Singh Jaskaran, Sood Arvinder Singh, Bhardwaj Bhanu, Parkash Divya, Seth Sania, Kalra Harmanjot Singh, Aulakh Dhanwant
Sri Guru Ram Das University of Health Sciences, Amritsar, Punjab India.
Mohali, India.
Indian J Otolaryngol Head Neck Surg. 2024 Dec;76(6):5757-5766. doi: 10.1007/s12070-024-05087-8. Epub 2024 Sep 18.
Ossicular defects due to chronic ear disease are common and continuous problem for otologic surgeon. Ossicular reconstruction prostheses are widely used to restore ossicular continuity when the incus is eroded or missing, for example, in chronic otitis media or cholesteatoma. In this regard; the total and partial ossicular replacement prosthesis (TORP and PORP) have been enthusiastically endorsed. Traditionally, either PORP or TORP is applicable, depending primarily on whether there is an intact stapes superstructure or only a stapes footplate. Laser interferometer studies on the mechanics of the reconstructed human middle ear have shown that, from a mechanical viewpoint, the malleus to footplate type of reconstruction gives a more favourable result compared with a malleus to stapes superstructure reconstruction even in presence of intact stapes suprastructure. However, it is still unclear whether ossicular reconstruction has a better long-term outcome with PORP or TORP in the presence of stapes suprastructure. A prospective randomised trial of 60 patients with Austin type A defects divided into two groups was conducted. In one group TORP was used and in other group PORP. Outcomes were studied in terms of hearing gain, AB gap closure and stability of the prosthesis. Preoperative PTA of Moderate Conductive Hearing loss (40-55 db) was most found followed by severe conductive hearing loss (> 55 db) with standard deviation of 7.155 and mean hearing loss was 46.30 db in TORP group. In this group post operative pure tone averages improved to mild hearing loss (26-30 db) in about 90 percent of patients with mean of 32 db and standard deviation of 7.06. Preoperative PTA of severe Conductive Hearing loss (> 55 db) was most found followed by moderate Conductive Hearing loss (45-55 db) with standard deviation of 6.471 and mean hearing loss was 47 db in PORP group. Post operative Pure Tone averages improved to Mild Hearing loss (26-30 db) in about 90 percent of patients with mean of 33 db and standard deviation of 5.431 in PORP group. ABG reduction in TORP group was 22.603 ± 12.34 while in PORP group was17.79 ± 10.743. Hearing gain and ABG closure is almost comparable with both TORP and PORP, however because of increased stability of TORP we recommend TORP for better long-term outcomes in Austin type A ossicular defects.
慢性耳部疾病导致的听骨链缺损是耳科医生常见且持续面临的问题。当砧骨被侵蚀或缺失时，例如在慢性中耳炎或胆脂瘤中，听骨重建假体被广泛用于恢复听骨链的连续性。在这方面，全听骨和部分听骨置换假体（TORP和PORP）得到了广泛认可。传统上，PORP或TORP的选择主要取决于镫骨上部结构是否完整，还是仅保留镫骨底板。对重建的人中耳力学进行的激光干涉仪研究表明，从力学角度来看，即使在镫骨上部结构完整的情况下，锤骨到镫骨底板类型的重建与锤骨到镫骨上部结构的重建相比，能产生更有利的结果。然而，在存在镫骨上部结构的情况下，PORP或TORP进行听骨重建的长期效果仍不清楚。对60例Austin A型缺损患者进行了一项前瞻性随机试验，分为两组。一组使用TORP，另一组使用PORP。从听力增益、ABG闭合和假体稳定性方面研究结果。TORP组中，术前中度传导性听力损失（40 - 55分贝）最为常见，其次是重度传导性听力损失（>55分贝），标准差为7.155，平均听力损失为46.30分贝。在该组中，约90%的患者术后纯音平均值改善为轻度听力损失（26 - 30分贝），平均值为32分贝，标准差为7.06。PORP组中，术前重度传导性听力损失（>55分贝）最为常见，其次是中度传导性听力损失（45 - 55分贝），标准差为6.471，平均听力损失为47分贝。PORP组中，约90%的患者术后纯音平均值改善为轻度听力损失（26 - 30分贝），平均值为33分贝，标准差为5.431。TORP组的ABG降低值为22.603±12.34，而PORP组为17.79±10.743。听力增益和ABG闭合在TORP和PORP两者中几乎相当，然而，由于TORP稳定性更高，我们建议在Austin A型听骨链缺损中使用TORP以获得更好的长期效果。
