陈旧性乳突术后全中耳重建术的听力变化

目的：探讨利用自体软骨进行听骨链成形的全中耳重建术患者听力恢复的可能性。方法：对65例(69耳)慢性化脓性中耳炎乳突手术后出现复发性耳漏再手术者，术中同时利用自体软骨进行Ⅲ或Ⅳ型鼓室成形术。比较手术前后听力的变化。结果：全中耳重建术后45耳(65．2％)成功提高了听力，Ⅲ型者听力成功率为74．2％(23耳)；Ⅳ型者听力成功率为57．9％(22耳)。全部患者平均听力提高10．6dB nHL。结论：全中耳重建术可有效地提高陈旧性乳突手术后患者的听力，存在镫骨者的听力成功率要好于镫骨缺失者；二期手术可更明显提高听力。     

Reconstruction of the chain of the auditory ossicles after radical operation on the middle ear

As restoration of hearing in patients after radical surgery on the middle ear for otitis media purulenta chronica remains topical, we tried to increase the efficacy of ossiculoplasty in such patients by staged reconstruction of the middle ear. A total of 102 patients were examined and operated on. A modified classification of osseous chain defects was used to evaluate the degree of damage to the osseous system. The following policy was employed for reconstruction of the middle ear: in patients with large trepanation cavities (more than 5 ml) mastoidoplasty was carried out as the first stage using a musculo-periosteal flap with an anterior or inferior pedicle; at the second stage, myringoplasty was performed using a two-layer graft followed by ossiculoplasty with autotransplants (fingernail plate, auricular or tragal cartilage, cortical layer bone). Long-term follow-up of the patients showed that good and satisfactory hearing levels were obtained in 79.4% of the patients. The air-bone gap was closed by 10 dB or more in the speech frequency range in 80.4% of the patients. Staged reconstruction of the middle ear using autotransplant materials significantly decreased the number of postoperative complications (perforation of the plastic flap, cicatrical displacement of the prosthesis and graft rejection).     

Assessment of total middle ear reconstruction by patient survey correlated with clinical findings

OBJECTIVE: Our objective was to assess, by patient survey and clinical examination, the results of correctional total middle ear reconstruction of problematic mastoid cavities following radical or modified radical mastoidectomy. SETTING: This study was performed in an academic tertiary referral center. PATIENTS: The study consisted of a retrospective survey, using the modified hearing satisfaction scale, of 50 patients, who had undergone total middle ear reconstruction of their problematic mastoid cavities. The survey results were correlated with their postoperative clinical findings. RESULTS: Postoperatively, 98% of these patients expressed satisfaction in terms of improvement of their preexisting otorrhea (median of 4.32 satisfied), 65% were satisfied with their hearing and 85% were satisfied with the overall of this operation. The survey results had a good correlation with the audiometric findings and the clinical findings, i.e. the surgery resulted in a dry ear in all 50 patients and 51% of these patients showed hearing improvement of more than 5 dBHL. CONCLUSIONS: This study indicates that most patients were satisfied with the outcomes of this operation. The patients' point of view and the postoperative clinical data both indicate that total middle ear reconstruction is an excellent procedure for correcting problematic mastoid cavities following a radical or modified radical mastoidectomy. The hearing satisfaction scale is a useful instrument for assessing patient satisfaction following this surgical procedure.     

Bone cement ossiculoplasty: incus to stapes versus malleus to stapes cement bridge.

OBJECTIVE: In this study, our purpose was to evaluate results of our experience with bone cement repair of ossicular discontinuity between the incus and stapes and between the malleus and stapes. METHODS: Medical records of patients who underwent surgery for chronic otitis media between March 2000 and December 2002 were evaluated retrospectively. Fifty-seven patients who underwent bone cement ossiculoplasty and had appropriate follow-up data were included in the study. Bone cement reconstruction of the ossicular chain was performed 1) from incus to stapes (I-S) in the absence of long arm or lenticular process of the incus and 2) from malleus to stapes (M-S) in the absence of the incus. The clinical data of the patients were evaluated by otoscopic examination and audiometry. RESULTS: The graft take rate was 84.1%. I-S procedure was performed in 42 and M-S in 8 patients. Pre- and postoperative PTAs of all patients were compared, which showed a significant improvement in air PTA (p < 0.001) while bone PTA did not change (p > 0.05). In I-S and M-S groups, successful hearing restoration could be achieved in 78.6.1% and 87.5% of the patients, respectively. Hearing results of different aural pathologies (chronic otitis media and conductive hearing loss) and surgeries (tympanotomy and tympanoplasty with or without mastoidectomy) were not significantly different (p > 0.05). CONCLUSION: Bone cement ossiculoplasty offers cost effective and significant improvement in conductive hearing loss.     

Mechanics of the TORP/stapes interface

The gain in hearing as a result of ossicular prosthesis (TORP) placement on the stapes footplate was evaluated in 10 patients during actual middle ear reconstructive surgery. The patients with radical mastoidectomy cavities were operated on under local anaesthesia and intra-operative hearing was tested with the TORP shaft in three positions with regard to the stapes footplate: anterior, central and posterior. The anterior position of the shaft provided greater hearing improvement than the posterior position, with the central position falling approximately midway.     

Double cartilage block ossiculoplasty in chronic ear surgery.

OBJECTIVES/HYPOTHESIS: Multiple techniques of ossicular reconstruction have been advocated for hearing rehabilitation in the setting of chronic otitis media No single method can adequately address the clinical spectrum of disease severity. In the situation of a severely diseased ear requiring a canal wall down (CWD) mastoidectomy in the presence of an intact stapes superstructure, the authors have employed a double cartilage block (DCB) ossiculoplasty. The technique and short-term results are reviewed. STUDY DESIGN: Retrospective chart review in a tertiary referral otologic practice. METHODS: Twenty-three patients underwent a CWD tympanomastoidectomy with DCB ossiculoplasty. Ages ranged from 6 to 85 years (mean, 36.1 y). The majority of ears were actively draining at the time of surgery (83%) and most procedures were revisions of prior mastoidectomies (74%). Audiometric data (mean postoperative follow-up, 19.5 mo) were calculated according to 1995 American Academy of Otolaryngology-Head and Neck Surgery guidelines. RESULTS: Audiometric results were available in 20 patients. The mean air-bone gap (ABG) was 23.8 dB after surgery. Closure of the ABG to within 20 dB was achieved in 10 of 20 patients (50%). No cases of DCB extrusion have occurred to date. CONCLUSIONS: The DCB represents an excellent alternative to biocompatible prostheses for ossicular reconstruction in the setting of severe chronic ear disease. As with all methods of ossiculoplasty, long-term follow-up will be necessary to determine if this technique remains stable in the hostile environment in which it has been employed.     

Ossicular chain reconstruction in chronic otitis media: hearing results and analysis of prognostic factors

IntroductionThe goal of ossiculoplasty is to improve hearing and the success of this procedure depends on several factors.ObjectiveAnalyze the hearing results in patients with chronic otitis media undergoing ossicular chain reconstruction, as well as predictive factors for successful surgery.MethodsCharts of patients undergoing ossiculoplasty between 2006 and 2016 were reviewed. Sixty-eight patients were included, totaling 72 ears. The following data was analyzed: gender, age, smoking status, laterality, pathology, audiometric exams, type of surgery, previous surgery, characteristics of the middle ear, otorrhea and ossicular chain status. Patients were also classified according to two indices: middle ear risk index and ossiculoplasty outcome parameter staging. The results were evaluated by comparing the air-bone gap before and after surgery. The success of reconstruction was defined as air-bone gap ≤20 dB and the improvement of speech reception Thresholds, calculated through the mean frequencies 0.5, 1, 2 and 3 kHz.ResultsReconstruction success rate was 61%. The mean preoperative air bone gap was 34.63 dB and decreased to 17.26 dB after surgery. There was a correlation between low risk in middle ear risk index and ossiculoplasty outcome parameter staging indices with postoperative success. The most frequently eroded ossicle was the incus and the type of prosthesis most used was tragal cartilage. In the patients without incus, we achieved success in 74.2% of the surgeries. In the absence of the stapes, the success rate decreased to 63.3%. In the absence of the malleus, 85% of the patients had and air bone gap ≤20 dB.ConclusionWe achieved good audiometric outcomes in ossiculoplasty and the results are comparable to other centers. Ossicle status influenced postoperative results, especially in the presence of stapes. We also concluded that the indexes analyzed may help to predict the success of the surgery.     

Hearing results after ossiculoplasty using Polycel prosthesis

CONCLUSIONS: Polycel is an effective material to use in ossiculoplasty. Good prognostic factors for hearing improvement after ossiculoplasty were healthy middle ear mucosa and the presence of stapes superstructure. OBJECTIVE: During the last decade, the surgical use of alloplasts has become increasingly widespread among otologists. This study aimed to evaluate the hearing results after ossiculoplasty using Polycel prosthesis. MATERIALS AND METHODS: We retrospectively reviewed 188 patients who underwent ossicular chain reconstruction using Polycel prosthesis and were followed up postoperatively for more than 12 months at Severance Eye-ENT Hospital from 1998 to 2002. Postoperative hearing results were assessed by measuring the postoperative air-bone gap (ABG) and closure of the ABG. Successful postoperative ABG criteria were defined as the following three measurements: ABG of 相似文献   

Obliteration of Radical Cavities and Total Reconstruction Procedure Without Staging After Canal Wall Down Mastoidectomy: Long-term Results

Objectives

We evaluate the long-term surgical and hearing results using a canal wall down mastoidectomy technique followed by cavities obliteration, canal wall reconstruction and ossiculoplasty without staging.

Methods

A total of 44 patients between January 2002 and October 2009 were selected and 27 of them were revision cases. Preoperative and postoperative pure tone average (PTA) and air-bone gap (ABG) were assessed and compared 1 and 4 years after surgery.

Results

The middle ear was well healed and aerated in 40 patients (90.9%) and the tympanic membrane was intact in 42 patients (95.5%). Recurrent cholesteatoma was found on postoperative follow-up in two of the revision patients (7.4%) but none in the primary patients. Seven patients were found to have partial canal bone absorption, but revision surgery was not required. Over 86.4% of all cases were water resistant. Long-lasting improvement and/or preservation of hearing, with maintenance of PTA-ABG closure in 63.7% of all cases within 20 dB, were obtained.

Conclusion

The efficacy of our technique after a canal wall down mastoidectomy is satisfactory, and the rate of complication is acceptably low. We believe that our technique could be a convenient method in disease control and providing an excellent basis for hearing restoration simultaneously.     

The use of allograft stapes

Since 1981, we have used the stapes allograft, singly or in combination with homograft incus, in 20 cases of tympanoplasty and in 7 cases of fixed stapes. All of the allograft stapes discussed were procured, processed and stored in 1980 by the Hyogo Ear Bank, the first to be established in Japan. The stapes allograft was used in three situations: an intact posterior canal wall, an open mastoidectomy cavity, or a fixed stapes (postinflammatory, congenital or otosclerotic). Two modalities of positioning of the donor stapes were attempted: (1) the allograft stapes was placed in the normal position and a shaped incus or cortical bone or tragal cartilage was placed on the top of the stapedial head and connected and (2) the allograft stapes was placed in the upside-down position and the columella was placed on the stapes footplate. Better results were obtained with the allograft stapes placed in the normal position. A two-stage operation, first to place an allograft stapes in the normal position with myringoplasty and then ossiculoplasty, was preferable to one-stage middle ear surgery.     

乳突根治术后同种异体肋软骨中耳重建71例报告

目的：探讨乳突根治术后,让术耳向外耳道开放的乳突腔重新中耳化和Ｉ期听力重建的方法。方法：以同种异体肋软骨为外耳后壁重建、乳突充填和听骨链重建的材料,对７１例（耳）于乳突根治术后行中耳重建术。结果：７１耳术后经０．５￣５年随访,除２耳外,全部病例重建外耳道接近正常生理结构;听力提高１５ｄＢ以上或达应用水平５５耳（７７．５％）,听力提高未达１５ｄＢ１１耳（１５．５％）,因不同原因失败５耳（７．０％）。     

Functional results of Plastipore prostheses for middle ear ossicular chain reconstruction.

OBJECTIVE: Assessment of plastipore prostheses for middle ear ossicular chain reconstruction. Hearing results with total and partial Plastipore ossicular replacement prostheses (TORP and PORP) were evaluated in open- and closed-cavity operations. STUDY DESIGN: A retrospective review of 237 patients who underwent operation for chronic ear disease as well as ossiculoplasty with plastipore prostheses. In order to assess the functional results, only 156 of 237 patients were included in the study. Follow-up ranged from 6 to 46 months. METHODS: Canal wall up and canal wall down operations were performed. Either TORP or PORP ossiculoplasty was performed in each operation. An airbone gap closure to within 20 dB was considered successful. RESULTS: With TORPs, the airbone gap closure to within 20 dB was achieved in 43.1%, and similar results were obtained with PORPs in 63.3%. In canal wall down and canal wall up operations, the success rates were 55.8% and 55.7%, respectively. The best results were obtained with PORPs in canal wall down operations, with a success rate of 82%. The extrusion rate of the prostheses was 4.2%. CONCLUSION: Hearing results of PORPs are better than TORPs. In canal wall up and canal wall down operations similar hearing results are obtained. PORP ossiculoplasty in a canal wall down operation yields the most favorable hearing result.     

Hearing results after ossiculoplasty using Polycel® prosthesis

Conclusions. Polycel® is an effective material to use in ossiculoplasty. Good prognostic factors for hearing improvement after ossiculoplasty were healthy middle ear mucosa and the presence of stapes superstructure. Objective. During the last decade, the surgical use of alloplasts has become increasingly widespread among otologists. This study aimed to evaluate the hearing results after ossiculoplasty using Polycel® prosthesis. Materials and methods. We retrospectively reviewed 188 patients who underwent ossicular chain reconstruction using Polycel® prosthesis and were followed up postoperatively for more than 12 months at Severance Eye-ENT Hospital from 1998 to 2002. Postoperative hearing results were assessed by measuring the postoperative air–bone gap (ABG) and closure of the ABG. Successful postoperative ABG criteria were defined as the following three measurements: ABG of ≤10 dB, ABG of ≤20 dB, and ABG of ≤30 dB. Several prognostic factors were analyzed, including the condition of the middle ear mucosa and ossicles, the presence or absence of cholesteatoma, surgical method, and staging and revision surgery. Results. Of the 188 cases, 22 cases (11.7%) showed an ABG of ≤10 dB, 96 cases (51.1%) presented with an ABG of ≤20 dB, and 158 cases (84.0%) had an ABG of ≤30 dB. In cases with healthy middle ear mucosa and the presence of stapes superstructure, the hearing results were good.     

Effect of adhesion on the acoustic functioning of partial ossicular replacement prostheses in the cadaveric human ear

BACKGROUND: Adhesion formation following ossiculoplasty surgery has been implicated as a cause of the progressive deterioration of an initially good postoperative hearing result. Scar tissue between the partial ossicular reconstruction prosthesis (PORP) and adjacent middle ear structures is a common finding at revision surgery. OBJECTIVES: This study aims to investigate the effects of simulated scarring on the microacoustic transmission characteristics of a PORP in the fresh cadaveric human temporal bone. METHODS: Cortical mastoidectomy and extended posterior tympanotomy permitted access to reflective markers placed on the stapes footplate. A sound stimulus at 80 to 95 dB was presented to the closed external ear canal and displacements were measured with the laser Doppler vibrometer. PORPs were placed in cadaveric specimens, and the shaft of the prosthesis was cemented to the adjacent promontory using dental cement. Serial measurements were made from the stapes footplate as the adhesive was allowed to harden, a process that we have taken to simulate the gradual fixation of the prosthesis by scarring in the live patient. RESULTS: There was a consistent reduction in stapes footplate displacement as the cement hardened. CONCLUSION: The gradual adhesion of a PORP to the promontory produces a consistent reduction in microacoustic transfer to the stapes footplate in the fresh human cadaveric model.     

Open and closed cavity mastoid operations: comparing early hearing results

The aim of the study is to compare audiological results in patients treated surgically with either an open or closed cavity mastoidectomy. A prospective review of a single surgeon’s case series based at two district general hospitals. All patients with 1-year post-operative hearing results following an open or closed cavity mastoid surgery were included. Outcome measured included the preoperative and postoperative air-bone gap (ABG). Belfast rule of thumb was used to assess the benefit from middle ear surgery. A total of 128 patients were identified from the database with 1 year post-operative hearing results. Sixty-three patients had undergone an open cavity mastoidectomy and 65 had a closed cavity mastoidectomy. The mean post-operative ABG in patients with open cavity mastoidectomy was 24 dB and for closed cavity 21 dB (p = 0.12). There was no statistical difference between open and closed cavity mastoidectomy with or without ossiculoplasty and if the underlying pathology was squamous or mucosal disease. However, patient with post-operative ABG below or equal to 20 dB was 41% for closed cavity compared to 21% for open cavity. Using the Belfast rule of thumb, 79% of the patients in both groups had successful hearing results post surgery. The 1-year post-operative audiological results between open and closed cavity masoidectomy showed no statistical difference. The pathology affecting the middle ear also had no influence on the hearing results between the two groups. However, there was a higher percentage of patients with closed cavity procedures who had a post-operative ABG that was below or equal to 20 dB.     

Ossiculoplasty with intact stapes: analysis of hearing results according to the middle ear risk index

Conclusions. In ossiculoplasty with intact stapes, using autologous incus, cortex bone chips and plastipore partial ossicular reconstruction prostheses, improvement in hearing was nearly equal. In patients who had mild risk scores, the incus had better gain values compared with patients who had severe scores. Objective. We aimed to prove the utility of the middle ear risk index score and its predictive value in hearing outcome. We also evaluated hearing results for different reconstruction materials. Patients and methods. This was a retrospective chart review of 189 patients who had ossiculoplasty with intact stapes using autologous incus, cortex bone chips and plastipore partial ossicular reconstruction prostheses. Hearing outcomes and the average improvement in hearing with different reconstruction materials were analysed by using middle ear risk index scores. Results. The average hearing improvements for incus, cortex and partial ossicular reconstruction prostheses were 12.77±14.58 (p<0.001), 12.34±15.98 (p=0.005) and 14.10±13.87 dB (p<0.001), respectively. The postoperative air–bone gap levels were 20.42±14.54 dB in incus, 17.33±16.86 dB in cortex and 17.59±11.66 dB in partial ossicular reconstruction prostheses. When the preoperative middle ear risk index scores and postoperative air–bone gap and gain values were compared, in the incus group, statistically significant associations were demonstrated between scores and hearing outcomes (p=0.009).     

听骨成形术的疗效观察

目的：评估听骨成形术的临床疗效。方法：用自体残存听小骨雕刻成形重建听骨连接。结果：术后3个月,171／196耳听力提高＞15dB,总有效率为87．24％,143／196耳达到应用听力水平,骨－气导间距＜20dB为68％,1年后为64％,随访3－5年仍保持术后的听力水平。结果：采用自体残存听小骨行听骨成形术是治疗慢性化脓性中耳炎、先天性中耳畸形及外伤性听骨链中断的一种有效方法。     

乳突切开术并一期听骨链重建的临床疗效分析

目的：评估乳突切开术并一期行听骨链重建的临床疗效。方法：对2008-01～2011-06期间在我科住院行乳突切开术并一期钛人工听骨植入手术并且有完整随访资料的患者139例进行回顾分析,其中置入部分听骨赝复物（PORP）者91例,置入全听骨赝复物（TORP）者48例,随访时间为2～5年,纯音测听法（PTA）检测患者术前及术后听力,比较手术前后的气导听阈（0．5、1．0、2．0、4．0kHz四个频率气导之平均值）及气骨导差（ABG）,分析钛人工听骨在同期听骨链重建术的听力重建效果。术后ABG≤20dB为听力提高有效。结果：PORP植入患者术前气导平均听阈为（53．97±11．32）dB,术后为（36．80土11．68）dB,平均降低（17．17±5．79）dB;术前ABG平均为（31．84±6．17）dB,术后为（15．13±7．22）dB,平均缩小（16．71±5．50）dB;TORP组患者术前气导平均听阈为（58．05±11．35）dB,术后为（44．53±13．15）dB,平均降低（13．52±7．81）dB;术前ABG平均为（35．67±5．73）dB,术后为（21．48±7．01）dB,平均缩小（14．18±7．53）dB;各组术前术后的差异均有统计学意义（P〈O．01）。PORP组术后ABG≤20dB者（术后听力提高有效）共68例,有效率为74．73％;TORP组术后ABG≤20dB者共26例,有效率为54．13％;总有效率为68．63％,两组之间的差异有统计学意义（P＜0．05）。结论：乳突切开术并同期钛人工听骨植入取得了良好的听力效果,PORP比TORP的听力改善效果好。     

不同类型先天性中耳畸形的手术治疗

探讨先天性中耳畸形的临床分型及其手术策略。方法选取2016年6月—2019年12月收治的23例（33耳）先天性中耳畸形患者进行中耳畸形临床分型及不同的手术策略进行回顾分析，观察术后疗效和听力的恢复情况。术前对23例（33耳）中耳畸形患者均行耳内镜检查、听力学检查及颞骨CT并听骨链三维重建检查。结果23例患者中18例为术前明确畸形，5例为术中探查发现畸形。其中15例为锤、砧骨畸形，选择人工听骨赝复物（TORP或PORP）或自体听骨植入修复；6例为镫骨畸形，选择人工镫骨赝复物（Piston）植入；1例为鼓膜穿孔伴有先天性中耳畸形，先行鼓膜成形术，二期行听骨链重建手术；1例畸形程度比较复杂，面神经走形异常，在前庭窗处分叉，遮挡前庭窗，未能行进一步治疗。术后气导阈值提高至正常的有15例（65.2%）；骨气导差（ABG）恢复至30 dB以内的有16例（69.6%），ABG术后仍超过30 dB的有5例（21.7%），1例听力未改善（4.3%），1例无法行听骨重建（4.3%）。结论先天性中耳畸形术前诊断比较困难，CT检查很难精确评估，手术探查为最有说服力的诊断标准，明确中耳畸形临床分型后选择最佳的手术方式，是治愈疾病并提高患者术后听力最佳选择。     

Hearing results in tympanoplasty

Recent reports from Scandinavian authors have put forth the concept that hearing improvement following tympanoplasty is seldom satisfactory and difficult to obtain. This view is contradictory to the experience of most American authors. A study, therefore, was undertaken to evaluate the hearing results obtained by this author through the use of homograft material in middle ear and mastoid reconstruction. These hearing results are categorized according to time periods, types of reconstruction, and materials used. The hearing statistics are all taken from audiograms obtained one year or more postoperatively. These correspond with the type of reconstruction employed such as an intact ossicular chain, absence of the malleus, absence of the superstructure of the stapes, or both. Other categories include tympanoplasty with mastoidectomy or reconstruction of the posterior canal wall with homograft knee cartilage. The surgical techniques are not discussed in this article because they have been detailed in previous publications.