Grünwald P, Lomas A, Müller J, Helms J
Univ.-HNO-Klinik Würzburg.
Laryngorhinootologie. 1998 Feb;77(2):67-9. doi: 10.1055/s-2007-996934.
In this retrospective study indications, intraoperative findings, reconstruction techniques and postoperative hearing results in revision stapes surgery were evaluated.
Between March 1988 and January 1996, 150 patients underwent stapes revision. Indications for surgery were the presence of conductive hearing loss (132), dizziness (12), sensorineural hearing loss (3), deafness (2), and tinnitus (1).
Intraoperative findings were lateral migration of the implant, regrowth of bone in the oval window niche, erosion of incus, cholesteatoma, and others. In most cases a new prosthesis (gold piston) was inserted between incus and vestibulum. In cases with incus erosion, a malleovestibulopexy was performed. Seventy-three percent of patients who underwent revision stapes surgery because of conductive hearing loss showed a hearing improvement of 20 dB or more. All patients who underwent revision stapes surgery because of dizziness reported an improvement of their symptoms postoperatively.
Revision stapes surgery should be approached by experienced surgeons, because the risk of severe sensorineural hearing loss is higher than at the time of primary stapedectomy. Informed consent is mandatory.
在这项回顾性研究中，对再次镫骨手术的适应证、术中发现、重建技术及术后听力结果进行了评估。
1988年3月至1996年1月期间，150例患者接受了镫骨再次手术。手术适应证包括传导性听力损失（132例）、头晕（12例）、感音神经性听力损失（3例）、耳聋（2例）及耳鸣（1例）。
术中发现包括植入物向外移位、卵圆窗龛内骨质再生、砧骨侵蚀、胆脂瘤等。多数情况下，在砧骨与前庭之间植入新的假体（金活塞）。对于砧骨侵蚀的病例，实施了锤骨前庭固定术。因传导性听力损失接受再次镫骨手术的患者中，73%听力改善20dB或更多。所有因头晕接受再次镫骨手术的患者术后症状均有改善。
再次镫骨手术应由经验丰富的外科医生进行，因为严重感音神经性听力损失的风险高于初次镫骨切除术。必须获得知情同意。
