Li Y, Schlegel Christoph, Linder Thomas
Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an 710004, China.
Department of Otolaryngology Head and Neck Surgery, Kantonsspital Luzern, Spitalstrasse, CH 6000 Luzerne, Switzerland.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Apr 7;55(4):332-337. doi: 10.3760/cma.j.cn115330-20190311-00132.
To compare the effectiveness of primary malleostapedotomy with revision malleostapedotomy for otosclerosis. From April 2002 to December 2017, 70 consecutive patients with otosclerosis who underwent malleostapedotomy were reviewed. Depending on the primary malleostapedotomy (P-MS) or revision malleostapedotomy (R-MS), the patients were divided into P-MS group or R-MS group.The intraoperative findings and hearing results before and after surgery were compared between the two groups. ALL data were analyzed using SPSS 23. Totally 73 malleostapedotomy were performed in 73 ears of 70 patients, including 38 P-MS and 35 R-MS. There was no significant difference between the two groups in sex ratio, age and operated ears (0.05 for all). The most common finding at P-MS was incus fixation (50.0%, 19/38) versus prosthesis displacement for R-MS (60.0%, 21/35) . Overall, the air-bone gap (ABG) improvement in P-MS were (18.1±8.2) dB in 0.5-3 kHz and (18.3±8.5) dB in 0.5-4 kHz, without significant difference to those in R-MS (0.05) . 31.4% of R-MS in 0.5-3 kHz and 22.9% R-MS in 0.5-4 kHz achieved an ABG<10 dB, significantly lower than those of P-MS (65.8% in 0.5-3 kHz and 57.9% in 0.5-4kHz; 0.05). Failure (postoperative ABG>30 dB) occurred in 11.4% in R-MS and 0 in P-MS (for 0.5-3 kHz and 0.5-4 kHz). The incidence of postoperative sensorineural hearing loss (>10 dB increase in bone conduct) in R-MS group was 8.6% in 0.5-3 kHz and 0.5-4 kHz, without significant difference to those in P-MS (0.05) . 80.0% (20/25) of first R-MS achieved ABG<20 dB, compared to 37.5% (3/8) of second R-MS with ABG<20 dB. Although both P-MS and R-MS can significantly improve hearing, with similar risk of inner ear damage, R-MS is less effective and poses a higher risk of failure than P-MS. For patients with insufficient hearing improvement after first R-MS, conventional hearing aids or implantable hearing devices may be considered as an alternative.
比较初次镫骨手术与翻修镫骨手术治疗耳硬化症的疗效。回顾2002年4月至2017年12月期间连续70例行镫骨手术的耳硬化症患者。根据初次镫骨手术（P-MS）或翻修镫骨手术（R-MS），将患者分为P-MS组或R-MS组。比较两组患者的术中发现及手术前后的听力结果。所有数据采用SPSS 23进行分析。70例患者的73耳共进行了73次镫骨手术，其中P-MS 38耳，R-MS 35耳。两组患者在性别比例、年龄和患耳方面无显著差异（均P>0.05）。P-MS最常见的发现是砧骨固定（50.0%，19/38），而R-MS最常见的是假体移位（60.0%，21/35）。总体而言，P-MS组在0.5 - 3kHz气骨导间距（ABG）改善为（18.1±8.2）dB，在0.5 - 4kHz为（18.3±8.5）dB，与R-MS组无显著差异（P>0.05）。R-MS组在0.5 - 3kHz有31.4%、在0.5 - 4kHz有22.9%的患者ABG<10dB，显著低于P-MS组（0.5 - 3kHz为65.8%，0.5 - 4kHz为57.9%；P<0.05）。R-MS组失败率（术后ABG>30dB）在0.5 - 3kHz和0.5 - 4kHz为11.4%，P-MS组为0（P<0.05）。R-MS组术后感音神经性听力损失（骨导增加>10dB）在0.5 - 3kHz和0.5 - 4kHz的发生率为8.6%，与P-MS组无显著差异（P>0.05）。首次R-MS中有80.0%（20/25）的患者ABG<20dB，而第二次R-MS中只有37.5%（3/8）的患者ABG<20dB。虽然P-MS和R-MS均能显著改善听力，内耳损伤风险相似，但R-MS效果较差且失败风险高于P-MS。对于首次R-MS后听力改善不足的患者，可考虑使用传统助听器或植入式听力设备作为替代方案。
