| Objective:The aim is to predict the effect in ossicular chain reconstruction by analyzing the factors affecting the efficacy of titanium ossicular prosthesis in hearing reconstruction in patients with chronic otitis media and secondary acquired cholesteatoma.Methods:The patients who had chronic otitis media or secondary acquired cholesteatoma,and underwent ossicular chain reconstruction using a titanium prosthesis due to poor ossicular chain continuity and mobility in our hospital from January 2013 to October2022 were reviewed.The prosthesis used in the operation was a Spiggle 1.5mm titanium partial ossicular replacement prosthesis(PORPs)or a Spiggle 4.0mm titanium total ossicular replacement prosthesis(TORPs).A total of 83 patients with85 ears were included.A total of 78 ears were implanted with PORP and 7 ears with TORP.The following demographic and clinical characteristics were recorded were analyzed: sex,age,otorrhoea,course of disease,smoking status,presence of cholestatoma,the status of malleus hand,and Middle Ear Risk Index(MERI).Air conduction(AC)and bone conduction(BC)thresholds at 0.5,1,2,and 4 k Hz were recorded and used to calculate pure tone average air-bone gap(PTA-ABG).Successful ossicular chain reconstruction was defined as a postoperative PTA-ABG≤ 20 d B.Univariate analysis was performed on the above factors that may affect the postoperative effect.logistic univariate analysis was performed on the factors with statistical significance,and multivariate regression analysis was performed on the indicators with high risk degree.Results:Overall mean speech reception thresholds was improved from 62.3±12.4d B to47.3 ± 15.9d B,the average preoperative PTA-ABG was 38.1 ± 8.8d B and postoperative PTA-ABG was 24.3±12.3d B.postoperative PTA-ABG≤20 d B was achieved in 51.5% of patients,and postoperative PTA-ABG≤10 d B was achieved in15.3% cases.A total of 78 ears were implanted with PORPs,and the success rate of partial ossicular bone replacement was 42.3%.A total of 7 ears were implanted with TORPs,and postoperative PTA-ABG≤20 d B were achieved in 5 ears.Univariate analysis showed that gender,age,otorrhoea,course of disease,and smoking had no statistical significance on postoperative effect(p > 0.05),while the status of malleus hand,presence of cholestatoma and MERI had statistical significance on postoperative effect(p < 0.05).In univariate logistic analysis,malleus status the status of malleus hand,presence of cholesteatoma and MERI had statistical significance on postoperative effect(p < 0.05),Patients with moderate disease(MERI score of 4-6)had 5 times(OR=5.000,95% CI,1.231-20.301,p=0.024)the risk of not achieving PTA-ABG ≤ 20 d B than those with mild disease(MERI score of 1-3),while the severe disease group(MERI score of 7 or more)was 12.083 times higher than the mild disease group(OR=12.083,95% CI,1.100-12.844,p < 0.001).In multivariate logistic analysis,presence of cholesteatoma had statistical significance on postoperative effect(p <0.05).Patients with middle ear cholestatoma had a 3.758 times greater risk of not achieving PTA-ABG ≤ 20 d B than non-cholestatoma patients(OR=3.758,95%CI 1.100-12.844,p=0.035).The difference of postoperative results between patients with disease course > 10 years and patients with disease course ≤1 year was close to statistical significance(p=0.06).Conclusion:1.Patients with middle ear cholesteatoma have worse postoperative effects than those with chronic otitis media without cholesteatoma,cholesteatoma is a risk factor affecting efficacy of middle ear hearing reconstruction.2.Postoperative effect is related to MERI.It is necessary to perform MERI score on patients before surgery.Stratification of risk index enables surgeons to predict postoperative hearing results according to preoperative conditions. |
PDF Full Text Request