Mulazimoglu Selcuk, Saxby Alexander, Schlegel Christoph, Linder Thomas
Department of Otorhinolaryngology Head and Neck Surgery, Luzerner Kantonsspital, Spitalstrasse, 6000, Lucerne, Switzerland.
Department of Otolaryngology, Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
Eur Arch Otorhinolaryngol. 2017 Sep;274(9):3303-3310. doi: 10.1007/s00405-017-4634-4. Epub 2017 Jun 10.
This study aimed to evaluate the benefit but also the extrusions, dislocations, and failures of a titanium incus prosthesis along with the long-term audiological outcomes. We prospectively collected data from 139 patients undergoing ossiculoplasty using the Fisch titanium incus prosthesis between 2001 and 2016. Overall, 126 patients with at least 6 months of follow-up (mean 4.5 years, range 6-155 months) were analyzed. Patients were grouped as "extrusion" (n = 9, 7%) if the prosthesis extruded, "failure" (n = 22, 18%) if a reoperation was needed concerning the prosthesis, and "stable" (n = 95, 75%) if the prosthesis remained functional in the middle ear. Mean postoperative air bone gaps (ABG) for 0.5-3 kHz for the overall group and the stable group were 19.8 (±11.9) and 15.3 (±7.5), respectively. Long-term results of stable group revealed an ABG (0.5-3 kHz) below 10 dB in 25% and below 20 dB in 81% of the patients. Atelectasis was the most frequent cause of extrusion, which occurred after a mean time of 28.7 months (range 15-48 months). Mean timing for reoperation was 30.7 months (range 5-131 months) in the failure group. There was no significant difference in mean postoperative ABG among patients with or without cholesteatoma, primary or staged ossiculoplasty in cholesteatoma, presence or absence of malleus head at the time of ossiculoplasty, open or closed cavity surgeries, or the degree of pneumatization of the temporal bone. The Fisch titanium incus prosthesis is a reliable alternative to using autologous incus for interposition ossiculoplasty, with similar hearing outcomes. Using this prosthesis, a 15 dB ABG should be expected.
本研究旨在评估钛质砧骨假体的益处以及其脱出、脱位和失败情况，同时评估长期听力学结果。我们前瞻性收集了2001年至2016年间139例使用菲施钛质砧骨假体进行鼓室成形术患者的数据。总体上，对126例至少随访6个月（平均4.5年，范围6 - 155个月）的患者进行了分析。若假体脱出，则将患者归为“脱出组”（n = 9，7%）；若因假体需要再次手术，则归为“失败组”（n = 22，18%）；若假体在中耳保持功能，则归为“稳定组”（n = 95，75%）。总体组和稳定组术后0.5 - 3kHz的平均气骨导差（ABG）分别为19.8（±11.9）和15.3（±7.5）。稳定组的长期结果显示，25%的患者ABG（0.5 - 3kHz）低于10dB，81%的患者低于20dB。肺不张是脱出最常见的原因，平均发生时间为28.7个月（范围15 - 48个月）。失败组再次手术的平均时间为30.7个月（范围5 - 131个月）。有无胆脂瘤、胆脂瘤患者初次或分期鼓室成形术、鼓室成形术时有无锤骨头、开放式或封闭式腔隙手术，或颞骨气房化程度不同的患者，术后平均ABG无显著差异。菲施钛质砧骨假体是用于植入性鼓室成形术替代自体砧骨的可靠选择，听力结果相似。使用该假体时，预计ABG为15dB。
