Persson P, Harder H, Magnuson B
Department of Otorhinolaryngology, Linköping University Hospital, Sweden.
Acta Otolaryngol. 1997 Jan;117(1):94-9. doi: 10.3109/00016489709117998.
Hearing results in a consecutive series of 407 patients with otosclerosis undergoing primary stapes surgery were analysed (437 operated ears). Partial stapedectomy was performed in 70 ears (16%), total stapedectomy in 205 ears (47%), in both groups using the House steel wire prosthesis on fascia in the oval window. The remaining 162 ears (37%) underwent stapedotomy using the Fisch 0.4 mm teflon-platinum piston. No case of cochlear loss (> 15 dB) occurred in the total series. The comparison between the three groups one year postoperatively showed that the air-bone gap was smaller for partial and total stapedectomy for all frequencies except 4 kHz. The air-bone gap was calculated as the difference between the preoperative bone conduction and the postoperative air conduction thresholds. Partial and total stapedectomy also showed larger improvements of bone conduction thresholds compared with stapedotomy for all frequencies but 4 kHz. At the 3-year follow-up, the hearing gain for all frequencies (250-8000 Hz) was larger for partial and total stapedectomy. Yet, when comparing the decline of hearing from 1 to 3 year postoperatively, the hearing gain achieved with partial and total stapedectomy seemed to deteriorate at a higher rate, which was considered to be caused by impaired sensorineural function. Our results show that in the short-term perspective partial or total stapedectomy can still compete for better hearing results even at higher frequencies, but stapedotomy seems to yield more stable hearing results over time and should therefore be considered as the method of choice.
对407例接受初次镫骨手术的耳硬化症患者（共437耳）的听力结果进行了分析。70耳（16%）行部分镫骨切除术，205耳（47%）行全镫骨切除术，两组均在椭圆窗的筋膜上使用豪斯钢丝假体。其余162耳（37%）使用菲施0.4毫米聚四氟乙烯 - 铂活塞进行镫骨足板钻孔术。整个系列中未发生耳蜗性听力损失（> 15 dB）的病例。术后一年三组之间的比较显示，除4 kHz外，部分和全镫骨切除术在所有频率下的气骨导间距均较小。气骨导间距计算为术前骨导阈值与术后气导阈值之间的差值。除4 kHz外，部分和全镫骨切除术在所有频率下的骨导阈值改善也比镫骨足板钻孔术更大。在3年随访时，部分和全镫骨切除术在所有频率（250 - 8000 Hz）下的听力增益更大。然而，比较术后1年至3年的听力下降情况时，部分和全镫骨切除术所获得的听力增益似乎以更高的速率恶化，这被认为是由感音神经性功能受损所致。我们的结果表明，从短期来看，部分或全镫骨切除术即使在较高频率下仍能获得更好的听力结果，但随着时间推移，镫骨足板钻孔术似乎能产生更稳定的听力结果，因此应被视为首选方法。
