Hospital Universitario Virgen Macarena, Sevilla, Spain.
Hospital Universitario Virgen Macarena, Sevilla, Spain.
Acta Otorrinolaringol Esp (Engl Ed). 2022 May-Jun;73(3):184-190. doi: 10.1016/j.otoeng.2021.02.003.
The treatment of cholesteatoma is surgical in most cases. When it is indicated, it is preferable to choose a reconstructive surgical technique with the dual purpose of eradicating the disease and preserving or improving the patient's hearing. In 2017, the European Academy of Otology and Neuro-Otology/Japanese Otological Society (EAONO/JOS) published a new cholesteatoma classification. The aims of this study were to determine the influence of the surgical technique used and this classification on patient's hearing outcomes.
A retrospective study that included patients who underwent reconstructive surgery of cholesteatoma between 2012 and 2017 was carried out. Based on pre-surgical computed tomography (CT) images, disease was staged according to the EAONO/JOS classification. Hearing outcomes obtained by pre and postoperative pure tone audiometry were analysed according to the surgical technique used and according to the stage of the disease.
143 patients with no statistically significant differences in hearing thresholds before surgery were included. One year after surgery, all the patients' (P = .01 and P = .001) airpure tone average (PTA) and mean differential auditory threshold had improved significantly. Those patients who underwent tympanoplasty with two-stage canal wall up mastoidectomy presented better postsurgical air PTA and postsurgical mean differential auditory threshold outcomes (P = .007 and P = .014) than those patients who underwent tympanoplasty with canal wall down mastoidectomy. Moreover, the patients who underwent tympanoplasty with two-stage canal wall up mastoidectomy had improved air PTA and mean differential auditory threshold one year after the surgery with statistical significance (P = .001, P = .013). The mean differential auditory threshold was also better (P = .008) in the patients who underwent tympanoplasty with canal wall down mastoidectomy one year after the procedure.
Reconstructive surgical techniques improve hearing one year after surgery. In our study, this improvement was significantly greater with tympanoplasty with two-stage canal wall up mastoidectomy.
在大多数情况下，胆脂瘤的治疗需要手术。当需要手术时，最好选择一种既能根治疾病又能保留或改善患者听力的重建性手术技术。2017 年，欧洲耳科学和神经耳科学学会/日本耳科学会（EAONO/JOS）发布了新的胆脂瘤分类。本研究旨在确定所使用的手术技术和该分类对患者听力结果的影响。
对 2012 年至 2017 年间接受胆脂瘤重建手术的患者进行回顾性研究。根据术前计算机断层扫描（CT）图像，按照 EAONO/JOS 分类对疾病进行分期。根据所使用的手术技术和疾病分期，分析术前和术后纯音测听获得的听力结果。
共纳入 143 例术前听力阈值无统计学差异的患者。术后 1 年，所有患者的（P = .01 和 P = .001）气导平均听阈（PTA）和平均听阈差值均显著改善。行完壁式鼓室成形加二期乳突根治术的患者术后气导 PTA 和平均听阈差值的改善情况明显优于行完壁式鼓室成形加乳突根治术的患者（P = .007 和 P = .014）。此外，行完壁式鼓室成形加二期乳突根治术的患者术后 1 年气导 PTA 和平均听阈差值改善具有统计学意义（P = .001，P = .013）。行完壁式鼓室成形加乳突根治术的患者术后 1 年平均听阈差值也更好（P = .008）。
重建性手术技术可改善术后 1 年的听力。在我们的研究中，完壁式鼓室成形加二期乳突根治术的效果更为显著。
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