Prognostic Factors of Hearing Improvement for EES and MES in Attic Cholesteatoma.

IF 2.6 3区医学 Q1 OTORHINOLARYNGOLOGY

Journal of Otolaryngology - Head & Neck Surgery Pub Date : 2024-01-01 DOI:10.1177/19160216241286794

Minqian Gao, Nan Zeng, Weibiao Kang, Yong Lin, Peng Li, Yuan Tao, Yongtian Lu, Wei Zhao, Xiangwei Chen, Zebin Jiang, Jinliang Gao, Youjun Yu, Wanshan Liang, Sijia Zhai, Qiong Yang, Haidi Yang

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引用次数: 0

Abstract

Objective: The surgical strategy of cholesteatomas is still controversial. This study aimed to compare the hearing improvement and determine the prognostic factors between endoscopic and microscopic ear surgery for attic cholesteatoma via a multicenter retrospective study.

Methods: This retrospective study included 169 patients with attic cholesteatoma who received endoscopic ear surgery (EES) or microscopic ear surgery (MES) from 12 otorhinolaryngology centers. Hearing improvement between EES and MES was evaluated, including the postoperative pure tone average (PTA) and air-bone gap (A-B Gap), as well as the hearing threshold across the low-, mid-, and high-frequency. The success rate of grafts was collected. Linear regression was performed to access the prognostic value of preoperative PTA and A-B Gap. Patients were followed up for at least 3 years.

Results: The graft success rate of EES was 89.66% (78/87) versus 80.49% (66/82) for MES. The postoperative PTA and A-B Gap demonstrated significant improvement in EES compared to MES (Post-PTA: t = 3.281, P = .001; Post-A-B Gap: t = 2.197, P = .029). In the EES group, there were 59 ears (67.82%) with a postoperative A-B Gap ≤20 dB HL, which revealed a higher rate of successful hearing outcomes in EES as opposed to MES (χ² = 9.904, P = .019). There were significantly better hearing improvement, shorter surgical times, and lower hospital stays in EES for epitympanic cholesteatoma without stapes superstructure involvement. The preoperative AC ≤79 dB and/or preoperative A-B Gap ≤52 dB was associated with a better prognosis in EES for epitympanic cholesteatoma with stapes superstructure involvement.

Conclusions: EES showed higher graft success rate, better hearing improvement, shorter surgical times and hospital stays for attic cholesteatoma, particularly without stapes superstructure involvement. The range of preoperative PTA and A-B Gap have shown the prognostic value, which maybe a favorable surgical indication for EES or MES.

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房角胆脂瘤患者听力改善的 EES 和 MES 预后因素

目的：胆脂瘤的手术策略仍存在争议。本研究旨在通过一项多中心回顾性研究，比较内窥镜和显微耳手术治疗阁楼胆脂瘤的听力改善情况，并确定预后因素：这项回顾性研究纳入了来自12个耳鼻喉科中心的169名阁楼胆脂瘤患者，他们分别接受了内窥镜耳部手术（EES）或显微镜耳部手术（MES）。对 EES 和 MES 的听力改善情况进行了评估，包括术后纯音平均值（PTA）和气-骨间隙（A-B 间隙），以及低、中、高频听阈。还收集了移植物的成功率。对术前 PTA 和 A-B 间隙的预后价值进行了线性回归分析。对患者进行了至少 3 年的随访：结果：EES 的移植成功率为 89.66%（78/87），而 MES 为 80.49%（66/82）。术后PTA和A-B间隙与MES相比有显著改善（术后PTA：t = 3.281，P = .001；术后A-B间隙：t = 2.197，P = .029）。在 EES 组中，有 59 耳（67.82%）的术后 A-B 间隙小于 20 dB HL，这表明 EES 的听力成功率高于 MES（χ2 = 9.904，P = .019）。对于没有镫骨上部结构受累的上鼓室胆脂瘤，EES的听力改善明显更好，手术时间更短，住院时间更短。术前AC≤79 dB和/或术前A-B间隙≤52 dB与EES治疗镫骨上部结构受累的上鼓室胆脂瘤的预后较好有关：EES治疗阁楼胆脂瘤，尤其是未累及镫骨上部结构的患者，移植成功率更高，听力改善更好，手术时间和住院时间更短。术前 PTA 和 A-B Gap 的范围显示了预后价值，这可能是 EES 或 MES 的有利手术指征。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Otolaryngology - Head & Neck Surgery 医学-耳鼻喉科学

CiteScore

6.50

自引率

2.90%

发文量

审稿时长

6 weeks

期刊介绍： Journal of Otolaryngology-Head & Neck Surgery is an open access, peer-reviewed journal publishing on all aspects and sub-specialties of otolaryngology-head & neck surgery, including pediatric and geriatric otolaryngology, rhinology & anterior skull base surgery, otology/neurotology, facial plastic & reconstructive surgery, head & neck oncology, and maxillofacial rehabilitation, as well as a broad range of related topics.