Polanik Marc D, Trakimas Danielle R, Castillo-Bustamante Melissa, Cheng Jeffrey T, Kozin Elliott D, Remenschneider Aaron K
Eaton-Peabody Laboratories Massachusetts Eye and Ear Infirmary Boston Massachusetts USA.
Department of Otolaryngology UMass Memorial Medical Center Worcester Massachusetts USA.
Laryngoscope Investig Otolaryngol. 2020 Jun 26;5(4):734-742. doi: 10.1002/lio2.418. eCollection 2020 Aug.
Conventional reporting of postoperative hearing outcomes utilizes a pure-tone averaged air-bone gap (ABG) that is biased toward low frequencies. Consequently, a high-frequency ABG after otologic surgery may go unnoticed. In this study, we evaluate changes in low- and high-frequency ABG following ossiculoplasty.
Retrospective review.
Consecutive series of patients who underwent ossiculoplasty at a single tertiary care center. Patients with pre- and postoperative audiograms were included.
Low-frequency ABG was calculated as the mean ABG at 250, 500, and 1000 Hz. High-frequency ABG was calculated at 4 kHz. Pre- and postoperative ABGs were compared.
Thirty-seven consecutive patients were included. Mean age at surgery was 38 years (range, 7-77 years). Reconstruction materials included: cartilage (N = 4), hydroxyapatite cement (N = 5), and partial or total ossicular replacement prostheses (N = 20 and N = 8, respectively). Postoperatively, the mean low-frequency ABG improved by 11.9 ± 15.1 dB ( < .0001) and the mean high-frequency ABG improved by 5.9 ± 16.0 dB ( = .030). Low-frequency ABG closure was significantly larger than high-frequency ABG closure ( = .007). Mean postoperative persistent high-frequency ABG was 22.0 ± 13.8 dB.
In this series, ossiculoplasty improved ABG across all frequencies, but greater improvements were observed at low frequencies when compared to high frequency. Current reporting standards may not identify persistent high-frequency ABG. Additional study of the mechanisms of high-frequency sound conduction in reconstructed middle ears is needed to improve high-frequency hearing outcomes in ossiculoplasty.
Level 4.
术后听力结果的传统报告采用偏向低频的纯音平均气骨导间距（ABG）。因此，耳科手术后的高频ABG可能未被注意到。在本研究中，我们评估了听骨链成形术后低频和高频ABG的变化。
回顾性研究。
在单一三级医疗中心接受听骨链成形术的连续系列患者。纳入术前和术后均有听力图的患者。
低频ABG计算为250、500和1000Hz处的平均ABG。高频ABG计算为4kHz处的ABG。比较术前和术后的ABG。
纳入37例连续患者。手术时的平均年龄为38岁（范围7 - 77岁）。重建材料包括：软骨（n = 4）、羟基磷灰石水泥（n = 5）以及部分或全听骨链置换假体（分别为n = 20和n = 8）。术后，平均低频ABG改善了11.9±15.1dB（P <.0001），平均高频ABG改善了5.9±16.0dB（P =.030）。低频ABG的闭合明显大于高频ABG的闭合（P =.007）。术后平均持续性高频ABG为22.0±13.8dB。
在本系列研究中，听骨链成形术改善了所有频率的ABG，但与高频相比，低频改善更为明显。当前的报告标准可能无法识别持续性高频ABG。需要对重建中耳高频声音传导机制进行更多研究，以改善听骨链成形术中的高频听力结果。
4级。
