Ramsay H A, Linthicum F H
House Ear Institute, Los Angeles, CA 90057, USA.
Am J Otol. 1994 Jul;15(4):536-9.
This retrospective study of 146 ears with long-term follow-up after otosclerosis surgery evaluated the stability of hearing results, the incidence of sensorineural hearing loss, and the effect of fluoride treatment. Follow-up was at least 15 years (mean, 25.2 yr; range, 15-44 yr). There were 97 large fenestra stapedectomy operations, 23 lateral canal fenestrations, 7 mobilizations, and 19 revision stapes operations. The level of air-bone gap achieved at surgery remained stable over time; the mean deterioration rate was only 0.2 dB per year. Profound sensorineural hearing loss ( > or = 65 dB bone conduction average) at the most recent follow-up occurred in 13 ears (8.9%). Such hearing loss occurred in all operative groups. Mean bone conduction average immediately postoperatively was significantly higher in these ears than in others in the study. This finding indicates that a mixed hearing loss at surgery is a factor that increases the risk of later profound cochlear loss. Only 3 percent of ears with pure conductive hearing loss, but 28 percent of patients with mixed hearing loss at surgery eventually suffered profound cochlear loss. Sodium fluoride was used to treat 11 ears with progressive cochlear loss. The rate of bone conduction hearing deterioration decreased in all ears after treatment, and none developed profound hearing loss. Follow-up after the first postoperative year is not necessary if pure conductive hearing loss is present at surgery. Annual follow-up with audiograms is recommended if a mixed hearing loss is present. Fluoride treatment is recommended if inner ear hearing loss progresses.
这项针对146例耳硬化症手术后长期随访患者的回顾性研究，评估了听力结果的稳定性、感音神经性听力损失的发生率以及氟化物治疗的效果。随访时间至少为15年（平均25.2年；范围15 - 44年）。其中有97例进行了大开窗镫骨切除术、23例外侧半规管开窗术、7例镫骨松动术以及19例镫骨翻修手术。术后气骨导差水平随时间保持稳定；平均每年恶化率仅为0.2dB。在最近一次随访时，13例（8.9%）患者出现了重度感音神经性听力损失（骨导平均听阈≥65dB）。所有手术组均出现了此类听力损失。这些耳朵术后即刻的平均骨导听阈显著高于研究中的其他耳朵。这一发现表明，手术时的混合性听力损失是后期发生重度耳蜗性听力损失风险增加的一个因素。手术时仅有单纯传导性听力损失的耳朵中，最终发生重度耳蜗性听力损失的仅占3%，但手术时存在混合性听力损失的患者中这一比例为28%。使用氟化钠治疗了11例出现进行性耳蜗性听力损失的耳朵。治疗后所有耳朵的骨导听力恶化速率均下降，且无一例发展为重度听力损失。如果手术时存在单纯传导性听力损失，术后第一年之后无需随访。如果存在混合性听力损失，建议每年进行听力图随访。如果内耳听力损失进展，建议进行氟化物治疗。
