Lailach Susen, Kemper Max, Lasurashvili Nikoloz, Beleites Thomas, Zahnert Thomas, Neudert Marcus
Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Medizinische Fakultät Carl Gustav Carus, Fetscher Strasse 74, 01307, Dresden, Saxony, Germany.
Eur Arch Otorhinolaryngol. 2015 Nov;272(11):3177-85. doi: 10.1007/s00405-014-3370-2. Epub 2014 Oct 31.
The objective of this study was to compare health-related quality of life (HRQOL) after sequential cholesteatoma surgery including exclusively transcanal technique (ETC), combined transcanal transmastoidal technique (TCM) and canal wall down surgery with obliteration (CWD). It was a clinical case study conducted in a tertiary referral center. 97 patients at least 12 months after cholesteatoma surgery were included. Interventions included sequential cholesteatoma surgery with ETC, TCM or CWD; ossiculoplasty with partial and total ossicular replacement prostheses. HRQOL assessed by Chronic Otitis Media Outcome Test 15 including an overall score and three subscores ('ear symptoms', 'hearing function' and 'mental health') as well as a general evaluation of HRQOL and the frequency of physician consultations, audiometric outcome related to HRQOL were the main outcome measures. Patients, who had undergone sequential cholesteatoma surgery, showed moderate restrictions in HRQOL postoperatively. Stratified for the three surgical techniques, patients receiving ETC tended to report lower restrictions in HRQOL. The ETC group offered a significantly lower value in the subscore 'ear symptoms'. The 'hearing function' was attributed to be the most restriction criteria for all techniques. The overall score and all subscores correlated moderately with the postoperative air conduction threshold. The strongest correlation coefficient was achieved for the subscore 'hearing function' (r(s) = 0.49, p < 0.001). Sequential cholesteatoma surgery offers acceptable moderate restrictions in HRQOL postoperatively. Patients receiving canal wall down surgery with obliteration showed equivalent limitations in HRQOL compared to closed techniques (ETC, TCM). The postoperative air conduction threshold was shown not to be a sufficient indicator for HRQOL. Therefore, disease-specific validated and reliable measuring instruments for HRQOL should be transferred from clinical research to clinical practice to provide an individualized postoperative assessment after cholesteatoma surgery.
本研究的目的是比较包括单纯经耳道技术（ETC）、经耳道-乳突联合技术（TCM）和开放式乳突根治术加填塞术（CWD）在内的胆脂瘤序贯手术后的健康相关生活质量（HRQOL）。这是一项在三级转诊中心进行的临床病例研究。纳入了97例胆脂瘤手术后至少12个月的患者。干预措施包括采用ETC、TCM或CWD进行胆脂瘤序贯手术；使用部分和全听骨置换假体进行鼓室成形术。通过慢性中耳炎结果测试15评估HRQOL，包括一个总分和三个子分数（“耳部症状”、“听力功能”和“心理健康”），以及HRQOL的总体评估和医生会诊频率，与HRQOL相关的听力测定结果是主要结局指标。接受胆脂瘤序贯手术的患者术后HRQOL有中度受限。按三种手术技术分层，接受ETC的患者HRQOL受限程度往往较低。ETC组在“耳部症状”子分数中的值显著较低。“听力功能”被认为是所有技术中受限最严重的标准。总分和所有子分数与术后气导阈值呈中度相关。“听力功能”子分数的相关系数最强（r(s)=0.49，p<0.001）。胆脂瘤序贯手术术后HRQOL有可接受的中度受限。与封闭技术（ETC、TCM）相比，接受开放式乳突根治术加填塞术的患者在HRQOL方面有同等程度的受限。术后气导阈值并非HRQOL的充分指标。因此，应将针对HRQOL的疾病特异性有效且可靠的测量工具从临床研究应用到临床实践中，以提供胆脂瘤手术后的个体化术后评估。
