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Abstract：
BACKGROUND: Transcanal endoscopic ear surgery (TEES) reportedly requires a long learning curve and may be associated with more complications and longer operative times than microscopic ear surgery (MES). In this study, we aimed to examine the usefulness and validity of TEES for ossicular chain disruption in the early stages of its introduction in our institution.
METHODS: TEES was performed on 11 ears (10 with congenital ossicular chain discontinuity and 1 with traumatic ossicular chain dislocation), and MES was performed with a retroauricular incision on 18 ears (6 with congenital ossicular chain discontinuity and 12 with traumatic ossicular chain dislocation) in a tertiary referral center. Postoperative hearing results, operative times, and postoperative hospital length of stay were retrospectively reviewed. The Mann-Whitney U test and Fisher\'s exact test was performed to compare variables between the TEES and MES groups. Pre- and postoperative air- and bone-conduction thresholds and the air-bone gap of each group were compared using the Wilcoxon signed-rank test. The Mann-Whitney U test and Wilcoxon signed-rank was performed to compare the pre- and postoperative air-bone gaps between the diagnoses.
RESULTS: No significant differences in the postoperative air-conduction thresholds, bone-conduction thresholds, air-bone gaps, or incidence of air-bone gap ≤ 20 dB were observed between the TEES and MES groups. The air-conduction thresholds and air-bone gaps of the TEES group significantly improved postoperatively. The air-conduction thresholds and air-bone gaps of the MES group also significantly improved postoperatively. No significant difference was observed in the operative times between the groups (TEES group: median, 80 min; MES group: median, 85.5 min). The TEES group had a significantly shorter postoperative hospital stay (median, 2 days) than the MES group (median, 7.5 days).
CONCLUSIONS: TEES was considered appropriate for the treatment of ossicular chain disruption, even immediately after its introduction at our institution. For expert microscopic ear surgeons, ossicular chain disruption may be considered a suitable indication for the introduction of TEES.
METHODS: TEES was performed on 11 ears (10 with congenital ossicular chain discontinuity and 1 with traumatic ossicular chain dislocation), and MES was performed with a retroauricular incision on 18 ears (6 with congenital ossicular chain discontinuity and 12 with traumatic ossicular chain dislocation) in a tertiary referral center. Postoperative hearing results, operative times, and postoperative hospital length of stay were retrospectively reviewed. The Mann-Whitney U test and Fisher\'s exact test was performed to compare variables between the TEES and MES groups. Pre- and postoperative air- and bone-conduction thresholds and the air-bone gap of each group were compared using the Wilcoxon signed-rank test. The Mann-Whitney U test and Wilcoxon signed-rank was performed to compare the pre- and postoperative air-bone gaps between the diagnoses.
RESULTS: No significant differences in the postoperative air-conduction thresholds, bone-conduction thresholds, air-bone gaps, or incidence of air-bone gap ≤ 20 dB were observed between the TEES and MES groups. The air-conduction thresholds and air-bone gaps of the TEES group significantly improved postoperatively. The air-conduction thresholds and air-bone gaps of the MES group also significantly improved postoperatively. No significant difference was observed in the operative times between the groups (TEES group: median, 80 min; MES group: median, 85.5 min). The TEES group had a significantly shorter postoperative hospital stay (median, 2 days) than the MES group (median, 7.5 days).
CONCLUSIONS: TEES was considered appropriate for the treatment of ossicular chain disruption, even immediately after its introduction at our institution. For expert microscopic ear surgeons, ossicular chain disruption may be considered a suitable indication for the introduction of TEES.
摘要：
背景：据报道，经肛门内窥镜耳部手术（TEES）需要较长的学习曲线，并且与显微耳部手术（MES）相比，可能会带来更多的并发症和更长的手术时间。在这项研究中,我们的目的是在我们机构引入TEES的早期阶段检查TEES对听骨链破坏的有用性和有效性。
方法：对11只耳进行TEES（10只为先天性听骨链不连续，1只为外伤性听骨链脱位），在三级转诊中心，对18耳（6耳先天性听骨链不连续，12耳外伤性听骨链脱位）进行了耳后切口MES。术后听力结果,手术时间，并对术后住院时间进行回顾性分析.进行Mann-WhitneyU检验和Fisher精确检验以比较TEES和MES组之间的变量。使用Wilcoxon符号秩检验比较各组的术前和术后空气和骨传导阈值以及空气-骨间隙。进行了Mann-WhitneyU检验和Wilcoxonsigned-rank，以比较诊断前后的气骨间隙。
结果：术后空气传导阈值无显著差异，骨传导阈值，空气-骨骼间隙,在TEES组和MES组之间观察到气-骨间隙≤20dB的发生率。TEES组的空气传导阈值和空气骨间隙在术后显着改善。MES组的空气传导阈值和空气-骨间隙也在术后显着改善。两组之间的手术时间没有显着差异（TEES组：中位数，80分钟；MES组：中位数，85.5分钟）。TEES组术后住院时间明显缩短（中位数，2天）比MES组（中位数，7.5天）。
结论：TEES被认为适合治疗听骨链断裂，甚至在我们机构推出后立即推出。对于专业的显微耳外科医生来说，听骨链破坏可被认为是引入TEES的合适指征。
方法：对11只耳进行TEES（10只为先天性听骨链不连续，1只为外伤性听骨链脱位），在三级转诊中心，对18耳（6耳先天性听骨链不连续，12耳外伤性听骨链脱位）进行了耳后切口MES。术后听力结果,手术时间，并对术后住院时间进行回顾性分析.进行Mann-WhitneyU检验和Fisher精确检验以比较TEES和MES组之间的变量。使用Wilcoxon符号秩检验比较各组的术前和术后空气和骨传导阈值以及空气-骨间隙。进行了Mann-WhitneyU检验和Wilcoxonsigned-rank，以比较诊断前后的气骨间隙。
结果：术后空气传导阈值无显著差异，骨传导阈值，空气-骨骼间隙,在TEES组和MES组之间观察到气-骨间隙≤20dB的发生率。TEES组的空气传导阈值和空气骨间隙在术后显着改善。MES组的空气传导阈值和空气-骨间隙也在术后显着改善。两组之间的手术时间没有显着差异（TEES组：中位数，80分钟；MES组：中位数，85.5分钟）。TEES组术后住院时间明显缩短（中位数，2天）比MES组（中位数，7.5天）。
结论：TEES被认为适合治疗听骨链断裂，甚至在我们机构推出后立即推出。对于专业的显微耳外科医生来说，听骨链破坏可被认为是引入TEES的合适指征。
