Kumar Suresh, Yadav Kanak, Ojha Tarun, Sharma Abhishek, Singhal Amit, Gakhar Saurabh
Department of Otorhinolaryngology, Hari Baksh Kanwatia Hospital, Shastri Nagar, Jaipur, Rajasthan 302016 India.
Department of Otorhinolaryngology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan India.
Indian J Otolaryngol Head Neck Surg. 2018 Mar;70(1):15-21. doi: 10.1007/s12070-017-1184-4. Epub 2017 Sep 7.
Chronic suppurative otitis media, with and without cholesteatoma, frequently results in disruption of the ossicular chain. The present study was designed to compare the outcome using autologous ossicle and titanium prosthesis in two groups of suitable patients presenting with chronic suppurative otitis media for middle ear reconstructive surgeries. A prospective study done from July 2012 to December 2013, at Mahatma Gandhi Medical College and Hospital, Sitapura, Jaipur (Rajasthan). The target group included patients with chronic suppurative otitis media admitted and planned for reconstructive middle ear surgery. The study group patients among the target group requiring certain ossicular reconstruction. The patients included were patients with CSOM with or without cholesteatoma in which there was ossicular discontinuity. The patients were divided in two groups A and B. In group A patients autologous incus was used and in group B titanium prosthesis either TORP or PORP was used for ossicular replacement. Out of 340 patients as target group, 88 patients were included in study group. Further 88 patients of study group, 51 patients were included in group A; rest 37 patients were included in group B. In group B patients partial ossicular replacement platinum prosthesis was used in 31 patients while in rest 6 patients a total ossicular replacement prosthesis was used. Out of 88 patients, 79 were primary cases and 9 were revision cases. Pre and post operative air bone gap were noted. Pre operatively both of the groups were identical in relation to air-bone gap. The postoperative air-bone gap was calculated as the difference between postoperative air conduction and preoperative bone conduction. On comparison of preoperative and post-operative hearing results there was improvement in air conduction threshold and air bone gap in both the groups. Post operatively difference in air bone gap closure between group A and group B was found statistically significant ( value = 0.032) suggesting better hearing outcomes after using titanium ossicular replacement prosthesis. On comparing partial or total ossicular replacement prosthesis no significant difference was found for the audiological outcome ( = 0.434). Various prognostic factors were also noted for air bone gap closure. Titanium ossicular replacement prosthesis have better outcome, and no significant difference found in audiological outcome for TORP and PORP.
伴有或不伴有胆脂瘤的慢性化脓性中耳炎常导致听骨链中断。本研究旨在比较两组适合进行中耳重建手术的慢性化脓性中耳炎患者使用自体听小骨和钛质假体的效果。这是一项于2012年7月至2013年12月在斋浦尔锡塔普拉的圣雄甘地医学院及医院（拉贾斯坦邦）进行的前瞻性研究。目标群体包括因慢性化脓性中耳炎入院并计划进行中耳重建手术的患者。研究组患者来自目标群体中需要进行特定听骨重建的患者。纳入的患者为伴有或不伴有胆脂瘤且存在听骨链中断的慢性化脓性中耳炎患者。患者被分为A组和B组。A组患者使用自体砧骨，B组使用钛质假体（TORP或PORP）进行听骨置换。在340名作为目标群体的患者中，88名患者被纳入研究组。研究组的88名患者中，51名患者被纳入A组；其余37名患者被纳入B组。B组患者中，31名患者使用部分听骨置换铂质假体，其余6名患者使用全听骨置换假体。88名患者中，79例为初治病例，9例为翻修病例。记录术前和术后的气骨导间距。术前两组在气骨导间距方面相同。术后气骨导间距通过术后气导与术前骨导之差计算得出。比较术前和术后听力结果发现，两组的气导阈值和气骨导间距均有改善。术后发现A组和B组在气骨导间距闭合方面的差异具有统计学意义（值 = 0.032），表明使用钛质听骨置换假体后听力结果更好。比较部分或全听骨置换假体，在听力学结果方面未发现显著差异（ = 0.434）。还记录了气骨导间距闭合的各种预后因素。钛质听骨置换假体效果更好，且TORP和PORP在听力学结果方面未发现显著差异。
