Thunberg Ulrica, Tahir Taj, Redfors Ylva Dahlin, Finizia Caterina
Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
Department of Otorhinolaryngology, Head, and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Otol Neurotol. 2025 Mar 1;46(3):265-271. doi: 10.1097/MAO.0000000000004413. Epub 2025 Jan 7.
To investigate whether degree of asymmetric hearing impairment influences patient-reported outcome measures and objective hearing results in primary stapedotomy.
Register study.
Data from the Swedish Quality Register for Otosclerosis Surgery consisting of 90% of stapes operations performed in Sweden.
The 984 patients eligible for inclusion were categorized on the basis of preoperative hearing impairment: unilateral, bilateral asymmetric, or bilateral symmetric. Pure-tone audiometry and patient-reported outcome measures were analyzed, and Glasgow benefit plots were constructed. Ordinal logistics regression analyses were performed to adjust for factors influencing PROMs associated with degree of asymmetric hearing.
Over 90% of patients across all groups reported improved or much improved hearing ability post-surgery. Ninety-five percent of patients who rated their hearing as worse or much worse after surgery had an air-conductive gain of <20 dB PTA4. Individuals with unilateral hearing impairment were more likely to report lower satisfaction with hearing function and daily life activities after surgery compared with those with bilateral hearing impairment, especially bilateral symmetric hearing impairment. In terms of hearing function, the bilateral symmetric hearing impairment group showed a significant decrease in the log odds of reporting lower satisfaction with a coefficient of -0.71 (95% confidence interval, -1.13 to -0.33), whereas the bilateral asymmetric hearing impairment group showed a nonsignificant decrease with a coefficient of -0.14 (95% confidence interval, -0.41 to 0.14) compared with the unilateral hearing impairment group. Tinnitus was more frequent in those with unilateral hearing impairment.
Those with preoperative unilateral hearing impairment were more likely to express lower satisfaction with the results, compared with patients with bilateral impairment. Our findings suggest that the degree of bilateral hearing impairment should be considered in preoperative counseling, to better align with patient expectations regarding the benefit of surgery. An estimated air-conductive gain of at least 20 dB PTA4 was favorable for patient satisfaction.
探讨不对称听力损失程度是否会影响患者报告的结局指标以及初次镫骨手术的客观听力结果。
登记研究。
来自瑞典耳硬化症手术质量登记处的数据，该登记处包含瑞典90%的镫骨手术。
将984名符合纳入标准的患者根据术前听力损失情况进行分类：单侧、双侧不对称或双侧对称。分析纯音听力测定结果和患者报告的结局指标，并绘制格拉斯哥获益图。进行有序逻辑回归分析，以调整影响与不对称听力程度相关的患者报告结局指标的因素。
所有组中超过90%的患者报告术后听力能力有所改善或大幅改善。95%术后将听力评为更差或差得多的患者气导增益<20 dB PTA4。与双侧听力损失患者相比，单侧听力损失患者术后对听力功能和日常生活活动的满意度较低，尤其是双侧对称听力损失患者。在听力功能方面，双侧对称听力损失组报告较低满意度的对数优势比显著降低，系数为-0.71（95%置信区间，-1.13至-0.33），而双侧不对称听力损失组与单侧听力损失组相比对数优势比无显著降低，系数为-0.14（95%置信区间，-0.41至0.14）。单侧听力损失患者耳鸣更常见。
与双侧听力损失患者相比，术前单侧听力损失患者对手术结果的满意度较低。我们的研究结果表明，术前咨询时应考虑双侧听力损失的程度，以便更好地使患者对手术获益的期望与之相符。气导增益估计至少20 dB PTA4有利于患者满意度。
