镫骨修正术的疗效分析

Effective analysis on Revision Stapedectomy

目的探讨镫骨修正术对耳硬化症患者初次手术后复发传导性聋的疗效,总结再次手术中的注意事项。方法回顾性分析我院自2004年至2014年行31例镫骨修正术患者的术中发现及术前、术后听力学资料。结果耳硬化症患者初次手术失败的主要原因是纤维粘连,砧骨固定和假体移位。镫骨修正术后患者气骨导差(听力级,下同)在20d B以内的21人(67.7%)。术后平均气骨导差13.4d B,平均纯音听阈气导由术前58.5d B减至术后42.7d B,提高15.8d B,术后未发现极重度感音神经性聋患者。结论镫骨修正术手术成功率虽较初次手术低,仍可明显改善多数传导性聋患者的听力。

Objective To investigate effects of revision stapedectomy on patients with recurrent conductive hearing loss after primary surgery and to sum up precautions in revision surgery. Methods We retrospectively reviewed a series of 31 revision stapes surgeries performed from 2004 to 2014. Inoperative findings, pre and postoperative audiometric results were noted. Results The leading causes of failure included fibrosis adhesions, refixation of incus and prosthesis dislocation. A postopera- tive gap within 20 dB was obtained in 21 （67.7%） of patients. The average postoperative air-bone gap was 13.4 dB and the mean pure-tone average improvement was 15.8 dB. No profound sensorincural hearing loss occurred. Conclusion Although revision stapedectomy provides less favorable success rate than primary surgery, it allows significant hearing improvement in large proportion of patients.