Sheehy J L, Nelson R A, House H P
Laryngoscope. 1981 Jan;91(1):43-51. doi: 10.1288/00005537-198101000-00007.
We reviewed the records of 258 revision stapedectomy operations performed at the Otological Medical Group during an eight year period. Displacement of the prosthesis to the inferior edge of the window was the commonest cause of failure (41%) and occurred predominately in wire-Gelfoam pad cases. An oval window fistula, a short prosthesis or bony closure of the window were causes of failure in 9% each. Incus necrosis was the cause of failure in 5%. Less than 50% of the operations resulted in postoperative conductive deficit of 10 db or less. The results were better than this in incus bypass procedures, in revisions of cases in which a tissue graft was used over the oval window and in revisions of ears initially operated on elsewhere. Severe sensorineural hearing impairment was the result in 7% of the operations and half of these impairments were dead ears. The majority of these adverse results followed a repeat drill out of obliterative otosclerosis or followed reopening of the oval window in patients with a postoperative inner ear problem other than a fistula. We concluded that 1. revision stapedectomy is a less satisfactory procedure than primary stapedectomy; 2. there is rarely an indication for a repeat drill out of obliterative otosclerosis; and 3. the oval window membrane usually should not be disturbed in revision stapedectomy in a patient with inner ear symptoms unless there is a fistula.
我们回顾了耳科医疗集团在八年期间进行的258例镫骨切除术翻修手术的记录。假体移位至圆窗下缘是最常见的失败原因（41%），主要发生在钢丝 - 明胶海绵垫病例中。圆窗瘘、假体过短或圆窗骨质封闭各占失败原因的9%。砧骨坏死占失败原因的5%。不到50%的手术导致术后传导性听力损失10分贝或更低。在砧骨旁路手术、在圆窗上使用组织移植的病例翻修以及最初在其他地方接受手术的耳朵的翻修中，结果要好于此。7%的手术导致严重的感音神经性听力障碍，其中一半是全聋。这些不良结果大多发生在对闭塞性耳硬化症进行再次钻孔后，或在术后内耳出现除瘘管外其他问题的患者中重新打开圆窗之后。我们得出以下结论：1. 镫骨切除术翻修手术不如初次镫骨切除术令人满意；2. 很少有再次对闭塞性耳硬化症进行钻孔的指征；3. 除非存在瘘管，对于有内耳症状的患者进行镫骨切除术翻修时，通常不应扰动圆窗膜。
