Prasad K C, Koneru Prathyusha, Swapanthi M B, Anjali P K, Gopi Indu Varsha
Department of ENT and HNS, Sri Devaraj URS Medical College and Research Centre, Tamaka, Kolar, India.
Indian J Otolaryngol Head Neck Surg. 2022 Aug;74(Suppl 1):148-152. doi: 10.1007/s12070-020-01924-8. Epub 2020 Jun 27.
Ossicular discontinuity is the most common cause of conductive hearing loss. The use of ossicular graft material in ossicular chain reconstruction significantly improves the result in hearing. This study was conducted to compare and analyze the outcome of ossicular reconstruction using allogenic septal spur cartilage and autologous cortical bone in terms of hearing results and graft uptake rates. Study design: randomized clinical trial. Study included 112 patients visiting our ENT department. Patients between 16 and 50 years of age with history of chronic ear discharge and air-bone-gap (ABG) of > 35 dB and ossicular involvement were included in the study. The patients underwent detailed ENT examination, audiological and radiological assessment of temporal bone and those patients with evidence of ossicular erosion were subjected to ossiculoplasty with allogenic septal spur cartilage (group I) and autologous cortical bone (group II) randomly. The patients were followed up to 6 months to analyze functional and anatomical results. 50 patients out of 56 patients (90%) from group I who underwent allogenic septal cartilage ossicular reconstruction showed significant improvement in hearing as assessed by pure tone audiogram after 3 months and 6 months. Remaining 10% of patients who did not show hearing improvement on PTA were reopened after 6 months. It was observed that the stapes head got necrosed in them. 40 patients (72%) out of 56 patients (50%) from group II who underwent autologous cortical bone reconstruction showed hearing improvement. Remaining 16 patients (28%) showed no hearing improvement. They were reopened and ankylosis, dislocation of ossicle and extrusion were noted. In our study, graft uptake rates, formation of retraction pockets, and hearing improvements were analyzed. Complications like ankylosis formation, dislocation of ossicle and extrusion rates were more in the group II compared to group I. Hearing results of group I are better compared to group II and the allogenic septal cartilage being readily available is a good option for ossicular reconstruction.
听骨链中断是传导性听力损失最常见的原因。在听骨链重建中使用听骨移植材料可显著改善听力结果。本研究旨在比较和分析同种异体鼻中隔棘突软骨和自体皮质骨用于听骨重建在听力结果和移植物吸收率方面的效果。研究设计：随机临床试验。研究纳入了112名到我院耳鼻喉科就诊的患者。年龄在16至50岁之间、有慢性耳流脓病史且气骨导差（ABG）>35dB并有听骨受累的患者被纳入研究。患者接受了详细的耳鼻喉科检查、颞骨的听力学和放射学评估，那些有听骨侵蚀证据的患者被随机采用同种异体鼻中隔棘突软骨（第一组）和自体皮质骨（第二组）进行听骨成形术。对患者进行6个月的随访以分析功能和解剖学结果。第一组中接受同种异体鼻中隔软骨听骨重建的56名患者中有50名（90%）在3个月和6个月时经纯音听力图评估显示听力有显著改善。其余10%在PTA上未显示听力改善的患者在6个月后再次手术。观察到他们的镫骨头坏死。第二组中接受自体皮质骨重建的56名患者中有40名（72%）显示听力改善。其余16名患者（28%）未显示听力改善。他们再次手术时发现有听骨链强直、听骨脱位和移植物挤出。在我们的研究中，分析了移植物吸收率、内陷袋的形成和听力改善情况。与第一组相比，第二组中听骨链强直形成、听骨脱位和移植物挤出率等并发症更多。第一组的听力结果优于第二组，并且同种异体鼻中隔软骨易于获取，是听骨重建的一个良好选择。
