背景:成人内窥镜听骨链重建(OCR)已证明与传统显微镜方法相当。关于儿童内镜OCR结果的数据较少,他们有独特的考虑因素,包括较小的经运河走廊和可变的病理学。这项研究的目的是调查短期和长期接受完全内窥镜和内窥镜辅助OCR的儿童的手术和听力测量结果。
方法:对2017年至2021年间在一家三级护理中心接受内镜OCR的所有儿童(<17岁)进行回顾性回顾。包括使用部分听骨重建假体(PORP)和全听骨重建假体(TORP)进行初次和修正内窥镜OCR的儿童。接受青少年耳硬化症或先天性stapes骨固定手术的儿童,或任何接受stapes骨假体的儿童被排除在外。主要结果指标是术后4个频率的变化(500Hz,1,2,4KHz)空气传导纯音平均值(ACPTA)和空气-骨骼间隙(ABG)的变化。次要措施包括需要再次入院和/或翻修手术,并发症发生率,和手术持续时间。
结果:17例患者符合纳入标准。平均年龄为11.3岁(范围,5-17岁);14人为男性。各种固定长度,使用全钛和部分假体。最常见的假体长度为2毫米(范围2-5毫米),并且没有术中或围手术期并发症。平均长期随访为2.6年。最常见的病理是先天性胆脂瘤(11/17,64%),其次是慢性中耳炎伴鼓膜穿孔(5/17,29.4%),和挤压假体(1/17,5.9%)。术中,最常见的发现是砧骨侵蚀(10/17,58.8%),其次是锤骨侵蚀(6/17,35.3%),骨侵蚀(4/17,23.5%),和stapes骨缺失(4/17,23.5%)。八名儿童(47%)用PORP重建,9名儿童(52.9%)用TORPs重建。平均ABG从术前的36.8dB提高到术后的19.9dB,长期稳定在19.5dB。PORP的平均短期ABG改善为4.2dB,TORP的平均短期ABG改善为18dB。从长远来看,平均ABG在PORPs中提高了2.3dB,在TORPs中提高了13.4dB。从长期来看,PORPs的ABG闭合率较高,ACPTA较低。
结论:对于各种原因导致听骨侵蚀的儿童,内窥镜下的骨成形术是一种可行的选择。内窥镜部分和全听骨重建后的听力测量改善随着时间的推移保持稳定,从长远来看,倾向于局部,并反映发表的显微镜手术结果。
BACKGROUND: Endoscopic ossicular chain reconstruction (OCR) in adults has demonstrated equivalent outcomes to the traditional microscopic approach. Less data exist on endoscopic OCR outcomes in children, who have unique considerations including a smaller transcanal corridor and variable pathology. The purpose of this study was to investigate surgical and audiometric outcomes in children undergoing fully endoscopic and endoscopic-assisted OCR in both the short and long-term.
METHODS: Retrospective review of all children (<17 years) who underwent endoscopic OCR at one tertiary care center between 2017 and 2021. Children undergoing primary and revision endoscopic OCR with either partial (PORP) and total ossicular reconstruction prostheses (TORP) were included. Children undergoing surgery for juvenile otosclerosis or congenital stapes fixation, or any child receiving a stapes prosthesis were excluded. Primary outcome measures were post-operative change in 4 frequency (500 Hz, 1, 2, 4 KHz) air conduction pure tone average (AC PTA) and change in air-bone gap (ABG). Secondary measures included need for readmission and/or revision surgery, complication rate, and surgery duration.
RESULTS: Seventeen patients met inclusion criteria. Average age was 11.3 years (range, 5-17 years); 14 were male. A variety of fixed length, titanium total and partial prostheses were used. The most common prosthesis length was 2 mm (range 2-5 mm), and there were no intra- or perioperative complications. Mean long-term follow-up was 2.6 years. Most common pathology was congenital cholesteatoma (11/17, 64%), followed by chronic otitis media with tympanic membrane perforation (5/17, 29.4%), and extruded prosthesis (1/17, 5.9%). Intraoperatively, the most common finding was incus erosion (10/17, 58.8%), followed by malleus erosion (6/17, 35.3%), stapes erosion (4/17, 23.5%), and stapes absence (4/17, 23.5%). Eight children (47%) were reconstructed with PORPs, and 9 children (52.9%) were reconstructed with TORPs. Average ABG improved from 36.8 dB preoperatively to 19.9 dB postoperatively in the short-term and remained stable at 19.5 dB in the long-term. Average short-term ABG improvement was 4.2 dB for PORPs and 18 dB for TORPs. In the long-term, average ABG improved by 2.3 dB in PORPs and 13.4 dB in TORPs. PORPs had higher rates of ABG closure and lower AC PTAs than TORPs in the long-term.
CONCLUSIONS: Endoscopic ossiculoplasty is a viable option in children presenting with ossicular erosion from various causes. Audiometric improvement following endoscopic partial and total ossicular reconstruction remains stable over time, with a preference towards partial in the long-term, and mirrors published outcomes for microscopic surgery.