Short-term postoperative outcome of laser-assisted stapedotomy in patients with otosclerosis
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摘要: 目的 评估耳硬化症患者行激光镫骨底板开窗术后的短期疗效。方法 回顾性分析21例(21耳)行激光镫骨底板开窗术的耳硬化症患者的临床资料。比较术前和术后3个月纯音测听0.5、1、2、4 kHz频率的气导(AC)、骨导(BC)阈值和气骨导差(ABG)平均值，并统计手术并发症的发生情况。结果 21耳术前和术后AC阈值分别为(58.2±12.7) dB HL和(43.0±23.1) dB HL，术后AC阈值降低15.2 dB HL(P < 0.01)；0.5、1、2、4 kHz各频率术后AC阈值较术前均显著降低。术前术后BC阈值分别为(31.4±10.3) dB HL和(33.3±16.6) dB HL，差异无统计学意义；各频率的手术前后BC阈值差异亦无统计学意义。3耳(14.3%)术后BC阈值减低>10 dB HL，出现过度闭合。手术前后ABG平均值分别为(27.0±9.1) dB HL和(9.6±9.9) dB HL，术后ABG缩小17.4 dB HL(P < 0.01)；各频率ABG平均值均显著缩小。14耳(66.7%)术后ABG≤10 dB HL，18耳(85.7%)术后ABG≤20 dB HL。术后2耳(9.5%)出现感音神经性听力损失；15耳(71.4%)耳鸣和3耳(14.3%)眩晕均于术后第3天缓解。结论 激光辅助下镫骨底板开窗术治疗耳硬化症安全有效，虽然术后骨导阈值稍有提高，但不影响总体听觉康复效果。Abstract: Objective To assess the short-term efficacy of laser-assisted stapedotomy in patients with otosclerosis.Method The clinical data of twenty-one patients with otosclerosis who underwent laser-assisted stapedotomy were retrospectively analyzed. Preoperative and 3-month postoperative standardized audiometric evaluations were carried out in all patients. The occurrence of surgical complications was observed.Result The mean preoperative and postoperative air conduction (AC) thresholds were (58.2±12.7) dB HL and (43.0±23.1)dB HL respectively; the postoperative AC threshold decreased by 15.2 dB HL which was statistically significant at 0.5, 1, 2, and 4 kHz (P < 0.01). The mean preoperative and postoperative bone conduction (BC) thresholds were (31.4±10.3)dB HL and (33.3±16.6)dB HL, and there was not significant difference between them as well as BC thresholds at each frequency. Overclosure >10 dB HL was occured in 3 ears (14.3%) while sensorineural hearing loss>10 dB HL was found in 2 ears (9.5%). The mean ABG decreased by 17.4 dB HL (P < 0.01) from preoperative (27.0±9.1) dB HL to postoperative (9.6±9.9) dB HL, and the ABG at each frequency had significant decrease. Fourteen ears (66.7%) had postoperative ABG of ≤10 dB HL while 18 ears (85.7%) had postoperative ABG of ≤20 dB HL. Sensorineural hearing loss occurred in 2 ears (9.5%) after surgery, tinnitus in 15 ears (71.4%) and vertigo in 3 ears (14.3%). But all were relieved on the third day after operation.Conclusion Laser-assisted stapedotomy is a safe and effective treatment of otosclerosis. Although BC thresholds was slightly increased after surgery, it did not affect the overall hearing outcomes.
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Key words:
- otosclerosis /
- laser /
- stapedotomy /
- treatment effectiveness
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表 1 手术前后听力学检查结果
dB HL 听力学检查 术前 术后 差值 P AC平均阈值 58.2±12.7 43.0±23.1 15.2 0.006 BC平均阈值 31.4±10.3 33.3±16.6 -1.9 0.537 ABG平均值 27.0±9.1 9.6±9.9 17.4 < 0.001 
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表 2 手术前后不同频率AC阈值比较
dB HL 频率/kHz 术前 术后 差值 P 0.5 61.9 41.2 20.7 0.002 1 58.3 40.0 18.3 0.004 2 53.6 39.8 13.3 0.010 4 59.0 51.0 8.1 0.040
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表 3 手术前后不同频率AC/BC平均阈值
dB HL 频率/ kHz 术前 术后 AC BC AC BC 0.5 61.9±10.9 23.1±10.9 41.2±25.1 28.1±16.1 1 58.3±12.3 28.6±7.1 40.0±24.2 28.8±16.5 2 53.6±15.0 39.3±14.5 39.8±22.8 36.2±19.3 4 59.0±23.3 34.8±19.2 51.0±28.7 40.2±22.8
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表 4 手术前后不同频率ABG值及缩小值
dB HL 频率/kHz 术前 术后 缩小值 P 0.5 39.3 13.1 26.2 ＜0.0001 1 30.2 11.2 19.0 0.0002 2 14.3 3.6 10.7 0.0003 4 24.3 10.7 13.6 0.0006
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