Saliba Issam, Sabbah Valérie, Poirier Jackie Bibeau
Division of Otorhinolaryngology-Head & Neck Surgery, University of Montreal, Montreal, QC, Canada.
Department of Otolaryngology, Sainte-Justine University Hospital Center (CHU SJ) Otology and Neurotology section, Montreal, QC, Canada.
Clin Med Insights Ear Nose Throat. 2018 Jan 3;11:1179550617749614. doi: 10.1177/1179550617749614. eCollection 2018.
To compare audiometric results between the standard total ossicular replacement prosthesis (TORP-S) and a new fat interposition total ossicular replacement prosthesis (TORP-F) in pediatric and adult patients and to assess the complication and the undesirable outcome.
This is a retrospective study.
This study included 104 patients who had undergone titanium implants with TORP-F and 54 patients who had undergone the procedure with TORP-S between 2008 and 2013 in our tertiary care centers. The new technique consists of interposing a fat graft between the 4 legs of the universal titanium prosthesis (Medtronic Xomed Inc, Jacksonville, FL, USA) to provide a more stable TORP in the ovale window niche. Normally, this prosthesis is designed to fit on the stapes' head as a partial ossicular replacement prosthesis.
The postoperative air-bone gap less than 25 dB for the combined cohort was 69.2% and 41.7% for the TORP-F and the TORP-S groups, respectively. The mean follow-up was 17 months postoperatively. By stratifying data, the pediatric cohort shows 56.5% in the TORP-F group (n = 52) compared with 40% in the TORP-S group (n = 29). However, the adult cohort shows 79.3% in the TORP-F group (n = 52) compared with 43.75% in the TORP-S group (n = 25). These improvements in hearing were statistically significant. There were no statistically significant differences in the speech discrimination scores. The only undesirable outcome that was statistically different between the 2 groups was the prosthesis displacement: 7% in the TORP-F group compared with 19% in the TORP-S group ( = .03).
The interposition of a fat graft between the legs of the titanium implants (TORP-F) provides superior hearing results compared with a standard procedure (TORP-S) in pediatric and adult populations because of its better stability in the oval window niche.
比较标准全听骨置换假体（TORP-S）与新型脂肪植入全听骨置换假体（TORP-F）在儿童和成人患者中的听力测试结果，并评估并发症及不良后果。
这是一项回顾性研究。
本研究纳入了2008年至2013年期间在我们的三级医疗中心接受TORP-F钛植入术的104例患者以及接受TORP-S手术的54例患者。新技术是在通用钛制假体（美国佛罗里达州杰克逊维尔市美敦力公司）的四条腿之间植入一块脂肪移植物，以便在卵圆窗龛中提供更稳定的全听骨置换假体。通常，这种假体设计为作为部分听骨置换假体安装在镫骨头上。
联合队列术后气骨导差小于25dB的比例，TORP-F组为69.2%，TORP-S组为41.7%。术后平均随访17个月。通过分层数据，儿童队列中TORP-F组为56.5%（n = 52），而TORP-S组为40%（n = 29）。然而，成人队列中TORP-F组为79.3%（n = 52），而TORP-S组为43.75%（n = 25）。这些听力改善具有统计学意义。言语辨别得分无统计学显著差异。两组之间唯一有统计学差异的不良后果是假体移位：TORP-F组为7%，TORP-S组为19%（P = 0.03）。
在钛植入物（TORP-F）的腿之间植入脂肪移植物，由于其在卵圆窗龛中具有更好的稳定性，与标准手术（TORP-S）相比，在儿童和成人中能提供更好的听力结果。
