Department of Otorhinolaryngology-Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Maglódi Út 89-91., Budapest, 1106, Hungary.
Department of Otorhinolaryngology-Head and Neck Surgery, Semmelweis University, Szigony Utca 36., Budapest, 1083, Hungary.
Eur Arch Otorhinolaryngol. 2023 Jul;280(7):3177-3185. doi: 10.1007/s00405-023-07835-y. Epub 2023 Feb 18.
To evaluate the efficacy of ossicular chain reconstruction (OCR) in primary and revision surgeries, and to investigate the impact of the number of previous surgeries on hearing outcomes.
Retrospective analysis of cases with OCR due to chronic otitis in a tertiary center between January 2018 and September 2021.
Altogether, 147 cases of ossicle involvement were assessed. In 91.83% (n = 135) OCR was performed, 96.26% of them with titanium TORP/PORP (n = 130), two cases with autologous prosthesis and three with piston. Mean follow-up was 8.8 months. The ABG significantly improved in the total group (TORP/PORP) from a mean (SD) of 30.94 (15.55) to 19.76 (13.36) dB (p < 0.0001) with 60.86% success. The best results were achieved in primary OCR with PORP implantation without cholesteatoma (89.47%). Primary cases have a significantly higher success rate in contrary to revision surgeries (72.27%, vs. 52.00%, p = 0.032). The only relevant predictive factor proved to be the fact of revision (p = 0.029). A statistically significant correlation between the number of previous surgeries and hearing results could not be proved. There was no difference in hearing outcomes between patients with only one or more than one previous surgeries in the revision groups. Neither the presence of cholesteatoma, nor the type of OCR (TOPR/PORP) and the indication of revision had an impact on postoperative ABG.
Titanium prostheses are effective in OCR both in primary and revision cases. It is not the number of previous surgeries, but the fact of revision that influences postoperative hearing results.
评估中耳赝复物重建（ossicular chain reconstruction，OCR）在初次和翻修手术中的疗效，并探讨既往手术次数对听力结果的影响。
对 2018 年 1 月至 2021 年 9 月在一家三级中心因慢性中耳炎行中耳赝复物重建的病例进行回顾性分析。
共评估了 147 例涉及听小骨的病例。在 91.83%（n=135）的病例中进行了 OCR，其中 96.26%（n=130）采用钛质 TORP/PORP，2 例采用自体假体，3 例采用活塞。平均随访时间为 8.8 个月。在 TORP/PORP 组中，总体 ABG 显著改善，从平均（标准差）30.94（15.55）dB 改善至 19.76（13.36）dB（p<0.0001），成功率为 60.86%。初次 OCR 中 PORP 植入且无胆脂瘤的效果最佳（89.47%）。初次手术的成功率明显高于翻修手术（72.27%比 52.00%，p=0.032）。唯一相关的预测因素是翻修手术（p=0.029）。既往手术次数与听力结果之间无统计学相关性。在翻修组中，仅有一次或多次既往手术的患者之间听力结果无差异。在翻修组中，胆脂瘤的存在、OCR 类型（TOPR/PORP）和翻修的适应证均对术后 ABG 无影响。
钛质假体在初次和翻修病例中均能有效行中耳赝复物重建。影响术后听力结果的不是既往手术次数，而是翻修手术。
