a technical simplification of a surgical procedure and an easier surgical choice for patients. In addition, age is not a detriment to hearing gain and instead might result in better use of hearing aids in older adults, thus facilitating social hearing recovery. Finally, hearing success does not depend on the extent of pre-operative hearing loss. Hence, patients with poor cochlear function should not be considered poor candidates for surgery. The predictive model has established recommendations for otologists for better case selection, and factors that are readily available pre-operatively may inform patients more explicitly about expected post-operative audiometric results.
本研究旨在分析临床因素对耳硬化症手术结果的影响，并为患者提供术前咨询的循证信息，以优化他们的选择。共纳入 93 例患者的 109 耳在三级转诊中心接受镫骨手术。记录了对听力结果有潜在影响的变量，重点是术前易于获得的因素。听力成功定义为术后气骨导差≤10dB。采用逻辑回归分析确定对听力成功预测有独立贡献的因素。平均随访时间为 18.0 个月。单因素和多因素分析表明，术前因素（活塞类型、年龄、性别、患侧、耳鸣、眩晕和术前听力阈值）均无显著影响听力成功（均 P>0.05）。总之，自卷曲镍钛诺活塞与传统手动卷曲假体提供可比的听力结果。然而，镍钛诺活塞简化了手术程序的技术，为患者提供了更简单的手术选择。此外，年龄不是听力增益的不利因素，反而可能导致老年人更好地使用助听器，从而促进社会听力康复。最后，听力成功并不取决于术前听力损失的程度。因此，耳蜗功能差的患者不应被视为手术的不良候选者。预测模型为耳科医生提供了更好的病例选择建议，术前易于获得的因素可以更明确地告知患者预期的术后听力结果。
