Department of Otolaryngology - Head and Neck Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Department of Neurotology, Michigan Ear Institute, Farmington Hills, Michigan.
Otol Neurotol. 2022 Feb 1;43(2):165-169. doi: 10.1097/MAO.0000000000003429.
Review surgical outcomes of stapedotomy in patients with concomitant otosclerosis and superior semicircular canal dehiscence.
Retrospective case review.
Tertiary referral center.
Patients with otosclerosis and radiographic superior semicircular canal dehiscence undergoing stapedotomy between 2008 and 2020.
Stapedotomy.
Pre- and postoperative hearing and unmasking of third-window symptoms. Hearing was measured by air conduction (AC) and bone conduction (BC) pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). Third-window symptoms included hyperacusis, autophony, sound- or pressure-induced vertigo, imbalance, or oscillopsia.
Twenty patients with otosclerosis and radiographic superior semicircular canal dehiscence underwent stapedotomy, 13 primary and 7 revision. Mean AC PTA was 49.3 dB preoperatively and 35.6 dB postoperatively (p = 0.0077), while the ABG improved on average from 23.9 to 9.68 dB (p < 0.0001). The ABG improved to ≤10 dB in 12/20 patients (60%), and ≤20 dB in 18/20 patients (90%). There was no significant difference in BC PTA or WRS postoperatively. Two patients (10%) experienced potential transient unmasking of third-window symptoms-hyperacusis and prolonged imbalance-which both resolved. There were no other complications. There was no significant difference in audiologic outcomes or unmasking of third window symptoms between primary or revision cases.
Persistent conductive hearing loss is common following stapedotomy for otosclerosis in patients with concomitant superior semicircular canal dehiscence. However, a majority of patients can achieve excellent hearing outcomes, while unmasking of third window symptoms appears to be rare. Radiographic superior semicircular canal dehiscence may not be an absolute contraindication to stapes surgery for otosclerosis.
回顾同时患有耳硬化症和上半规管裂的患者行镫骨手术的结果。
回顾性病例研究。
三级转诊中心。
2008 年至 2020 年间行镫骨手术治疗耳硬化症和影像学上的上半规管裂的患者。
镫骨手术。
术前和术后听力和第三窗口症状的掩盖情况。听力通过气导（AC）和骨导（BC）纯音平均值（PTA）、气骨导间隙（ABG）和言语识别得分（WRS）进行测量。第三窗口症状包括听觉过敏、自声增强、声音或压力引起的眩晕、失衡或眼震。
20 例同时患有耳硬化症和影像学上的上半规管裂的患者接受了镫骨手术，其中 13 例为初次手术，7 例为翻修手术。术前平均 AC PTA 为 49.3dB，术后为 35.6dB（p=0.0077），ABG 平均从 23.9 改善至 9.68dB（p<0.0001）。20 例患者中有 12 例（60%）的 ABG 改善至≤10dB，18 例（90%）患者的 ABG 改善至≤20dB。术后 BC PTA 或 WRS 无显著差异。2 例（10%）患者出现潜在的第三窗口症状短暂性未掩盖-听觉过敏和延长的失衡-均已解决。无其他并发症。初次手术和翻修手术的听力结果或第三窗口症状未掩盖情况无显著差异。
同时患有上半规管裂的耳硬化症患者行镫骨手术后，持续性传导性听力损失较为常见。然而，大多数患者可以获得良好的听力结果，而第三窗口症状的暴露似乎很少见。影像学上的上半规管裂可能不是镫骨手术治疗耳硬化症的绝对禁忌证。
