Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear & Hearing, Amsterdam Public Health research institute, De Boelelaan, Amsterdam, the Netherlands.
Department of Neurosciences, University of Padova, Audiology Unit at Treviso Hospital, Treviso, Italy.
Ear Nose Throat J. 2021 Jun;100(5):368-374. doi: 10.1177/0145561319866825. Epub 2019 Sep 26.
To evaluate stapedotomy learning curve with cumulative summation methodology using different success criteria (ie, air-bone gap [ABG] ≤10 dB, ABG ≤15 dB, restoration of interaural symmetry, or hearing threshold gain >20 dB), and to assess patient characteristics influencing or modifying the learning curve.
Retrospective chart review of primary and revision stapedotomy cases performed by surgeon 1 (S1, n = 78) and surgeon 2 (S2, n = 85).
Using the classic criterion for a successful stapedotomy (ABG ≤10 dB), patients with preoperative ABG >34 dB were associated with unsuccessful procedures (S1 = .02; S2 = .07). Revision surgery was associated with unsuccessful outcomes (S1 = .005; S2 = .0012). Cumulative summation plots using different criteria did not show a linear trend of association between stapedotomy success and number of operations, but preoperative characteristics of the patients who underwent stapedotomy significantly influenced the plots. Cumulative summation plots showed an initial increasing tendency with improving results, but when ear surgeons got more skilled, they operated on more complex cases (ie, patients with higher preoperative ABG or revision stapedotomy) and they could not meet the success criteria.
Cumulative summation plots do not seem useful to evaluate the stapedotomy learning curve, as they do not correctly deal with heterogeneous case series. The increasing complexity of the stapedotomy patients during the surgeons' career impacts on the outcome of stapedotomy and confounds the evaluation of the growing skills of the surgeon. Stapedotomy audiological success rates are strongly influenced by the success criteria used.
使用不同的成功标准（即气骨导差[ABG]≤10dB、ABG≤15dB、听力重建或听阈增益>20dB），采用累积和方法评估镫骨切开术的学习曲线，并评估影响或改变学习曲线的患者特征。
回顾性分析由第 1 位（S1）和第 2 位（S2）外科医生进行的初次和修正镫骨切开术的病例。
使用经典的成功镫骨切开术标准（ABG≤10dB），术前 ABG>34dB 的患者手术结果不理想（S1=0.02；S2=0.07）。修正手术与手术结果不理想相关（S1=0.005；S2=0.0012）。使用不同标准的累积和图并未显示镫骨切开术成功率与手术次数之间存在线性关联趋势，但接受镫骨切开术的患者术前特征显著影响了图形。累积和图显示出最初的上升趋势，但随着手术者技术的提高，他们开始对更复杂的病例（即术前 ABG 较高或修正镫骨切开术的患者）进行手术，并且无法达到成功标准。
累积和图似乎不能用于评估镫骨切开术的学习曲线，因为它们不能正确处理异质病例系列。在外科医生的职业生涯中，镫骨切开术患者的复杂性不断增加，这会影响镫骨切开术的结果，并混淆对外科医生技术进步的评估。镫骨切开术的听力成功率受所使用的成功标准强烈影响。
