先天性アブミ骨底板固着症例に対する手術―ツチ骨とキヌタ骨へのワイヤー固定の比較検討―

Abstract

We report the surgical results of stapes surgery using the Schukneht-type wire piston prosthesis performed on 30 ears with fixation of the stapes footplate and absence of the long process of the incus. The prosthesis was reformed to avoid dislocation and fixed to the handle of the malleus. The surgical results in another 49 ears, the comparator group, in which the prosthesis was fixed to the long process of the incus because the anomaly was restricted to fixation of the footplate without other associated anomalies, were also analyzed for comparison. The mean postoperative air conduction hearing levels were 28.6dB in the subjects and 21.6dB in the comparator group, and the mean hearing improvements were 35.7dB and 29.7dB, respectively. The success rate of the operation, based on the criteria established by the Japan Otological Society, was 90% in the subjects and 98% in the comparator group. The mean postoperative air-bone gap in the subjects was 15.8dB, which was 4.3dB higher than that in the comparator group. The difference between the two groups was considered to be due to the difference in the effectiveness of the conduction mechanism after the surgery. We therefore concluded that the surgical procedure using the Schukneht-type wire piston prosthesis to fix the malleus handle is a useful surgical method that yields satisfactory results.