Loader Benjamin, Atteneder Claudia, Kaider Alexandra, Franz Peter
Department of Otorhinolaryngology, Head and Neck Surgery, Rudolfstiftung Tertiary Teaching Hospital , Vienna , Austria.
Acta Otolaryngol. 2013 Dec;133(12):1285-91. doi: 10.3109/00016489.2013.829921.
Tympanotomy with sealing of the round window is a promising surgical alternative as a salvage strategy in younger patients with acute idiopathic sensorineural hearing loss (SNHL) and may be considered as an alternative drug delivery method to the round window.
To analyze the potential benefit of the sealing of the round window with special emphasis on the age of treated patients and the influence of time elapsed between symptom onset and surgery.
This was a retrospective cohort study of 25 patients (13 males,12 females) with an average age of 55 years (range 31-75 years) with sudden SNHL, who underwent an enaural tympanotomy with sealing of the round niche using triamcinolone-soaked fascia. Pre- and postoperative bone conduction thresholds were compared for each frequency and for the pure-tone average (PTA) measured at 500 Hz, 1 kHz, 2 kHz, and 3 kHZ. The time (days) between primary symptom onset and surgery as well as age was scrutinized. Hearing improvement was described as 'no improvement' (0-9 dB), 'moderate recovery' (10-29 dB), or 'marked recovery' (≥30 dB). The difference in age of patients who improved was compared to those who did not.
A statistically significant improvement in PTA values (mean change 20.4 dB) was noted (p = 0.0002). In all, 13/25 (52%) patients exhibited improved bone conduction postoperatively regardless of age and time of treatment. A marked recovery (≥30 dB) could be seen in eight patients (median time to surgery, 9 days; average age, 48.5 years); recovery between 10 and 30 dB in five patients (median time to surgery, 10 days; average age, 46.6 years). Twelve significantly older patients showed no improvement (average time to surgery, 19 days; average age, 61.8 years; p = 0.004). No patient over the age of 65 years showed improvement in bone conduction.
圆窗封闭鼓室切开术作为一种挽救策略，对于患有急性特发性感音神经性听力损失（SNHL）的年轻患者而言，是一种有前景的手术选择，并且可被视为一种向圆窗给药的替代方法。
分析圆窗封闭的潜在益处，特别关注接受治疗患者的年龄以及症状发作与手术之间的时间影响。
这是一项回顾性队列研究，研究对象为25例突发SNHL患者（13例男性，12例女性），平均年龄55岁（范围31 - 75岁），他们接受了经耳鼓室切开术，使用曲安奈德浸润的筋膜封闭圆窗龛。比较每个频率以及在500Hz、1kHz、2kHz和3kHz测量的纯音平均听阈（PTA）术前和术后的骨导阈值，并仔细研究主要症状发作与手术之间时间（天数）以及年龄情况 。听力改善被描述为“无改善”（0 - 9dB）、“中度恢复”（10 - 29dB）或“显著恢复”（≥30dB）。比较改善患者与未改善患者的年龄差异。
注意到PTA值有统计学显著改善（平均变化20.4dB）（p = 0.0002）。总体而言，13/25（52%）的患者术后骨导改善，与年龄和治疗时间无关。8例患者出现显著恢复（≥30dB）（手术中位时间，9天；平均年龄，48.5岁）；5例患者恢复10至30dB（手术中位时间，10天；平均年龄，46.6岁）。12例年龄较大的患者无改善（手术平均时间，19天；平均年龄，61.8岁；p = 0.004）。65岁以上患者骨导均未改善。
