耳硬化症 聴力成績・術中術後合併症とその対策

Abstract

We reviewed 313 cases in which stapes surgery was performed during the past 22 years. Operations were performed by one of four experienced otologists using the same surgical method of stapes surgery.When the criteria for success was defined as closure of the post operative air-bone gap to 10dB or less in the mean for 500, 1000, 2000Hz, the rate of success was 75.7% in the primary operations, which was fairly comparable with those in the literature. Hearing results achieved in this investigation did not differ between stapedectomy (76.7%) and stapedotomy (78.1%). The rate of success was poorer in use of gelform wire piston than in that of teflon piston. Hearing improvement was not achieved in 14 patients (4.5%) in the primary surgery. Incus (2.6%) or, both malleus and incus (0.6%) fixation was the major cause of failure in the primary operation. Sensorineural hearing impairment was the result in 4.5% of the operations, but half of these impairments showed air-bone gap closure of 10dB or less.Revision surgery was performed in 14 patients. Problems with the prosthesis, including displacement or shortness of the prosthesis, were the commonest cause of failure (50%). Cerebrospinal fluid otorrhea was found in 28.6%. The rate of success was 57.1% in the revision surgery.