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耳硬化症手术后镫骨-前庭修复性肉芽肿的手术治疗：一项STROBE回顾性研究

Surgical Management of Stapedo-Vestibular Reparative Granuloma Following Otosclerosis Surgery: A STROBE Retrospective Study.

作者信息

Krief Alexandre, Ayache Denis, Tuset Maria-Pia, Tran Alexia, Veyrat Mathieu, Daval Mary, Gargula Stéphane

机构信息

Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Fondation Adolphe de Rothschild, Paris, France.

Department of Otorhinolaryngology, Head and Neck Surgery, Hospital La Conception, Marseille, France.

出版信息

J Otolaryngol Head Neck Surg. 2025 Jan-Dec;54:19160216251364762. doi: 10.1177/19160216251364762. Epub 2025 Aug 21.

DOI:10.1177/19160216251364762
PMID:40838397
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12374032/
Abstract

ImportanceReparative granuloma (RG) is a rare but severe complication of otosclerosis surgery, presenting with vertigo, tinnitus, and hearing loss. Surgical intervention may offer effective symptom relief.ObjectiveTo evaluate the effectiveness of surgical management for RG following otosclerosis surgery in alleviating vestibular symptoms and preserving hearing.DesignRetrospective cohort study (STROBE guidelines).SettingTertiary referral center.ParticipantsNineteen adult patients with histologically confirmed RG and persistent symptoms (vertigo and/or hearing loss) within 3 months of primary stapes surgery.InterventionRevision surgery included granuloma resection, prosthesis replacement, and corticosteroid-soaked graft placement as needed.Main Outcome MeasuresPostoperative relief of vestibular symptoms, hearing thresholds [pure-tone average (PTA)], and length of hospital stay.ResultsSymptoms developed on average 3.6 ± 3.9 days postoperatively. Revision surgery resolved vertigo in 18 of 19 patients (95%) by discharge (mean 4.8 ± 1.9 days). Audiometric improvement was limited, with 11 patients retaining serviceable hearing. Preoperative versus postoperative bone conduction PTA showed no significant change ( = .58).ConclusionsSurgical management effectively alleviates vestibular symptoms associated with RG but has minimal impact on hearing restoration.RelevanceThis study highlights the efficacy of revision surgery for RG in addressing vestibular symptoms. Further multicenter studies are warranted to better understand reparative granuloma and improve treatment strategies.

摘要

重要性

修复性肉芽肿（RG）是耳硬化症手术一种罕见但严重的并发症，表现为眩晕、耳鸣和听力损失。手术干预可能有效缓解症状。

目的

评估耳硬化症手术后RG的手术治疗在缓解前庭症状和保留听力方面的有效性。

设计

回顾性队列研究（遵循STROBE指南）。

设置

三级转诊中心。

参与者

19例成年患者，经组织学确诊为RG，在初次镫骨手术后3个月内有持续症状（眩晕和/或听力损失）。

干预

翻修手术包括肉芽肿切除、假体置换以及必要时放置皮质类固醇浸泡的移植物。

主要结局指标

术后前庭症状缓解情况、听力阈值[纯音平均听阈（PTA）]和住院时间。

结果

症状平均在术后3.6±3.9天出现。翻修手术使19例患者中的18例（95%）在出院时眩晕得到缓解（平均4.8±1.9天）。听力改善有限，11例患者保留了可用听力。术前与术后骨传导PTA无显著变化（P = 0.58）。

结论

手术治疗可有效缓解与RG相关的前庭症状，但对听力恢复影响极小。

相关性

本研究强调了RG翻修手术在解决前庭症状方面的疗效。有必要进行进一步的多中心研究，以更好地了解修复性肉芽肿并改进治疗策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/286c/12374032/bcbfc6fb52c8/10.1177_19160216251364762-fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/286c/12374032/64b521f0db4b/10.1177_19160216251364762-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/286c/12374032/7fbec2c90a9e/10.1177_19160216251364762-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/286c/12374032/36ff6026a371/10.1177_19160216251364762-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/286c/12374032/726b4764cfd7/10.1177_19160216251364762-fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/286c/12374032/bcbfc6fb52c8/10.1177_19160216251364762-fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/286c/12374032/64b521f0db4b/10.1177_19160216251364762-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/286c/12374032/7fbec2c90a9e/10.1177_19160216251364762-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/286c/12374032/36ff6026a371/10.1177_19160216251364762-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/286c/12374032/726b4764cfd7/10.1177_19160216251364762-fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/286c/12374032/bcbfc6fb52c8/10.1177_19160216251364762-fig5.jpg

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本文引用的文献

1
Prevention and Management of Complications in Otosclerosis Surgery.耳硬化症手术并发症的预防与处理
Otolaryngol Clin North Am. 2018 Apr;51(2):453-462. doi: 10.1016/j.otc.2017.11.015. Epub 2018 Feb 1.
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Post-stapedectomy granuloma: a devastating complication.镫骨切除术后肉芽肿：一种严重的并发症。
J Laryngol Otol. 2017 Jun;131(6):557-560. doi: 10.1017/S0022215117000627. Epub 2017 Mar 20.
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Early Postoperative Imaging of the Labyrinth by Cone Beam CT After Stapes Surgery for Otosclerosis With Correlation to Audiovestibular Outcome.
耳硬化症镫骨手术后通过锥形束CT对迷路进行的早期术后成像及其与听前庭结果的相关性
Otol Neurotol. 2017 Feb;38(2):168-172. doi: 10.1097/MAO.0000000000001306.
4
MPR-CT Imaging for Stapes Prosthesis: Accuracy and Clinical Significance.镫骨假体的多平面重建计算机断层扫描成像：准确性及临床意义
Otol Neurotol. 2016 Apr;37(4):321-3. doi: 10.1097/MAO.0000000000000987.
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Reparative granuloma following stapes surgery.镫骨手术后的修复性肉芽肿。
Indian J Otolaryngol Head Neck Surg. 2007 Dec;59(4):346-8. doi: 10.1007/s12070-007-0098-y. Epub 2007 Dec 11.
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Diagnostic findings in stapes revision surgery--a retrospective of 26 years.镫骨revision 手术中的诊断结果——26 年的回顾。
Otol Neurotol. 2011 Apr;32(3):373-83. doi: 10.1097/MAO.0b013e3182096da1.
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How to manage post stapedotomy reparative granuloma.如何处理镫骨切除术后修复性肉芽肿。
Rev Laryngol Otol Rhinol (Bord). 2009;130(4-5):323-6.
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Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.流行病学观察性研究报告强化（STROBE）声明：观察性研究报告指南
BMJ. 2007 Oct 20;335(7624):806-8. doi: 10.1136/bmj.39335.541782.AD.
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Imaging of postoperative sensorineural complications of stapes surgery: a pictorial essay.镫骨手术术后感音神经性并发症的影像学表现：图文综述
Adv Otorhinolaryngol. 2007;65:308-313. doi: 10.1159/000098850.
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Reparative granuloma related to perilymphatic fistula.与外淋巴瘘相关的修复性肉芽肿。
Adv Otorhinolaryngol. 2007;65:296-299. doi: 10.1159/000098845.