Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, 3508 GA, Utrecht, The Netherlands.
Brain Center, University Medical Centre Utrecht, Utrecht, The Netherlands.
Eur Arch Otorhinolaryngol. 2023 Oct;280(10):4327-4337. doi: 10.1007/s00405-023-08091-w. Epub 2023 Jul 6.
To review hearing and surgical outcomes after reconstructive middle ear surgery in class 4 congenital middle ear anomalies (CMEA), e.g., patients with oval- or round window atresia of dysplasia.
Pubmed/Medline, Embase and Cochrane library.
Articles containing data on hearing outcomes and complications after reconstructive ear surgery in class 4 anomalies were analyzed and critically appraised. The following data were included and reviewed: patient demographics, audiometric testing, surgical techniques, complications, revision surgeries and their outcomes. Risk of bias was determined, and GRADE certainty of evidence was assessed. Primary outcomes were postoperative air conduction thresholds (AC), change in AC, and success rates (closure of the ABG to within 20 dB), the occurrence of complications (most importantly sensorineural hearing loss) and the long-term stability of hearing results (> 6-month follow-up) and occurrence of recurrence of preoperative hearing loss.
Success rates varied from 12.5 to 75% at long-term follow-up with larger cohorts reporting success rates around 50%, mean postoperative gain in AC varied from 4.7 to 30 dB and - 8.6 to 23.6 dB at, respectively, short- and long-term follow-up. No postoperative change in hearing occurred in 0-33.3% of ears, and recurrence of hearing loss occurred in 0-66.7% of ears. SNHL occurred in a total of seven ears across all studies of which three experienced complete hearing loss.
Reconstructive surgery can be an effective treatment option which should be considered in patients with very favorable baseline parameters, while also considering the substantial risk of recurrence of hearing loss, the possibility of unchanged hearing despite surgery and the rare occurrence of SNHL.
2c.
回顾 4 类先天性中耳畸形（CMEA）患者（例如，圆窗或卵圆窗闭锁畸形患者）行中耳重建术后的听力和手术效果。
PubMed/Medline、Embase 和 Cochrane 图书馆。
分析并批判性评估了关于 4 类畸形患者中耳重建术后听力结果和并发症的文章。纳入和回顾了以下数据：患者人口统计学、听力测试、手术技术、并发症、翻修手术及其结果。确定了偏倚风险，并评估了证据的 GRADE 确定性。主要结局是术后气导阈值（AC）、AC 变化和成功率（ABG 闭合至 20dB 以内）、并发症（最重要的是感音神经性听力损失）的发生以及听力结果的长期稳定性（>6 个月随访）和术前听力损失的复发。
长期随访成功率为 12.5%-75%，较大的队列报告成功率约为 50%，术后平均 AC 增益在短期和长期随访时分别为 4.7-30dB 和-8.6-23.6dB。0-33.3%的耳朵术后听力无变化，0-66.7%的耳朵听力损失复发。所有研究中共有 7 只耳朵出现 SNHL，其中 3 只耳朵完全失聪。
重建手术是一种有效的治疗选择，对于基线参数非常有利的患者应考虑手术，但同时也应考虑到听力损失复发的高风险、尽管手术但听力无变化的可能性以及 SNHL 的罕见发生。
2c。
