Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington Hills, MI, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Ann Otol Rhinol Laryngol. 2021 Jul;130(7):769-774. doi: 10.1177/0003489420971337. Epub 2020 Nov 12.
To describe audiologic outcomes following hydroxyapatite bone cement fixation of stapedotomy prostheses.
A retrospective case review at a tertiary neurotology referral center was performed of patients undergoing primary or revision stapedotomy between 2010 and 2017. Patients with hydroxyapatite bone cement fixation of stapes prostheses were assessed. Pre- and postoperative hearing was compared, consisting of air conduction (AC) and bone conduction (BC) pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). Short and long-term outcomes were assessed.
Forty-six patients with otosclerosis underwent stapedotomy with bone cement fixation: 21 primary cases and 25 revision cases, with an average follow-up time of 17 months. Mean AC PTA was 56 dB preoperatively, and 34 dB postoperatively ( < .0001), while the ABG improved on average from 27 dB to 9 dB ( < .0001). There was no significant difference in postoperative ABG between primary and revision stapes surgery (6 dB vs 10 dB, = .07). These results persisted through long-term follow-up in a subgroup of patients with significantly longer follow-up time (mean 44 months). There was no significant change in BC PTA or word recognition scores. Three patients underwent subsequent revisions, one patient developed sensorineural hearing loss.
Stapedotomy with bone cement fixation of the prosthesis provides excellent hearing outcomes in both primary and revision treatment of otosclerosis. Results are consistent and stable through long-term follow-up. The use of bone cement should be incorporated into the surgical armamentarium of the otologist for the prevention and treatment of loose-wire syndrome and incus necrosis.
描述羟基磷灰石骨水泥固定镫骨假体后的听力结果。
对 2010 年至 2017 年期间在一家三级神经耳科转诊中心接受初次或翻修镫骨手术的患者进行了回顾性病例分析。评估了接受羟基磷灰石骨水泥固定镫骨假体的患者。比较了术前和术后的听力，包括气导（AC）和骨导（BC）纯音平均值（PTA）、气骨导差（ABG）和言语识别率（WRS）。评估了短期和长期结果。
46 例耳硬化症患者行镫骨手术并用骨水泥固定：21 例初次手术，25 例翻修手术，平均随访时间为 17 个月。术前平均 AC PTA 为 56 dB，术后为 34 dB（<0.0001），ABG 平均从 27 dB 改善至 9 dB（<0.0001）。初次和翻修镫骨手术的术后 ABG 无显著差异（6 dB 与 10 dB，=0.07）。在具有显著较长随访时间的患者亚组中，这些结果在长期随访中持续存在（平均随访时间 44 个月）。BC PTA 或言语识别率无显著变化。3 例患者行后续翻修手术，1 例患者发生感音神经性听力损失。
镫骨手术并用骨水泥固定假体在耳硬化症的初次和翻修治疗中均可提供良好的听力结果。结果在长期随访中是一致和稳定的。骨水泥的使用应纳入耳科医生的手术武器库，以预防和治疗松动线综合征和砧骨坏死。
