B H Shrikrishna, G Deepa
Otorhinolaryngology Head-Neck Surgery, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND.
Anatomy, All India Institute of Medical Sciences, Bibinagar, Hyderabad, IND.
Cureus. 2025 Aug 9;17(8):e89692. doi: 10.7759/cureus.89692. eCollection 2025 Aug.
This systematic review investigates the influence of fenestration size and prosthesis diameter on hearing outcomes in patients undergoing primary stapedotomy for otosclerosis. A total of 11 studies were included, comprising randomized controlled trials, cohort studies, and one cross-sectional study, with follow-up durations ranging from three months to one year. Fenestration sizes most commonly ranged from 0.5 mm to 0.8 mm, while prosthesis diameters varied between 0.4 mm and 0.6 mm. Across studies, postoperative air conduction thresholds improved by 20-30 dB, and air-bone gap (ABG) closure within 10 dB was achieved in 57% to 88.9% of cases. Although some studies reported marginally better bone conduction gains with 0.6 mm prostheses, no definitive audiological superiority was established for any specific fenestration-prosthesis size combination. The use of larger prosthesis diameters was associated with modest improvements in mid-frequency sound transmission, particularly at 2000 Hz, but these differences were often not statistically significant. Postoperative complications were minimal, with transient vertigo being the most commonly reported, especially in laser-assisted techniques. Importantly, no study linked complication rates directly to specific fenestration or prosthesis sizes. Overall, the findings suggest that both fenestration size and prosthesis diameter within the commonly used ranges yield consistently favorable audiological outcomes without significantly affecting safety. The choice of prosthesis size may be tailored to individual anatomical and surgical considerations without compromising efficacy. This review highlights the flexibility in surgical approach for stapedotomy, supporting the use of varying size parameters according to intraoperative conditions and surgeon preference.
本系统评价研究了开窗大小和人工镫骨直径对耳硬化症患者一期镫骨手术听力结果的影响。共纳入11项研究，包括随机对照试验、队列研究和1项横断面研究，随访时间为3个月至1年。开窗大小最常见的范围是0.5毫米至0.8毫米，而人工镫骨直径在0.4毫米至0.6毫米之间变化。在各项研究中，术后气导阈值提高了20 - 30分贝，57%至88.9%的病例实现了10分贝以内的气骨导间距（ABG）闭合。尽管一些研究报告0.6毫米人工镫骨的骨导增益略好，但对于任何特定的开窗 - 人工镫骨大小组合，均未确立明确的听力学优势。使用较大直径的人工镫骨与中频声音传输的适度改善相关，尤其是在2000赫兹时，但这些差异通常无统计学意义。术后并发症极少，最常报告的是短暂性眩晕，尤其是在激光辅助技术中。重要的是，没有研究将并发症发生率直接与特定的开窗或人工镫骨大小联系起来。总体而言，研究结果表明，常用范围内的开窗大小和人工镫骨直径均能产生一致良好的听力学结果，且不会显著影响安全性。人工镫骨大小的选择可根据个体解剖和手术考虑进行调整，而不影响疗效。本综述强调了镫骨手术手术方法的灵活性，支持根据术中情况和外科医生偏好使用不同的尺寸参数。
