PDF(Pubmed)
Abstract：
Background and Objectives: Besides classical stapedotomy, reverse stapedotomy has been used for many years in the management of otosclerosis. Our study aims to investigate whether reversing the surgical steps in stapedotomy impacts vestibular function and hearing improvement. Materials and Methods: A cohort of 123 patients underwent either classic or reverse stapedotomy procedures utilizing a fiber-optic argon laser. Audiological assessments, following the guidelines of the Committee on Hearing and Equilibrium, were conducted, including pure tone average, air-bone (AB) gap, overclosure, and AB gap closure. Vestibular evaluation involved pre- and postoperative comparison of rotatory test parameters, including frequency, amplitude, and slow phase velocity of nystagmus. Results: The study demonstrated an overall median overclosure of 3.3 (3.3, 5.0) dB and a mean AB gap closure of 20.3 ± 8.8 dB. Postoperative median AB gap was 7.5 (7.5, 11.3) dB in the reverse stapedotomy group and 10.0 (10.0, 12.5) dB in the classic stapedotomy group. While overclosure and AB gap closure were marginally superior in the reverse stapedotomy group, these differences did not reach statistical significance. No significant disparities were observed in the frequency, slow phase velocity, or amplitude of nystagmus in the rotational test. Conclusions: Although not always possible, reverse stapedotomy proved to be a safe surgical technique regarding postoperative outcomes. Its adoption may mitigate risks associated with floating footplate, sensorineural hearing loss, and incus luxation/subluxation, while facilitating the learning curve for less experienced ear surgeons.
摘要：
背景和目的：除了经典的钳制切开术，反向钉扎切开术已用于治疗耳硬化症多年。我们的研究旨在调查是否逆转stapedoption手术步骤影响前庭功能和听力改善。材料和方法：一组123例患者使用光纤氩激光进行了经典或反向staped切开术。听力学评估，遵循听证与平衡委员会的指导方针，进行了，包括纯音平均，空气骨（AB）间隙，封闭,和AB间隙闭合。前庭评估涉及旋转测试参数的术前和术后比较，包括频率,振幅,和慢相速度的眼球震颤。结果：研究表明，总体中值过度闭合为3.3（3.3，5.0）dB，平均AB间隙闭合为20.3±8.8dB。反向staped切开术组术后中位AB间隙为7.5（7.5，11.3）dB，经典staped切开术组为10.0（10.0，12.5）dB。而在反向骨切开术组中，过度闭合和AB间隙闭合略优越，这些差异没有达到统计学意义.在频率上没有观察到显著的差异，慢相速度，或旋转试验中眼球震颤的幅度。结论：虽然并不总是可能的，就术后结局而言,反向钉扎切开术被证明是一种安全的手术技术.它的采用可能会减轻与浮动踏板相关的风险，感觉神经性听力损失,和砧骨脱位/半脱位，同时促进经验不足的耳外科医生的学习曲线。
