Fernandez Ignacio Javier, Villari Domenico, Botti Cecilia, Presutti Livio
Department of Otolaryngology, Head and Neck Surgery, University Hospital of Modena, Via del Pozzo, 71, 41100, Modena, Italy.
Eur Arch Otorhinolaryngol. 2019 Mar;276(3):703-710. doi: 10.1007/s00405-019-05280-4. Epub 2019 Jan 11.
Hearing results in revision stapes surgery are largely dependent on the cause of failure, and an appropriate intraoperative diagnosis is crucial for a good outcome. The endoscope allows a detailed exploration of the middle ear cavity and is particularly suitable for the intraoperative assessment of the cause of failure of previous stapes surgery. The present study analyzes the intraoperative findings and outcomes of patients undergoing revision stapes surgery through the endoscopic transcanal approach.
Surgical videos and charts of patients undergoing endoscopic revision stapes surgery from 2008 to 2017 were reviewed retrospectively. Intraoperative findings, difficulties encountered during the surgery and hearing outcomes were evaluated. The feasibility of each surgical step with the totally endoscopic approach or the need for bimanual manipulation was assessed as well.
Thirty-four patients were included in the study. The endoscopic transcanal approach allowed a detailed exploration of the middle ear cavity and an accurate intraoperative diagnosis and management of the different causes of failure of the previous surgery. 89.8% of patients achieved an air-bone gap for the PTA ≤ 20 dBHL and 68.5% a closure of the air-bone gap.
The present study showed that totally endoscopic revision stapes surgery is a feasible, safe and effective procedure. The transcanal endoscopic approach allowed an accurate intraoperative diagnosis without the need for an endaural or retroauricular approach, with the possibility to manage all the possible intraoperative scenarios. A larger series with a longer follow-up is needed to validate the results.
镫骨手术翻修的听力结果很大程度上取决于失败原因，术中进行恰当诊断对取得良好疗效至关重要。内镜可对中耳腔进行详细探查，特别适用于术中评估既往镫骨手术失败的原因。本研究分析了通过内镜经耳道入路进行镫骨手术翻修患者的术中发现及手术结果。
回顾性分析2008年至2017年接受内镜下镫骨手术翻修患者的手术视频和病历。评估术中发现、手术中遇到的困难及听力结果。还评估了全内镜入路各手术步骤的可行性或双手操作的必要性。
34例患者纳入研究。内镜经耳道入路可对中耳腔进行详细探查，并对既往手术失败的不同原因进行准确的术中诊断和处理。89.8%的患者纯音听阈气骨导差≤20 dBHL，68.5%的患者气骨导差闭合。
本研究表明，全内镜镫骨手术翻修是一种可行、安全且有效的手术。经耳道内镜入路无需耳内或耳后入路即可进行准确的术中诊断，并有可能处理所有可能的术中情况。需要更大样本量和更长随访时间的研究来验证结果。
