Millman B, Giddings N A, Cole J M
Department of Otolaryngology-Head and Neck Surgery, Geisinger Medical Center, Danville, PA 17822, USA.
Otolaryngol Head Neck Surg. 1996 Jul;115(1):78-81. doi: 10.1016/S0194-5998(96)70140-7.
Otosclerosis presenting in children and adolescents is uncommon. Typically, otosclerosis presents as a slowly progressive conductive hearing loss in the third to fourth decade. Many well-documented studies have demonstrated excellent long-term hearing results with stapedectomy. Although stapedectomy is highly effective, the rare complications may be devastating. Thirty-one patients, 21 years or younger, underwent 40 stapedectomies for otosclerosis at our institution. The average age at surgery was 16 years, with a range of 7 to 21 years. Postoperative results showed an average improvement in air-bone gap of 22 dB. Clinical and audiologic data were collected over a mean follow-up period of 25 years. There was no statistically significant difference in air-bone gap when comparing the immediate postoperative gap (measured 2 months after stapedectomy) with the last gap recorded (mean, 25 years after stapedectomy). Fifty percent of the ears operated on maintained an air-bone gap within 10 dB at the last follow-up, and an additional 40% maintained a 10- to 20-dB gap. There were no significant relationships between demographic or clinical factors and "success" (gap <= 10 dB) or long-term gap closure. Our data demonstrate that stapedectomy is an effective method for closing the air-bone gap in children and adolescents with otosclerosis, and long-term results parallel those of adults, showing maintenance of excellent gap closure. This review represents the largest population with the longest follow-up in children who underwent stapedectomy for the treatment of otosclerosis.
儿童和青少年期出现的耳硬化症并不常见。典型的耳硬化症表现为在第三至第四个十年中缓慢进展的传导性听力损失。许多有充分记录的研究表明，镫骨切除术能带来出色的长期听力结果。尽管镫骨切除术非常有效，但罕见的并发症可能是灾难性的。在我们机构，31名21岁及以下的患者接受了40次针对耳硬化症的镫骨切除术。手术时的平均年龄为16岁，范围在7至21岁之间。术后结果显示气骨导差平均改善了22分贝。在平均25年的随访期内收集了临床和听力学数据。将术后即刻（镫骨切除术后2个月测量）的气骨导差与最后记录的导差（平均，镫骨切除术后25年）进行比较时，气骨导差没有统计学上的显著差异。在最后一次随访时，50%接受手术的耳朵气骨导差维持在10分贝以内，另外40%维持在10至20分贝的导差。人口统计学或临床因素与“成功”（导差<=10分贝）或长期导差闭合之间没有显著关系。我们的数据表明，镫骨切除术是闭合耳硬化症儿童和青少年气骨导差的有效方法，长期结果与成人相似，显示出良好的导差闭合维持情况。这篇综述代表了接受镫骨切除术治疗耳硬化症的儿童中随访时间最长、人数最多的群体。
