Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Semmelweis Egyetem (Semmelweis University), Szigony Utca 36, Budapest, 1083, Hungary.
Department of Voice, Speech and Swallowing Therapy, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.
Eur Arch Otorhinolaryngol. 2024 Oct;281(10):5051-5059. doi: 10.1007/s00405-024-08741-7. Epub 2024 Jun 5.
Revision stapes surgery is a challenging procedure performed in relatively small numbers compared to other middle ear procedures. Despite numerous data on hearing results of different middle ear surgeries, the audiological standards for successful outcome of this procedure are still not clarified. On the basis of well-documented data, we wanted to determine what the expected audiological results and complications are after revision stapes surgery in order to set a realistic threshold for surgical success.
After the protocol registration in the PROSPERO database, a systematic review was performed in multiple databases (PubMed, Cochrane, Web of Science, Scopus, ScienceOpen, ClinicalTrials.gov, Google Scholar) according to PRISMA guidelines. Twelve articles were reviewed according to the inclusion criteria. A total of 1032 cases were obtained for evaluation. A modified version of Newcastle-Ottawa Scale (NOS) was used to assess publication quality.
Average air-bone gap (ABG) gain was 17.3 dB, average air conduction (AC) gain was 17.5 dB. The average postoperative air-bone gap was 11.1 dB. The postoperative ABG distribution was the following 0-10 dB: 53.3%, > 10-20 dB: 28.2%, > 20 dB: 18.5%. SNHL as a surgical complication was described in a total of 17 cases (1.6%), no equilibrium disorder was reported.
The pooled data suggest that revision stapes surgery is an effective solution after failure of previous stapes surgery. However, the results are clearly inferior to those of primary stapedotomies. Hence, we need to apply different expectations and use different standards in the indication and evaluation of this type of surgery.
相较于其他中耳手术，镫骨手术翻修是一种数量相对较少但极具挑战性的手术。尽管有大量关于不同中耳手术听力结果的数据，但该手术成功的听力学标准仍未明确。基于充分记录的数据，我们希望确定镫骨手术翻修后的预期听力结果和并发症，以便为手术成功设定一个现实的门槛。
在 PROSPERO 数据库中进行方案注册后，根据 PRISMA 指南，在多个数据库（PubMed、Cochrane、Web of Science、Scopus、ScienceOpen、ClinicalTrials.gov、Google Scholar）中进行了系统评价。根据纳入标准，共审查了 12 篇文章。使用改良版的纽卡斯尔-渥太华量表（NOS）评估文献质量。
平均气骨导差（ABG）增益为 17.3dB，平均气导增益为 17.5dB。术后平均气骨导差为 11.1dB。术后 ABG 分布如下：0-10dB：53.3%，>10-20dB：28.2%，>20dB：18.5%。总共描述了 17 例（1.6%）手术并发症中的感音神经性听力损失，未报告平衡障碍。
汇总数据表明，在前次镫骨手术失败后，镫骨手术翻修是一种有效的解决方案。然而，结果明显劣于初次镫骨切开术。因此，我们需要在这种手术的适应证和评估中应用不同的期望和标准。
