Department Speech-Language Pathology Audiology, University of Pretoria, University of Kwazulu Natal Department Otorhinolaryngology Head and Neck Surgery, Hillcrest Hospital, Durban, South Africa.
Department of Otolaryngology Head and Neck, Beijing Luhe Hospital Capital Medical University, Tongzhou District, Beijing, China.
J Int Adv Otol. 2021 Jul;17(4):282-287. doi: 10.5152/iao.2021.9267.
The objective of our study was to ascertain the functional results in terms of air bone gap (ABG) closure over 4 frequencies (0.5, 1, 2, 3 kHz) in patients with chronic otitis media (COM) that underwent tympanoplasty in the presence of a mobile stapes superstructure, and in particular excluding those cases in which the malleus was used in the reconstruction.
A retrospective review of our database between January 1, 2006 and June 1, 2018 identified all cases that underwent one of 3 reconstructive options: the classic Type III tympanoplasty in an open-cavity setting; the "stapes augmentation" (SA) type reconstruction where the stapes superstructure is augmented to the drum by an interposing partial ossiculoplasty of either autologous bone, cartilage, or prosthetic material; and the use of a total articular replacement prosthesis (TORP) from the stapes footplate to the drum in the presence of an intact superstructure.
A total of 116 procedures in 112 patients were identified with a mean ABG reduction from 27 dB to 21 dB (P < .05). There was no significant difference in the mean post-operative ABG result between Type III (19.21 dB), TORP+ (24.90 dB), or SA (20.94 dB) reconstructions (P = .368). Overall, an ABG ≤ 20 dB or "surgical success" was achieved in 56% (n = 65) of cases. Only 20% (n = 23) of cases had "failure" or a post-operative ABG >30 dB.
Tympanoplasty with an intact stapes superstructure in COM is expected to provide acceptable levels of surgical success. We did not identify any particular risk factors associated with improved outcome.
我们的研究目的是确定在慢性中耳炎（COM）患者中，存在活动镫骨上部结构的情况下，行鼓室成形术时，在 4 个频率（0.5、1、2、3 kHz）方面的空气骨导间隙（ABG）闭合的功能结果，特别是排除那些使用锤骨进行重建的病例。
回顾 2006 年 1 月 1 日至 2018 年 6 月 1 日期间我们数据库中的所有病例，这些病例均接受了以下 3 种重建方案之一：开放式鼓室腔的经典 III 型鼓室成形术；通过自体骨、软骨或假体材料的部分听小骨成形术将镫骨上部结构增强到鼓膜的“镫骨增强”（SA）型重建；以及在完整的上部结构存在的情况下，从镫骨脚到鼓膜使用全关节置换假体（TORP）。
共发现 112 例患者的 116 例手术，平均 ABG 从 27 dB 降低到 21 dB（P <.05）。III 型（19.21 dB）、TORP+（24.90 dB）或 SA（20.94 dB）重建的术后平均 ABG 结果无显著差异（P =.368）。总体而言，56%（n = 65）的病例达到了 ABG ≤ 20 dB 或“手术成功”。只有 20%（n = 23）的病例出现“失败”或术后 ABG >30 dB。
在 COM 中存在完整的镫骨上部结构的鼓室成形术有望提供可接受的手术成功率。我们没有发现任何与改善结果相关的特定危险因素。
