Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
University of Zurich, Zurich, Switzerland.
Eur Arch Otorhinolaryngol. 2021 Oct;278(10):3795-3800. doi: 10.1007/s00405-020-06487-6. Epub 2020 Nov 26.
Different types of chronic middle ear disease (CMED) present with differing severity of single symptoms, such as discharge, vertigo or hearing loss, which impair health-related quality of life (HRQoL). Here, we aimed to (i) investigate characteristics of HRQoL and (ii) evaluate the association between HRQoL and hearing among different types of CMED.
In this prospective longitudinal cohort study, we included adult patients undergoing surgical treatment for CMED. Primary outcomes included HRQoL assessed by the Zurich Chronic Middle Ear Inventory (ZCMEI-21) and hearing assessed by pure-tone audiometry.
In the included 108 patients (51% females), CMED were chronic otitis media (COM) with (n = 46) or without (n = 22) cholesteatoma, persistent mastoid cavity (with [n = 15] or without [n = 10] recurrent cholesteatoma), revision ossiculoplasty for hearing restoration (n = 14), and postinflammatory meatal fibrosis (n = 1). Preoperatively, the mean ZCMEI-21 score showed statistically significant differences among different types of CMED (p = 0.007) with persistent mastoid cavity without cholesteatoma exhibiting the highest score (34.1, SD 7.7) indicating poor HRQoL. At a mean follow-up period of 183 days, no statistically significant differences in the ZCMEI-21 scores among different types of CMED were observed (p = 0.67).
This study objectifies differences in HRQoL among different types of CMED. In patients with indication for functional surgery only, e.g., persistent mastoid cavity without cholesteatoma, the worst HRQoL was observed. Yet, in these types of CMED, HRQoL guides decision for treatment. Moreover, differences in HRQoL among different types of CMED were not closely associated with hearing, but largely depended on other symptoms, such as discharge or vertigo.
不同类型的慢性中耳疾病（CMED）表现出不同严重程度的单一症状，如分泌物、眩晕或听力损失，这些都会损害健康相关生活质量（HRQoL）。在这里，我们旨在（i）研究 HRQoL 的特征，（ii）评估不同类型的 CMED 中 HRQoL 与听力之间的关系。
在这项前瞻性纵向队列研究中，我们纳入了接受手术治疗的 CMED 成年患者。主要结局包括使用苏黎世慢性中耳量表（ZCMEI-21）评估的 HRQoL 和纯音测听评估的听力。
在纳入的 108 名患者（51%为女性）中，CMED 包括伴有（n=46）或不伴有（n=22）胆脂瘤的慢性中耳炎、持续乳突腔（伴发[ n=15]或不伴发[ n=10]复发性胆脂瘤）、为听力恢复而行的再修复听骨链成形术（n=14）和炎症后耳道纤维性狭窄（n=1）。术前，不同类型的 CMED 的 ZCMEI-21 评分存在统计学显著差异（p=0.007），其中无胆脂瘤的持续乳突腔表现出最高的评分（34.1，SD 7.7），表明 HRQoL 较差。在平均 183 天的随访期间，不同类型的 CMED 之间的 ZCMEI-21 评分没有统计学显著差异（p=0.67）。
本研究客观地反映了不同类型的 CMED 之间的 HRQoL 差异。在仅需要功能性手术的患者中，例如无胆脂瘤的持续乳突腔，观察到最差的 HRQoL。然而，在这些类型的 CMED 中，HRQoL 指导治疗决策。此外，不同类型的 CMED 之间的 HRQoL 差异与听力没有密切关系，但在很大程度上取决于其他症状，如分泌物或眩晕。
