Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
Eur Arch Otorhinolaryngol. 2024 Jun;281(6):2931-2939. doi: 10.1007/s00405-023-08407-w. Epub 2024 Jan 26.
To evaluate the effect of piston diameter in patients undergoing primary stapes surgery on audiometric results and postoperative complications.
A retrospective single-center cohort study was performed. Adult patients who underwent primary stapes surgery between January 2013 and April 2022 and received a 0.4-mm-diameter piston or a 0.6-mm-diameter piston were included. The primary and secondary outcomes were pre- and postoperative pure-tone audiometry, pre- and postoperative speech audiometry, postoperative complications, intraoperative anatomical difficulties, and the need for revision stapes surgery. The pure-tone audiometry included air conduction, bone conduction, and air-bone gap averaged over 0.5, 1, 2 and 3 kHz.
In total, 280 otosclerosis patients who underwent 321 primary stapes surgeries were included. The audiometric outcomes were significantly better in the 0.6 mm group compared to the 0.4 mm group in terms of gain in air conduction (median = 24 and 20 dB, respectively), postoperative air-bone gap (median = 7.5 and 9.4 dB, respectively), gain in air-bone gap (median = 20.0 and 18.1 dB, respectively), air-bone gap closure to 10 dB or less (75% and 59%, respectively) and 100% speech reception (median = 75 and 80 dB, respectively). We found no statistically significant difference in postoperative dizziness, postoperative complications and the need for revision stapes surgery between the 0.4 and 0.6 mm group. The incidence of anatomical difficulties was higher in the 0.4 mm group.
The use of a 0.6-mm-diameter piston during stapes surgery seems to provide better audiometric results compared to a 0.4-mm-diameter piston, and should be the preferred piston size in otosclerosis surgery. We found no statistically significant difference in postoperative complications between the 0.4- and 0.6-mm-diameter piston. Based on the results, we recommend always using a 0.6-mm-diameter piston during primary stapes surgery unless anatomical difficulties do not allow it.
评估在接受初次镫骨手术的患者中，活塞直径对听力结果和术后并发症的影响。
进行了一项回顾性单中心队列研究。纳入 2013 年 1 月至 2022 年 4 月期间接受初次镫骨手术且植入 0.4mm 直径活塞或 0.6mm 直径活塞的成年患者。主要和次要结局为术前和术后纯音听阈测试、术前和术后言语测听、术后并发症、术中解剖困难以及是否需要翻修镫骨手术。纯音听阈测试包括空气传导、骨传导以及 0.5、1、2 和 3kHz 处的平均气骨导差。
共纳入 280 例耳硬化症患者，他们接受了 321 例初次镫骨手术。与 0.4mm 组相比，0.6mm 组在空气传导增益（中位数分别为 24dB 和 20dB）、术后气骨导差（中位数分别为 7.5dB 和 9.4dB）、气骨导差增益（中位数分别为 20.0dB 和 18.1dB）、气骨导差缩小至 10dB 或以下（分别为 75%和 59%）和 100%言语识别率（中位数分别为 75dB 和 80dB）方面的听力结果均显著改善。0.4mm 组和 0.6mm 组在术后头晕、术后并发症和需要翻修镫骨手术方面无统计学显著差异。0.4mm 组的解剖困难发生率更高。
与 0.4mm 直径活塞相比，在镫骨手术中使用 0.6mm 直径活塞似乎可提供更好的听力结果，应成为耳硬化症手术的首选活塞尺寸。我们发现 0.4mm 直径活塞和 0.6mm 直径活塞之间的术后并发症无统计学显著差异。基于研究结果，我们建议在初次镫骨手术中始终使用 0.6mm 直径活塞，除非存在解剖困难。
