Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea; Department of Medical Informatics, Korea University College of Medicine, Seoul, Republic of Korea.
Am J Otolaryngol. 2023 Nov-Dec;44(6):103969. doi: 10.1016/j.amjoto.2023.103969. Epub 2023 Jul 5.
Sometimes performing PORP adequately is challenging when the stapes is tilted or the suprastructure is partially damaged owing to inflammation or infection. In such cases, the implementation of a TORP bypassing the stapes can be a useful alternative. This study aimed to investigate whether bypassing the stapes suprastructure during total ossicular replacement prosthesis (TORP) affects postoperative complications or audiological outcomes.
Among 104 patients who underwent open cavity mastoidectomy and ossiculoplasty using a titanium prosthesis at Korea University Ansan Hospital between January 2012 and December 2019, we compared the preoperative and postoperative audiological results and surgical complications of 52, 21, and 31 patients who underwent partial ossicular replacement prosthesis (PORP), TORP bypassing the remaining stapes suprastructure, and TORP on the stapes footplate or oval window, respectively.
The air-bone gap before surgery was significantly different in the TORP on the stapes footplate group (34.2 ± 12.0 dB) than that in the PORP (22.9 ± 13.8 dB) and TORP bypassing the stapes groups (20.7 ± 11.5 dB, p < 0.001). After surgery, there were no significant differences among the groups (p = 0.818). The air-bone gap difference before surgery was associated with the presence of stapes before surgery (p < 0.001). There was no difference in the proportion of postoperative tympanic perforation, whether it was a revision surgery, malleus status, or the size of perforation of the tympanic membrane among the three groups.
When performing ossiculoplasty using TORP, bypassing the stapes did not affect surgical and audiologic outcomes.
当镫骨倾斜或由于炎症或感染导致听骨上部结构部分受损时，有时难以充分进行 PORP。在这种情况下，绕过镫骨的 TORP 可以作为一种有用的替代方法。本研究旨在探讨在全听骨置换假体（TORP）期间绕过镫骨上部结构是否会影响术后并发症或听力结果。
在韩国大学安山医院 2012 年 1 月至 2019 年 12 月期间接受开放式鼓室乳突切除术和钛假体听骨成形术的 104 例患者中，我们比较了 52 例接受部分听骨置换假体（PORP）、21 例和 31 例分别接受绕过残留镫骨上部结构的 TORP、镫骨脚或卵圆窗 TORP 的患者的术前和术后听力结果以及手术并发症。
镫骨脚 TORP 组（34.2±12.0 dB）的术前气骨间隙明显大于 PORP 组（22.9±13.8 dB）和绕过镫骨 TORP 组（20.7±11.5 dB，p<0.001）。手术后，各组之间无显着差异（p=0.818）。术前气骨间隙差异与术前镫骨存在有关（p<0.001）。三组之间术后鼓膜穿孔的比例、是否为翻修手术、锤骨状态或鼓膜穿孔大小均无差异。
在使用 TORP 进行听骨成形术时，绕过镫骨不会影响手术和听力结果。
