Results of stapedotomy in otosurgical treatment of adult patients with osteogenesis imperfecta

ObjectiveThis is a retrospective study of hearing results and characteristics of osteogenesis imperfecta (OI) patients treated for hearing loss by stapedotomy at tertiary reference center.MethodsThis study enrolled 20 patients with a clinical diagnosis of OI- (11M:9F). 18 patients (90%) underwent surgery due to hearing loss in the period 2003–16. The audiometric analysis provides the pure tone audiometry results of stapedotomy in adult patients in 2 periods (≤12 months and >12 months).Air-bone gap (ABG), hearing gain (HG), and changes in air and bone conduction thresholds after surgical treatment were analyzed.ResultsIn short-time follow-up we noted statistically significant improvement in mean AC thresholds and ABG (p < 0.001 for both), change in mean BC thresholds was statistically negligible. Comparing the observation periods short-term and long-term, it was found that AC thresholds, ABG, HG, ABG closure did not significantly change, although BC thresholds and BC closure deteriorated significantly (p < 0.05).ConclusionStapes surgery for OI can be considered as a method of treating the conductive and/or mixed hearing loss suffered by these patients; however, the surgery is more difficult than that for otosclerosis because OI cases often have extremely difficult anatomical conditions. The hearing results of OI stapes surgery differ from typical otosclerosis cases, with the ABG closure not being as good. In addition, sensorineural hearing loss inevitably progresses.     

Frequency-specific hearing results after stapes surgery for Chinese population otosclerosis with different degrees of hearing loss

Abstract

Background: Frequency-specific hearing studies are important for predicting hearing results and the prognosis after stapes surgery, to prepare for the rehabilitation of frequency-specific hearing in patients with otosclerosis.

Objectives: To evaluate outcomes of stapes surgery of Chinese otosclerosis patients with different degrees of hearing loss.

Methods: We conducted a retrospective analysis of 213 otosclerosis patients who underwent stapes surgery in our hospital. Pre- and post-operative audiometric evaluation using conventional audiometry.

Results: The post-op ABG was less than 20?dB in 94.52% of all cases after surgery. There was no statistical significance of the post-op ABG among different groups at all frequencies except extremely severe group (p?<?.05). There was a significant improvement of both AC and BC thresholds in post-op period and the most significant improvement was found in severe group. There were no serious post-op complications and no re-operations during the follow-up period.

Conclusion: Stapes surgery is a suitable treatment option for otosclerosis with mild to extremely severe HL. The mild to moderate hearing loss groups had the most significant improvement of AC thresholds in the low frequency region, and the severe to extremely severe groups appeared in the high frequency region.     

Effect of esterified hyaluronic acid as middle ear packing in tympanoplasty for adhesive otitis media

Objectives: The goal of this study was to evaluate the effects of middle ear packing agents (MEPA) on post-operative hearing improvement and complications after tympanoplasty in patients with adhesive otitis media (OM).

Materials and methods: Patients with adhesive OM who underwent tympanoplasty surgery were enrolled in the study between January 2012 and January 2015. A total of 205 patients who received canal wall-down tympanoplasty with ossicular chain reconstruction were randomized into one of the three groups with different MEPA. Group 1 (n?=?72) received MeroGel as the MEPA, Group 2 (n?=?64) cartilage, and Group 3 (n?=?69) both. Air conduction (AC) and bone conduction (BC) thresholds at 0.5, 1, 2, and 4?kHz were measured, and air-bone gaps (ABG) were analyzed before and after the surgery for each patient.

Results: Mean pre- and post-operative ABG was 30.9?dB and 17.6?dB in Group 1, 31.4?dB and 21.9?dB in Group 2, and 32.2?dB and 19.1?dB in Group 3. The ABG closure was 13.3?±?7.5 in Group 1, 9.5?±?5.9 in Group 2, and 13.1?±?9.3 in Group 3. The improvement of ABG after surgery was statistically significant in all three groups (p?p?Conclusions: Tympanoplasty using esterified hyaluronic acid (i.e. MeroGel) or cartilage as the MEPA resulted in improved hearing for patients with conductive hearing loss due to adhesive OM. Using MeroGel as the MEPA appeared to achieve a better post-operative outcome than using cartilage.     

Steigbügelchirurgie

Background

The first hearing results with a new stapes prosthesis with clip function (Soft-CliP® piston) are presented.

Patients and Methods

This new prosthesis was used in 15 patients (mean age 45.2 years; range 21-63 years) undergoing routine stapes surgery. Soft-CliP® piston prostheses with a shaft diameter of 0.4 mm and a length ranging from 4.25 mm to 5.5 mm were used. Postoperative audiological testing and measurement of the air-bone gap were performed after an average of 47.3 days and compared with the preoperative values.

Results

The median observed postoperative air-bone gap (ABG) was 8.33 dB ±4.16 dB. All patients had less than 20 dB ABG and in 53.3% of cases was less than 10 dB. The operating time showed a clear difference between the left (66.5 min ±37.79 min) and right ears (47.2 min ±11.08 min).

Discussion

This new prosthesis design greatly facilitates a very difficult step in stapes surgery, the prosthesis fixation to the incus. The first postoperative hearing results are very promising but long-term results in a larger group of patients are still pending.     

Meta-analysis of hearing outcomes of chronic otitis media surgery in the only hearing ear

ObjectiveTo assess the hearing outcomes of surgery for patients with chronic otitis media (COM) with or without cholesteatoma in case of the only hearing ear (OHE).MethodsThis meta-analysis included COM patients with hearing in only one ear. The PubMed, Scopus, and Cochrane databases were reviewed.ResultsThirteen studies were included, 252 excluded. The total number of operated ears was 229. The patients’ ages ranged from 6 to 78 years. A change greater than 10 dB in hearing thresholds in the OHE was considered as a significant result. When both the COM with (cCOM) and without cholesteatoma (ncCOM) cases were considered, the air bone gap (ABG), air conduction (AC) and bone conduction (BC) thresholds were stable or improved in 91.06% (95% CI:81.94–97.19%), 87.91% (82.14–92.34%), and 94.99% (95% CI:90.20–97.97%) of patients, respectively. Stable or improved ABG, AC and BC thresholds were observed in 92.36% (95% CI:81.67–97.86%), 87.36% (95% CI:71.46–96.23%), and 94.85% (95% CI:81.36–99.49%) of those with ncCOM, respectively. For patients with cCOM, the results were 85.96% (95% CI:81.36–99.49%), 85.20% (95% CI:76.04–91.87%), and 97.01% (95% CI:89.62–99.63%), respectively. There were no significant differences in these thresholds between either category.ConclusionHearing deterioration in AC and BC thresholds can be expected in about 13–15% and 5–3%, respectively, of patients, with ncCOM or cCOM. Our results should not be construed as a guide for determining surgery eligibility in patients with COM in the OHE.     

保留乳突的改良完壁式鼓室成形术的临床疗效观察

目的 探讨局限于上鼓室区病变的慢性化脓性中耳炎、中耳胆脂瘤行上鼓室径路保留乳突的改良完壁式鼓室成形术的长期临床疗效.方法 诊断慢性化脓性中耳炎、中耳胆脂瘤47例(47耳)患者,结合患者专科检查,依据手术方式不同分A、B两组,A组行上鼓室径路保留乳突的改良完壁式鼓室成形术,B组行完壁式乳突切开+鼓室成形术.术后随访5～7...     

Are computed tomography and densitometric measurements useful in otosclerosis with mixed hearing loss? A retrospective clinical study

The objective of the study was to investigate the relationship between extent of otosclerotic foci and audiological findings in otosclerotic patients with mixed hearing loss using high-resolution computed tomography (HRCT) and also to measure the density of bony labyrinth in otosclerotic patients and compared with control group. This was a retrospective study. Twenty-five patients with clinical otosclerosis and mixed hearing loss were included in the study. The average threshold of air-bone conductions (AC, BC) within the 0.5–4 kHz frequency range, and average air bone gap (ABG) were calculated. Eleven patients with normal HRCT who received cochlear implant were included in the study as the control group. The lesions in HRCT were staged according to their extension. Eight different points of the otic capsule in each patient were measured using HRCT. Fifty ears total, from 25 patients, had bilateral otosclerosis. The mean AC of all the ears was 63 dB, mean BC was 35.2 dB, and mean ABG was 27.8 dB. HRCT staging indicated 22 ears had Grade 1, 21 ears had Grade 2, and 7 ears had Grade 3 lesions. There was a statistically significant difference between the mean AC, BC of ears with Grade 1 and Grade 2 when compared with the mean AC, BC of ears with Grade 3. When comparing the densitometric measurements of fissula ante fenestram localizations, a statistically significant difference was observed. HRCT examination and densitometric measurements in otosclerotic patients with mixed hearing loss presented significant results. We were unable to show a significant relationship between early stage and hearing thresholds, but there was a significant relationship in advanced stage. Densitometric measurements may provide significant results for otosclerosis, particularly for the FAF region when comparing with control group.     

KTP laser stapedotomy with a self-crimping,thermal shape memory Nitinol piston: follow-up study reporting intermediate-term hearing

The aim of this study was an evaluation of the mid-term hearing results after the implantation of a self-crimping heat memory Nitinol piston in stapes surgery. The 12-month postoperative results were compared with those at a minimum of 3 years (maximum 6.7, average 4.4 years). The medical records of all 44 patients who underwent surgery with a Nitinol piston for stapes fixation between November 2005 and January 2007 were evaluated retrospectively. The prostheses used in all cases measured either 4.5 or 4.75 × 0.6 mm. We hypothesized that the 12-month postoperative hearing results would be permanent after an average follow-up of 4.4 years. Thirty-two of the 44 consecutive patients were females and 12 were males. Their mean age was 40.4 years (range 27–69). All underwent a 12-month postoperative audiometric evaluation. 38 (30 females, 8 males, average age 45, range 28–77 years) of the 44 were available for mid-term 4.4-year (minimum 3 years, maximum 6.7 years) postoperative audiometric evaluation. The mean air–bone gap (ABG) for the frequencies 0.5, 1, 2 and 3 kHz at the 12-month postoperative follow-up was 11 dB (SD 4.1) and that after an average 4.4-year postoperative evaluation was 6.4 dB (SD 3.6). The mean decrease in ABG after 12 months was 19.5 dB, and that after the average 4.4 years was 21.3 dB. ABG closure within 10 dB was achieved in 77.2 % after 12 months and in 89.5 % after the average 4.4 years. No patient with an ABG > 20 dB was recorded after the average 4.4 years. The mean air conduction threshold at 4 kHz was examined pre and postoperatively so as to indicate any possible inner ear damage. At the 12-month follow-up, the difference between the pre and postoperative values was ?2.5 dB, whereas after the average 4.4 years the difference was surprisingly +13 dB. The individual AC improvements were also demonstrated with the use of Amsterdam Hearing Evaluation Plots (AHEPs). The Nitinol prosthesis allowed excellent intraoperative handling and no postoperative complication was reported. As compared with conventional stapes prostheses, the Nitinol-based SMart prosthesis is a safe and reliable stapes prosthesis. Our mid-term audiometric evaluations revealed that the audiometric parameters demonstrated a hearing improvement between the postoperative 12-month and average 4.4-year examinations. We consider the elimination of manual crimping and the use of a “non-touch” hand-held laser technique has a positive impact on the mid-term audiometric results. Most of the previous studies presented only relatively short-term (from 6 weeks up to 6–12 months) audiometric evaluations. Complications are rare, but a longer follow-up is needed to establish the long-term stability.     

Microdrill stapedotomy for otosclerosis with small and large preoperative air-bone gap: a retrospective comparison of results

Abstract

Background: In otosclerosis mixed hearing loss is the most frequent symptom and arises when the focus involves the stapes footplate. Surgeons usually prefer to wait a minimum air-bone gap of 25 – 35?dB before surgery.

Objectives: To evaluate the outcome of microdrill stapedotomy for otosclerosis in patients with a preoperative air-bone gap (ABG) <25?dB versus patients with a preoperative gap ≥ 25?dB.

Material and methods: For this retrospective study, the outcomes and complications after microdrill stapedotomy were compared between adult patients with a preoperative small ABG (n?=?127, ABG <25?dB) and those with a large ABG (n?=?254, ABG ≥25?dB).

Results: The postoperative ABG was significantly smaller than the preoperative ABG (p?<?.05) in both groups; there were no differences in complications rates (severe sensorineural hearing loss, footplate fracture or early postoperative vertigo) between the two groups.

Conclusions: Our findings show that microdrill stapedotomy is safe and can be performed even in patients with a preoperative small ABG without increasing the risk of sensorineural hearing loss due to inner ear damage.     

晚期耳硬化症CO2激光辅助镫骨开窗术疗效的初步观察

目的　探讨CO2激光辅助镫骨开窗人工镫骨植入术治疗晚期耳硬化症的效果。方法　2010年1月~2014年1月间15例（16耳）临床确诊为晚期耳硬化症的患者在我科接受了CO2激光辅助镫骨开窗人工镫骨植入术,术前言语频率平均气导听阈70.21 dB HL,平均骨导听阈38.49 dB HL,平均气骨导差（air conduction-bone conduction gap,ABG）31.72 dB HL,所有病例术后随访超过半年。结果　术后半年言语频率平均气导听阈 43.7 dB HL,平均骨导听阈28.95 dB HL,平均气骨导差14.75 dB HL,ABG≤20 dB者9耳,占比56.3%,ABG闭合≤10 dB者6耳,占比37.5%。无一例术后出现顽固性眩晕、感音神经性聋及面瘫等严重并发症。结论  CO2激光辅助技术降低了镫骨开窗手术严重并发症的几率,多数患者术后听力明显提高,是一种安全、实用、相对经济的选择。     

鼓室硬化镫骨固定的手术疗效分析

目的分析不同手术方法治疗鼓室硬化镫骨固定的疗效。方法回顾性分析1992～2004年于我科手术且资料完整的鼓室硬化镫骨固定病例56例（62耳）,按Wielinga分型Ⅲ型40耳;Ⅳ型22耳,其中镫骨撼动术15耳（Ⅲ型12耳、Ⅳ型3耳）、全人工听骨赝复物（tatolossicular replacement prosthesis,TORP）重建听骨链25耳（Ⅲ型16耳、Ⅳ型9耳）、自制Teflon小柱活塞型人工镫骨（Piston）重建听骨链22耳（Ⅲ型14耳、Ⅳ型8耳）。术后随访1～5年,分析患者言语频率（0.5、1、2kHz）平均纯音气导阈值及气骨导差,应用SPSS13.0软件包进行统计分析。结果鼓室硬化Ⅲ型、Ⅳ型患者术前言语频率平均纯音气导阈值及气骨导差差异无统计学意义（P〉0.05）;镫骨撼动组、TORP组、Piston组术前3组病例平均纯音气导阈值及气骨导差差异无统计学意义（P〉0.05）;术后1、3、5年3组病例平均纯音气导阈值及气骨导差差异有统计学意义（P〈0.01）;术后5年Piston组在纯音气导阈值及气骨导差方面疗效优于TORP组,差异有统计学意义（P〈0.01）。结论鼓室硬化镫骨固定无论锤、砧骨固定与否,最好去除锤骨头及砧骨,予人工听骨重建听骨链,镫骨足板造孔术是安全的,而且疗效稳定。     

Hearing results after stapedotomy with a nitinol piston prosthesis

OBJECTIVE: To compare the hearing results in patients with otosclerosis who underwent a stapedotomy with either a platinum wire prosthesis or a commercially available, heat-activated nitinol stapes piston prosthesis. DESIGN: Retrospective medical chart review. SETTING: Academic tertiary care medical center. PATIENTS: Seventy-nine consecutive patients diagnosed as having otosclerosis who underwent primary stapedotomy (33 men and 46 women) were included in this study (41 ears per group). INTERVENTION: Stapedotomy. MAIN OUTCOME MEASURES: The operative records of the senior surgeon (B.J.G.) were retrospectively reviewed, and hearing results were obtained. The hearing results of the patients who received a platinum wire prosthesis were compared with those who received a nitinol prosthesis. RESULTS: Results for the platinum wire prosthesis group revealed a postoperative mean (SD) air-bone gap (ABG) of 7 (6) dB, a mean (SD) ABG closure of 21 (12) dB, and a postoperative mean (SD) speech reception threshold of 25 (16) dB. Results for the nitinol prosthesis group revealed a postoperative ABG of 8 (6) dB, an ABG closure of 25 (10) dB, and a postoperative speech reception threshold of 25 (12) dB. CONCLUSIONS: These data show that the nitinol prosthesis is equivalent to the platinum wire prosthesis in closing the ABG in patients with otosclerosis. Comparable efficacy combined with the ease and safety of heat-activated crimping supports the continued use of this prosthesis for stapes surgery.     

Retrospective analysis of the results of implanting Nitinol pistons with heat-crimping piston loops in stapes surgery

The study presented here evaluates the hearing results after the implantation of a new nickel–titanium (Nitinol) prosthesis in stapes surgery; on heating, this prosthesis crimps itself around the long process of the incus. In addition, we compare the outcome with results published in the literature. The medical records of all patients who underwent surgery for otosclerosis with implantation of a Nitinol piston during the period 2004–2006 were evaluated retrospectively. 83 patients (58 women and 25 men), with a provisional diagnosis of otosclerosis that was confirmed during surgery in all but one of the cases, were treated by primary stapes surgery (85 ears). We were able to include 53 patients (55 ears) who had audiograms with air and bone conduction preoperatively and both 2–6 weeks and about 1 year after surgery. We found a mean air–bone gap (ABG) for the frequencies 0.5, 1, 2 and 4 kHz (ABG4000) of 10.4 ± 5.5 dB after a mean postoperative follow-up period of 24.5 ± 16 days, and of 7.4 ± 3.7 dB after 462 ± 119 days. For the frequencies 0.5, 1, 2 and 3 kHz (ABG3000), the results were 9.1 ± 4.8 and 6.4 ± 3.9 dB. The differences in preoperative versus postoperative air–bone gap, referred to as ABGC, after 25 and 462 days, respectively, were 19.4 ± 8.9 and 22.3 ± 8.8 dB for AGB4000, and 19.5 ± 8.8 and 22.2 ± 8.9 for ABG3000. Very good results were achieved with a new nickel–titanium prosthesis that crimps itself around the long process of the incus, thus facilitating stapes surgery and at the same time stabilizing the high quality of the results. However, no long-term results after 10 years or more, which would allow a final judgment, are yet available.     

High-frequency sensorineural hearing loss after stapedectomy.

OBJECTIVE: To describe the pattern and duration of high frequency sensorineural hearing loss after stapedectomy. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. PATIENTS: All patients who underwent stapedectomy by the senior author during the period between January 1, 1998, and October 1, 2005, with preoperative, 4- to 6-week postoperative, and at least 9-month postoperative audiograms were included. Fifty-three patients met the inclusion criteria, with surgeries performed on 61 ears. INTERVENTION(S): Stapedectomy was performed using a CO2 laser. MAIN OUTCOME MEASURE(S): Mean preoperative and postoperative pure-tone bone thresholds, mean preoperative and postoperative pure-tone air thresholds, and hearing outcomes for 4,000 Hz bone conduction (BC) and 8,000 Hz air conduction (AC) based on the patient's age and interval after the operative procedure. RESULTS:: Mean BC thresholds at 4,000 Hz BC worsened by 6 dB at 4 to 6 weeks and improved by 3 dB by 9 months. There was an 8-dB average loss at 8,000 Hz AC at 4 to 6 weeks with a gain of 4 dB by 9 months. Patients older than 40 years were 4 times more likely to experience early loss at 4,000 Hz BC when preoperative thresholds were held constant. The late outcome for hearing loss was dependent more on the preoperative threshold than was the age of the patient. At 8,000 Hz AC, the preoperative hearing threshold was a predictor of early and late hearing loss at 8,000 Hz. CONCLUSION: High-frequency sensorineural hearing loss is initially seen after stapes surgery, and improvement does occur over time. When preoperative hearing threshold is held constant, patients older than 40 years are more likely to experience short-term hearing loss at high frequencies than patients younger than 40 years. Age was not a predictor of postoperative high-frequency hearing loss in the long term.     

Comparison of various bone cement ossiculoplasty techniques and functional results

Objective: In this study, functional results of different bone cement ossiculoplasty techniques are compared.

Methods: Retrospective case review at a tertiary referral center. Patients who underwent middle ear surgery and bone cement ossiculoplasty between 2006–2012 were included. A total of 52 patients, including 30 patients with ‘Incus to stapes’ (Group 1) and 13 patients with ‘malleus to stapes’ (Group 2), five patients with ‘incudoplasty?+?stapedotomy’ (Group 3), and four patients with ‘malleus to incus’ (Group 4) ossiculoplasty were enrolled in the study. Pre-operative and post-operative audiological findings of each group were evaluated.

Results: The mean hearing gain (the difference between pre-operative and post-operative air bone gap (ABG)) was 13?dB for Group 1, 30?dB for Group 2, 24?dB for Group 3, and 9?dB for Group 4. The pre-operative air pure tone averages (PTA) of groups 1, 2, and 3 improved significantly in the post-operative period (p?Conclusions: The results showed that glass ionomer cement is a simple and effective method for reconstruction of ossicular discontinuity in various ossicular chain pathologies and can be an alternative to conventional rebridging techniques such as sculpted incus interposition or partial ossicular replacement prosthesis (PORP).     

Stapedotomy in osteogenesis imperfecta: a prospective study of 23 consecutive cases.

OBJECTIVE: To prospectively evaluate the hearing results in surgically treated cases of stapes fixation in patients with osteogenesis imperfecta. STUDY DESIGN: A prospective study of osteogenesis imperfecta patients with stapes fixation. SETTING: One tertiary referral center. PATIENTS: Eighteen patients (23 ears) who underwent stapes surgery from 1994 to 2004 were prospectively included. INTERVENTION: Stapedotomy with vein graft interposition and reconstruction with a Teflon piston or a bucket handle (cup) prosthesis. MAIN OUTCOME MEASURES: Preoperative and postoperative audiometric evaluation using conventional audiometry. Air-bone gap, bone-conduction thresholds, and air-conduction thresholds were measured. Postoperative audiometry was performed at 6, 9, 12, 18, and 24 months after surgery and at a yearly interval thereafter. RESULTS: Overall, a postoperative air-bone gap closure to within 10 dB was achieved in 85.7% of cases. Postoperative improvement of air-conduction thresholds superior to 20 dB was found in 57% of cases. The postoperative bone-conduction thresholds were unchanged. CONCLUSION: This study shows that safe and successful stapedotomy is possible in cases of stapes fixation in patients with osteogenesis imperfecta.     

Eliminating the Limitations of Manual Crimping in Stapes Surgery? A Preliminary Trial with the Shape Memory Nitinol Stapes Piston

OBJECTIVE: Manual piston malcrimping in stapedotomy may be the major cause of the occurrence of the significant, interindividual variations of postoperative air-bone gap (ABG), air-bone gap closures (ABGC), and postoperative recurrences of conductive hearing loss. To eliminate the effects of manual crimping on stapedotomy outcomes, the self-crimping, shape memory alloy Nitinol stapes piston was investigated and hearing evaluated. STUDY DESIGN: Prospective, preliminary case-control study in a tertiary care referral center. METHODS: Sixteen patients with otosclerosis undergoing reversed stapedotomy using the Nitinol stapes piston were matched to reference patients out of our conventional titanium piston database. The effects of the self-crimping Nitinol piston on the postoperative ABGC, the postoperative air-bone gap (ABG) variations, and the postoperative short-term hearing results were investigated 3, 6 and 9 months postoperatively. These data were statistically compared with the results of the control patients in our titanium stapes piston database. RESULTS: The mean postoperative ABG and the interindividual variations of the postoperative ABG were significantly smaller in the Nitinol group, the extent of ABGC greater in the Nitinol piston group, but not significant. The postoperative short-term stability of ABGC was similar in both groups. No infections or adverse reactions occurred during follow-up. CONCLUSION: Our preliminary results suggest that the self-crimping shape memory alloy Nitinol stapes piston eliminates the limitations of manual malcrimping in stapedotomy, thus optimising the surgical procedure. This allows reliable, safe, and consistent air-bone-gap closure in patients with otosclerosis up to 1 year after surgery.     

经典Wullstein Ⅲ型鼓室成形术在慢性化脓性中耳炎手术中的应用分析

目的：探讨经典Wullstein Ⅲ型鼓室成形术在慢性化脓性中耳炎手术中的适应证及其术后听力效果。方法回顾性分析行开放式Ⅲ型鼓室成形术的患者34例（34耳）,患者均有听骨链破坏而镫骨结构完整,鼓膜内陷与镫骨头或砧骨豆状突直接连接,根据术中是否植入钛合金部分人工听骨（partial ossicular replacement prosthesis,PORP）分为两组, Wullstein Ⅲ型鼓室成形术（Ⅲ型组）11例和植入钛合金部分人工听骨（PORP组）23例。分别比较两组术后0.5、1、2和4 kHz的平均气导听阈、平均气骨导差的变化情况。结果Ⅲ型组患者术前平均气导听阈为46.59±16.60 dB HL,术后为34.89±10.34 dB HL,气导听阈提高11.70±19.30 dB HL;PORP组术前平均气导听阈为44.23±12.31 dB HL,术后为37.08±14.36 dB HL,提高7.14±14.39 dB HL;Ⅲ型组术前平均气骨导差（air-bone gap,ABG）为23.98±13.08 dB HL,术后为16.25±6.98 dB HL,缩小7.73±14.93 dB HL;PORP型组术前平均ABG为26.58±10.27 dB HL,术后为19.40±13.28 dB HL,缩小7.17±13.63 dB HL。两组患者在气导听阈提高值及ABG缩小的差异均无显著统计学意义（P＆gt;0.05）。结论开放式鼓室成形术中,如果鼓膜内陷与镫骨头或砧骨豆状突形成连接,可以予以保留,短期随访术后听力水平与植入PORP重建听骨链的效果相当,长期效果还需随访观察。     

Effects of packing on the postoperative hearing after middle ear surgery

CONCLUSION: The changes of hearing by packing after middle ear surgery should be anticipated and carefully interpreted. OBJECTIVES: To evaluate the amount and patterns of hearing loss resulting from packing in middle ear cavity (MEC) and external auditory canal (EAC) after middle ear surgery. METHOD: We obtained pure tone thresholds by bone (BC) and air conduction (AC) up to 12 weeks after middle ear surgery in 17 patients who had minimal middle ear pathology. To observe the effects of packing only in the EAC as in cases of explorative tympanotomy or stapes surgery, BC and AC threshold were obtained after packing only in the EAC in 18 volunteers. The changes of BC and AC thresholds in terms of pure tone average (PTA) and high frequency PTA were analyzed. RESULTS: PTA by AC increased significantly by a maximal value of 38.7 dB at the second postoperative day, by 35.0 dB at 1 week after middle ear surgery. PTA by BC also increased maximally at the second postoperative day by 4.8 dB. The elevation of BC threshold at high frequencies (2, 3, 4 kHz) was more pronounced. Packing of EAC without MEC packing resulted in elevation of AC threshold by 43.0 dB, with similar patterns of BC threshold changes as MEC and EAC packing.     

Predictors of hearing outcomes after stapes surgery in otosclerosis

Abstract

Background: The current surgical treatment of otosclerosis is stapes surgery; however, few studies have reported the predictors of surgical outcomes.

Aim/objective: This study aimed to investigate the prognostic predictors for postoperative hearing outcomes.

Materials and methods: A total of 181 ears in 152 patients undergoing stapes surgery at a tertiary referral centre in Taiwan from 1996 to 2016 were retrospectively enrolled and preoperative and intraoperative parameters were obtained. Univariate and multivariate analyses were used to determine independent predictors of postoperative hearing outcomes. A regression model was also established. Hearing success was defined as a postoperative air-bone gap (ABG) ≤10?dB.

Results: In univariate analysis, the absence of floating footplate during surgery (p?=?.003) and small preoperative ABG (p?=?.014) were associated with successful hearing outcomes. Multivariate logistic regression analysis further revealed the absence of floating footplate during surgery (p?=?.010) and small preoperative ABG (p?=?.015) remained independent predictors of postoperative hearing success.

Conclusions and significance: Preoperative audiometric data and intraoperative finding may provide surgeons and patients with a better insight into surgical outcomes.