Coleman Holli, Tikka Theofano, Curran John, Iyer Arunachalam
Department of Ear, Nose, and Throat Surgery, University Hospital Monklands, North Lanarkshire, Airdrie, ML6 0JS, UK.
Eur Arch Otorhinolaryngol. 2023 Jan;280(1):89-96. doi: 10.1007/s00405-022-07451-2. Epub 2022 May 22.
The relatively new technique of trans-canal endoscopic ear surgery (TEES) when compared to microsurgery for ossiculoplasty has advantages of better visualization and no external incision but also has the disadvantage of being a one-handed procedure. Our study aimed to compare audiometric outcomes following ossiculoplasty performed via TESS with results of microsurgery.
Data from a prospective audit of 157 consecutive patients who underwent ossiculoplasty by a single otologist from 2009 to 2018 was analyzed. TEES was introduced in the department in 2014; therefore, all patients before this period underwent microsurgery. Patients were classified by surgical approach, TEES, or microsurgery. Audiological outcomes were recorded at 3 and 12 months postoperatively and compared to pre-operative levels. Other variables included were the condition of stapes and reconstruction material used.
Of the 157 cases, 50 were TEES and 107 were microsurgery (81 microscope only and 27 combined with endoscope). There was statistically significant improvement (p < 0.001) in AC (43.4 dB pre-operatively, 36.2 dB postoperatively), BC (20.3 dB pre-operatively, 17.6 dB postoperatively), and ABG (21.8 dB pre-operatively, 16.7 dB postoperatively) in the total cohort. Both groups achieved an ABG better than 20 dB; 72% in TEES, 73% in the microscopic group, and there was no significant difference. There was no change in hearing at 12 months when compared to 3 months. No statistically significant difference was noted based on stapes condition, type of material used for ossiculoplasty, or tympanic membrane graft.
TEES is safe and as effective as microsurgery in ossiculoplasty with possibly much less pain and morbidity.
与用于听骨链成形术的显微手术相比，经外耳道内镜耳手术（TEES）这项相对较新的技术具有可视化更好且无外部切口的优点，但也有单手操作的缺点。我们的研究旨在比较经TEES进行听骨链成形术后的听力测量结果与显微手术的结果。
分析了2009年至2018年由一名耳科医生对157例连续接受听骨链成形术患者进行的前瞻性审计数据。TEES于2014年引入该科室；因此，在此之前的所有患者均接受显微手术。患者按手术方式分为TEES组或显微手术组。在术后3个月和12个月记录听力结果，并与术前水平进行比较。其他纳入变量包括镫骨情况和所使用的重建材料。
在157例病例中，50例为TEES手术，107例为显微手术（81例仅用显微镜，27例联合内镜）。整个队列的气导（术前43.4 dB，术后36.2 dB）、骨导（术前20.3 dB，术后17.6 dB）和耳声发射气骨导差（术前21.8 dB，术后16.7 dB）有统计学显著改善（p < 0.001）。两组的耳声发射气骨导差均优于20 dB；TEES组为72%，显微镜组为73%，无显著差异。与术后3个月相比，术后12个月听力无变化。基于镫骨情况、听骨链成形术所用材料类型或鼓膜移植，未发现统计学显著差异。
在听骨链成形术中，TEES是安全的，与显微手术效果相同，且可能疼痛和发病率更低。
