| Objective: Retrospectively analyze the clinical efficacy of implantation of different titanium artificial hearing bones in the postoperative treatment of middle ear cholestylema performing tympanoplasty.Methods: This research enrolled 129 middle ear cholesteatoma patients admitted to Shenzhen Longgang Otorhinolaryngology Hospital from July 2017 to December 2021,including 81 males and 48 females,aged 16-65 years old.All patients accepted modified radical mastoidectomy and tympanoplasty operated by same surgical team.During the surgery,74 cases were implanted with partial artificial ossicles,and 20 cases were implanted with full ossicular prostheses,and 35 patients refused to undergo artificial ossicle implantation.A thin Tragus cartilage complex was put between the tympanic membrane graft and the titanium artificial ossicle.By comparing the preoperative and postoperative air-bone gap(ABG),air conduction(AC),AC value increased decibels,ABG increased decibels,to assess short-term hearing reconstruction after surgery.Results:(1)The mean postoperative voice frequency AC threshold of 35 patients who refused to undergo hearing reconstruction was(56.66±18.15)d B HL,it in Group PORP was(34.92±11.00)d B HL,and the effective rate of hearing reconstruction was 50%.The average AC threshold of postoperative speech frequency in TORP group was(42.95±13.52)d B HL,and the effective rate of hearing reconstruction was 45%.(2)Taking postoperative ABG,preoperative and postoperative ABG increase in decibels,preoperative and postoperative AC increase in decibels as evaluation indicators,the difference was statistically significant when comparing the groups without hearing reconstruction and those with hearing reconstruction(P < 0.05).When comparing PORP or TORP implantation,the difference was not statistically significant(P>0.05).(3)There was a positive correlation between postoperative ABG and preoperative ABG in cases with ossicular prosthesis placed,and a negative correlation between postoperative ABG and preoperative and postoperative AC improvement in cases with ossicular prosthesis placed.(4)All cases were followed up for ≥1 month and ≤6 months,and 112 cases of artificial tympanic membrane healed in one stage.During long-term follow-up,cholesteatoma recurred after operation,0 cases in the no-ossicular group,and 6 cases in the ossicular placement group,including 4 cases in PORP group,2 cases in TORP group,12 cases of ossicle prolapse after operation,11 cases in PORP group,and 1 case in TORP group.During the study,no artificial auditory bone deformation,metal poisoning or allergic reactions were found.Conclusion: 1.In the treatment of middle ear cholesteatoma surgery,the implantation of artificial hearing bone for hearing reconstruction at the same time can obtain great clinical efficacy.2.The better basic hearing,the lighter preoperative hearing loss,the smaller preoperative ABG value,the better postoperative hearing reconstruction efficacy.3.When the continuity of the ossicles is interrupted,the integrity of the stapes has no significant effect on the improvement of postoperative hearing reconstruction efficacy.4.Cases that do not heal in the first stage after surgery,which surgical area are infected,will increase the displacement and expulsion rate of artificial hearing bone implantation.5.Titanium artificial hearing bone has the advantages of non-toxicity,strong stability and not easy to be allergic in use,and is currently a great hearing reconstruction material. |
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