Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner", Rostock University Medical Center, Doberaner Strasse 137-139, 18057, Rostock, Germany.
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
Eur Arch Otorhinolaryngol. 2020 Jun;277(6):1637-1643. doi: 10.1007/s00405-020-05881-4. Epub 2020 Mar 6.
To assess the change in health-related quality of life (HRQoL) in patients undergoing mastoid cavity obliteration.
Patients who had undergone canal wall-down mastoidectomy for chronic otitis media with creation of a persistent mastoid cavity and underwent revision tympanomastoid surgery including mastoid cavity obliteration using autologous material were included. Audiological measurements including air conduction (AC) and bone conduction (BC) pure-tone averages (PTA) and the air-bone gap (ABG) were assessed. Health-related Quality of Life (HRQoL) was assessed by the Zurich Chronic Middle Ear Inventory (ZCMEI-21) pre- and postoperatively.
A total of 25 patients (16 females and 9 males; mean age 51.6 years, 14 right and 11 left ears) were included. Patients were reexamined after a mean follow-up period of 9.2 months (SD = 6.5) after obliteration of the mastoid cavity. Compared to the preoperative visit, patients showed a significantly reduced AC PTA at the postoperative visit (mean difference: - 4.1; SD = 10.4, p = 0.045). The mean ZCMEI-21 score changed from 31.7 (SD = 14.5) preoperatively to 17.4 (SD = 15.1) postoperatively (mean difference: - 14.3; SD = 19.1; p = 0.0002). The mean ZCMEI-21 score changes were neither correlated to the AC PTA shift (p = 0.60) nor to the ABG shift (p = 0.66).
This is the first study reporting a highly significant and clinically important improvement in HRQoL after mastoid cavity obliteration in a prospective setting. The improvement in HRQoL was not correlated to the hearing improvement. As a clinical implication, we provide evidence for a substantial subjective benefit of the surgical obliteration of a symptomatic mastoid cavity and, therefore, encourage this surgical procedure.
评估接受乳突腔填塞患者的健康相关生活质量(HRQoL)变化。
纳入接受完壁式乳突切除术(伴持续乳突腔形成的慢性中耳炎)并接受 Revision tympanomastoid surgery(包括使用自体材料进行乳突腔填塞)的患者。评估听力学测量值,包括气导(AC)和骨导(BC)纯音平均值(PTA)和气骨导间隙(ABG)。术前和术后使用苏黎世慢性中耳量表(ZCMEI-21)评估健康相关生活质量(HRQoL)。
共纳入 25 例患者(16 名女性和 9 名男性;平均年龄 51.6 岁,14 例右侧和 11 例左侧耳朵)。在乳突腔填塞后平均 9.2 个月(SD=6.5)进行了再次检查。与术前就诊相比,患者在术后就诊时的 AC PTA 明显降低(平均差异:-4.1;SD=10.4,p=0.045)。ZCMEI-21 评分从术前的 31.7(SD=14.5)变为术后的 17.4(SD=15.1)(平均差异:-14.3;SD=19.1;p=0.0002)。ZCMEI-21 评分变化与 AC PTA 变化无相关性(p=0.60),也与 ABG 变化无相关性(p=0.66)。
这是第一项在前瞻性研究中报告乳突腔填塞后 HRQoL 显著且具有临床重要意义改善的研究。HRQoL 的改善与听力改善无关。这一临床发现为症状性乳突腔填塞手术带来实质性主观获益提供了证据,因此我们鼓励进行此类手术。