聽小骨成形術後之聽力改善－預後因子分析

Hearing Results after Ossiculoplasty-An Analysis of Prognostic Factors

潘明勳(Ming-Hsiung Pan) ； 洪嘉駿(Chia-Chun Hung) ； 陳忠雄(Chung-Hsiung Chen)

《秀傳醫學雜誌》 7卷4期 (2007/12) Pp. 135-142

摘要

BACKGROUND: Patients with chronic otitis media often have various kinds of defects of the ossicular chain. Reconstruction and restoration of the ossicular structure, ossiculoplasty, is one of the important procedures for hearing improvement in those patients. Several factors involve the prognosis of ossiculoplasty. This study aims to review the procedures and methods of ossiculoplasty performed in our hospital and analyze the possible prognostic factors effecting hearing outcomes.
METHODS: We retrospectively reviewed the charts of the patients who received ossiculoplasty, from January 2000 to December 2002, as one of the procedures of type3 tympanoplasty in Farrior's classification. The recorded data included pre-and post-operative hearing threshold, symptoms and signs before surgery, intraoperative findings, and postoperative complications during the period of follow up. These cases were subgrouped according to the following conditions: 1) pre-operative otorrhea or not. 2) the types of ossicular defect. 3) canal-wall-up or canal-wall-down mastoidectomy. 4) revised surgery or not. 5) materials used for reconstruction of the ossicular chain. The hearing results of each subgroups were compared and analyzed.
RESULTS: There were 105 operations performed by 3 otolaryngologists. The mean follow-up time was 9.4 months. The post-operative complications were: wound infections: 9 cases (8.6%); unhealed perforation of the eardrum: 18 cases (17.1%); recurrence of disease: 3 cases (2.9%); extrusion of the prosthesis or the ossicles: 4 cases (3.8%). The post-operative hearing threshold was available in 52 cases. The mean time of those examinations was 6.6 months postoperatively. The mean postoperative air-bone gap was 28.0 dB, and was statistically different from the mean preoperative air-bone gap: 34.9 dB (p＜0.001). The hearing results showed significant difference when using different reconstructive materials. (autograft vs PORP, p=0.047), while no significant difference was found in other comparison.
CONCLUSIONS: The results of our study differed from other studies. The reasons could be: 1) The procedures were not performed by the same surgeon. 2) The case number was too small for statistical analysis. 3) The mean length of time between the operation and post-op PTA was inuyfficient. More experiences as well as longer and closer follow-up were needed for more conclusive results.

關鍵字

聽小骨成形術 ； 聽力結果 ； 預後因素

並列摘要

BACKGROUND: Patients with chronic otitis media often have various kinds of defects of the ossicular chain. Reconstruction and restoration of the ossicular structure, ossiculoplasty, is one of the important procedures for hearing improvement in those patients. Several factors involve the prognosis of ossiculoplasty. This study aims to review the procedures and methods of ossiculoplasty performed in our hospital and analyze the possible prognostic factors effecting hearing outcomes.
METHODS: We retrospectively reviewed the charts of the patients who received ossiculoplasty, from January 2000 to December 2002, as one of the procedures of type3 tympanoplasty in Farrior's classification. The recorded data included pre-and post-operative hearing threshold, symptoms and signs before surgery, intraoperative findings, and postoperative complications during the period of follow up. These cases were subgrouped according to the following conditions: 1) pre-operative otorrhea or not. 2) the types of ossicular defect. 3) canal-wall-up or canal-wall-down mastoidectomy. 4) revised surgery or not. 5) materials used for reconstruction of the ossicular chain. The hearing results of each subgroups were compared and analyzed.
RESULTS: There were 105 operations performed by 3 otolaryngologists. The mean follow-up time was 9.4 months. The post-operative complications were: wound infections: 9 cases (8.6%); unhealed perforation of the eardrum: 18 cases (17.1%); recurrence of disease: 3 cases (2.9%); extrusion of the prosthesis or the ossicles: 4 cases (3.8%). The post-operative hearing threshold was available in 52 cases. The mean time of those examinations was 6.6 months postoperatively. The mean postoperative air-bone gap was 28.0 dB, and was statistically different from the mean preoperative air-bone gap: 34.9 dB (p＜0.001). The hearing results showed significant difference when using different reconstructive materials. (autograft vs PORP, p=0.047), while no significant difference was found in other comparison.
CONCLUSIONS: The results of our study differed from other studies. The reasons could be: 1) The procedures were not performed by the same surgeon. 2) The case number was too small for statistical analysis. 3) The mean length of time between the operation and post-op PTA was inuyfficient. More experiences as well as longer and closer follow-up were needed for more conclusive results.

並列關鍵字

ossiculoplasty ； hearing results ； prognostic factors