Lorente-Piera Joan, Manrique-Huarte Raquel, Picciafuoco Sebastián, Lima Janaina P, Calavia Diego, Serra Valeria, Manrique Manuel
Clinica Universidad de Navarra, Pamplona, Spain.
Eur Arch Otorhinolaryngol. 2025 Apr 13. doi: 10.1007/s00405-025-09365-1.
In otology consultations, patients with chronic otitis media (COM) often present as candidates for various hearing rehabilitation options. Selecting the most suitable approach requires careful consideration of patient preferences and expectations, the risk of disease progression, and the integrity of the bone conduction pathway. This study aims to evaluate and compare postoperative hearing outcomes in COM patients undergoing tympanoplasty (with or without passive middle ear implants), bone conduction systems (BCI), or active middle ear implants (AMEI). The objective is to assess the effectiveness of each surgical approach in hearing rehabilitation, considering the type and severity of hearing loss as well as the duration of the disease.
Retrospective data analysis in a tertiary referral center studying average PTA across six different frequencies, speech perception at 65 dB, influence of Eustachian tube dysfunction, reintervention rate and adverse effects, and the influence of disease duration on functional outcomes via linear regression analysis.
116 patients underwent surgery due to COM between 1998 and 2024. With a slight female predominance (54.31%). AMEIs and bone conduction devices provided the highest amplification in terms of PTA and speech discrimination, with a lower reintervention rate when comparing both groups with passive middle ear implants, OR in BCI group of 0.30 (0.10; 0.89, p = 0.030), OR in VSB group of 0.15 (0.04; 0.56, p = 0.005). It was also observed that a longer evolution time could be associated with greater auditory gain, with a p-value = 0.033.
The selection of each treatment option primarily depends on bone conduction thresholds, along with surgical risk, patient preferences, and MRI compatibility. In our study, AMEIs demonstrated the highest functional gain in terms of speech discrimination and frequency-specific amplification, followed by BCI. These findings support the use of implantable hearing solutions as effective alternatives for auditory rehabilitation in COM patients.
在耳科学会诊中，慢性中耳炎（COM）患者常作为各种听力康复方案的候选者。选择最合适的方法需要仔细考虑患者的偏好和期望、疾病进展风险以及骨传导通路的完整性。本研究旨在评估和比较接受鼓室成形术（有无被动中耳植入物）、骨传导系统（BCI）或主动中耳植入物（AMEI）的COM患者的术后听力结果。目的是考虑听力损失的类型和严重程度以及疾病持续时间，评估每种手术方法在听力康复中的有效性。
在一家三级转诊中心进行回顾性数据分析，研究六个不同频率的平均纯音听阈（PTA）、65dB时的言语感知、咽鼓管功能障碍的影响、再次干预率和不良反应，以及通过线性回归分析疾病持续时间对功能结果的影响。
1998年至2024年间，116例患者因COM接受手术。女性略占优势（54.31%）。就PTA和言语辨别而言，AMEI和骨传导装置提供了最高的放大效果，与被动中耳植入物组相比，两组的再次干预率较低，BCI组的比值比（OR）为0.30（0.10；0.89，p = 0.030），VSB组的OR为0.15（0.04；0.56，p = 0.005）。还观察到，病程较长可能与更大的听觉增益相关，p值 = 0.033。
每种治疗方案的选择主要取决于骨传导阈值，以及手术风险、患者偏好和磁共振成像兼容性。在我们的研究中，就言语辨别和频率特异性放大而言，AMEI显示出最高的功能增益，其次是BCI。这些发现支持使用可植入听力解决方案作为COM患者听觉康复的有效替代方案。
