Wardenga Nina, Diedrich Victoria, Waldmann Bernd, Lenarz Thomas, Maier Hannes
Cluster of Excellence Hearing4all, Hannover, Germany,
Department of Otolaryngology, Hannover Medical School, Hannover, Germany,
Audiol Neurootol. 2020;25(3):125-132. doi: 10.1159/000502994. Epub 2020 Feb 11.
The purpose of the present study was to determine the fraction of patients with mixed hearing loss who can or cannot expect benefit from power hearing aids (HAs) after stapes surgery.
The audiological outcome of 374 stapes surgeries was used to calculate the patients' individual postoperative requirements in terms of gain and output of HAs. These requirements were compared to the available gain and output provided by state-of-the-art power HAs at 0.5, 1.0, 2.0, and 4.0 kHz. According to these comparisons, ears were divided into three groups. For G0, required gain and output lay within the corresponding technical limits of the HAs at all frequencies. In G1, one or both requirements could not be fulfilled at 1 frequency. G2 combined all ears where the requirements lay beyond the HA's technical limitations at 2 or more frequencies.
Stapes surgery resulted in an improvement of air-bone gap (ABG) in 84.5% of the cases by 15.7 dB on average. Based on pure-tone average (0.5, 1.0, 2.0, 4.0 kHz), 40.6% of all cases showed an ABG ≤10 dB. 44.9% of all cases did no longer need a HA after stapes surgery. A power HA would fulfill both audiological criteria at all 4 frequencies in 81.6% of cases that needed a HA postoperatively. However, 18.4% would not be sufficiently treatable at 1 or more frequencies (15.0% in G1, 3.4% in G2).
The present study identified a subset of patients with mixed hearing loss after stapes surgery that cannot be treated sufficiently with available power HAs. As the residual ABG is an important reason for this lack of treatment success, the advancement of alternative hearing devices that circumvent the middle ear, such as powerful active middle ear implants, is indicated.
本研究的目的是确定混合性听力损失患者中，在镫骨手术后能够或无法从耳背式助听器（HA）中获益的患者比例。
374例镫骨手术的听力学结果用于计算患者术后对HA增益和输出的个体需求。将这些需求与现有先进耳背式助听器在0.5、1.0、2.0和4.0kHz频率下提供的增益和输出进行比较。根据这些比较，将耳朵分为三组。对于G0组，所需增益和输出在所有频率下均处于HA相应的技术限制范围内。在G1组中，在1个频率下无法满足一项或两项需求。G2组合并了所有在2个或更多频率下需求超出HA技术限制的耳朵。
镫骨手术使84.5%的病例气骨导间距（ABG）平均改善了15.7dB。基于纯音平均值（0.5、1.0、2.0、4.0kHz），所有病例中有40.6%的ABG≤10dB。所有病例中有44.9%在镫骨手术后不再需要HA。对于术后需要HA的病例，81.6%的耳背式助听器在所有4个频率下都能满足两项听力学标准。然而，18.4%的病例在1个或更多频率下无法得到充分治疗（G1组为15.0%，G2组为3.4%）。
本研究确定了镫骨手术后混合性听力损失患者中的一个亚组，他们无法用现有的耳背式助听器得到充分治疗。由于残余ABG是治疗失败的重要原因，因此需要研发替代的听力设备，如强大的有源中耳植入物，以绕过中耳。
