Faculty of Medicine Carl Gustav Carus, Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden Saxony, Germany.
Department of Medicine, Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany.
Eur Arch Otorhinolaryngol. 2021 Sep;278(9):3217-3225. doi: 10.1007/s00405-020-06397-7. Epub 2020 Oct 3.
The aim of this study was to determine whether preoperative depressive symptoms influence health-related quality of life (HRQOL) after middle ear surgery in patients with chronic otitis media (COM).
This prospective clinical case study was conducted at a tertiary referral center. All 102 patients who had undergone middle ear surgery for COM were assessed clinically and by audiometric testing (pure tone audiometry) in pre- and postoperative settings. Disease-specific HRQOL was assessed by the validated chronic otitis media outcome test 15 (COMOT-15) and the Zurich chronic middle ear inventory (ZCMEI-21). General HRQOL was measured using the short form 36 (SF-36). Depressive symptoms were assessed using the patient health questionnaire (PHQ-D). The Charlson comorbidity index (CCI) was used to classify comorbidities. The middle ear status was determined using the ossiculoplasty outcome parameter staging (OOPS) index.
After middle ear surgery, the total COMOT-15 and ZCMEI-21 scores improved significantly (p < 0.001). General HRQOL (total SF-36 score) was unaffected by surgery (p < 0.05). Patients without elevated depressive symptoms had significantly better total scores for the COMOT-15 (p < 0.01), ZCMEI-21 (p < 0.001), and for SF-36 (p < 0.001) postoperatively. The results of the multiple regression analyses show that, after adjusting for the OOPS, CCI, and hearing improvement, preoperative depressiveness was significantly associated with worse postoperative COMOT-15 and ZCMEI-21 outcome scores (β = 0.425 and β = 0.362, p < 0.001).
Preoperative depressiveness was an essential predictive factor for HRQOL in patients with COM. This should be considered during patient selection to provide more suitable preoperative counseling.
本研究旨在确定慢性中耳炎（COM）患者中耳手术后术前抑郁症状是否会影响健康相关生活质量（HRQOL）。
这是一项在三级转诊中心进行的前瞻性临床病例研究。所有接受 COM 中耳手术的 102 例患者均在术前和术后进行临床和听力测试（纯音测听）评估。采用经验证的慢性中耳炎结局测试 15 项（COMOT-15）和苏黎世慢性中耳炎量表 21 项（ZCMEI-21）评估疾病特异性 HRQOL。使用简明健康调查问卷（PHQ-D）评估抑郁症状。使用 Charlson 合并症指数（CCI）对合并症进行分类。中耳状况采用听骨链重建结果参数分期（OOPS）指数确定。
中耳手术后，COMOT-15 和 ZCMEI-21 总分显著改善（p<0.001）。手术对一般 HRQOL（总 SF-36 评分）无影响（p<0.05）。无抑郁症状升高的患者术后 COMOT-15（p<0.01）、ZCMEI-21（p<0.001）和 SF-36 总分（p<0.001）显著改善。多元回归分析结果表明，在调整 OOPS、CCI 和听力改善后，术前抑郁与术后 COMOT-15 和 ZCMEI-21 结局评分较差显著相关（β=0.425 和β=0.362，p<0.001）。
术前抑郁是 COM 患者 HRQOL 的重要预测因素。在选择患者时应考虑这一点，以便提供更合适的术前咨询。
