耳硬化症患者镫骨手术后的耳鸣和听力结局：系统评价和荟萃分析。
Tinnitus and hearing outcomes following stapes surgery in otosclerosis patients: A systematic review and meta-analysis.
文献信息
| PMID | 42822231 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Kuan-Ting Yeh |
| 作者单位 | Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. |
| 期刊 | American journal of otolaryngology |
| SCI 分区 | Q2 |
| IF | 1.8 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 评估伴有术前耳鸣的耳硬化症患者接受镫骨手术后的耳鸣和听力学结局。
方法： 对PubMed、EMBASE和Web of Science进行文献检索，以识别1990年至2026年间发表的涉及伴有术前耳鸣的耳硬化症患者接受初次镫骨手术（镫骨切除术或镫骨切开术）的研究。如果使用耳鸣功能指数（TFI）、耳鸣残疾量表（THI）、视觉模拟量表（VAS）或自我报告的耳鸣变化评估耳鸣结局，则纳入研究。在报告时提取听力学结局。排除涉及翻修手术的病例。对TFI评分、自我报告的耳鸣变化和听力学结局进行随机效应荟萃分析。
结果： 在确定的313篇文章中，纳入了19项研究，涉及1318名伴有术前耳鸣的耳硬化症患者。耳鸣结局在五项研究中使用TFI评估，两项中使用THI，两项中使用VAS。四项研究（n=412）被纳入TFI的荟萃分析，显示术后显著降低（平均差：-10.87；95% CI：-16.04至-5.69；p<0.00001）。14项研究（n=868）提供了自我报告的耳鸣变化，加权比例显示耳鸣消失为48.52%（95% CI：37.95-59.15%），减轻为28.60%（95% CI：21.51-36.27%），无变化为18.12%（95% CI：12.23-24.87%），恶化为3.78%（95% CI：1.71-6.61%）。六项研究（n=306）被纳入气骨导差（ABG）闭合结局的荟萃分析，表明分别有67.17%（95% CI：40.94-88.64%）和91.50%（95% CI：79.10-98.64%）的患者术后ABG达到≤10 dB和≤20 dB。
结论： 约70-80%的患者报告镫骨手术后耳鸣缓解，且汇总TFI评分术后显著降低。然而，显著的异质性和缺乏非手术对照组限制了因果解释。此外，耳鸣缓解与听力改善之间的关系仍不确定。需要进一步的多中心、前瞻性研究并设置适当的对照组，以阐明预后因素。
英文摘要
PURPOSE: To evaluate tinnitus and audiological outcomes following stapes surgery in otosclerosis patients with preoperative tinnitus.
METHODS: A literature search of PubMed, EMBASE, and Web of Science was conducted to identify studies published between 1990 and 2026 involving otosclerosis patients with preoperative tinnitus who underwent primary stapes surgery (stapedectomy or stapedotomy). Studies were included if tinnitus outcomes were assessed using Tinnitus Functional Index (TFI), Tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS), or self-reported tinnitus changes. Audiological outcomes were extracted when reported. Cases involving revision procedures were excluded. Random-effects meta-analyses were performed for TFI scores, self-reported tinnitus changes, and audiological outcomes.
RESULTS: Of 313 articles identified, 19 studies involving 1318 otosclerosis patients with preoperative tinnitus were included. Tinnitus outcomes were evaluated using TFI in five studies, THI in two, and VAS in two. Four studies (n = 412) were included in the meta-analysis of TFI, which demonstrated a significant postoperative reduction (mean difference: -10.87; 95% CI: -16.04 to -5.69; p < 0.00001). Self-reported tinnitus changes were available from 14 studies (n = 868), with weighted proportions showing tinnitus disappearance in 48.52% (95% CI: 37.95-59.15%), alleviation in 28.60% (95% CI: 21.51-36.27%), no change in 18.12% (95% CI: 12.23-24.87%), and deterioration in 3.78% (95% CI: 1.71-6.61%). Six studies (n = 306) were included in the meta-analysis of air-bone gap (ABG) closure outcomes, indicating that 67.17% (95% CI: 40.94-88.64%) and 91.50% (95% CI: 79.10-98.64%) of patients achieved postoperative ABG of ≤10 dB and ≤20 dB, respectively.
CONCLUSIONS: Approximately 70-80% of patients reported tinnitus relief following stapes surgery, and pooled TFI scores decreased significantly postoperatively. However, substantial heterogeneity and the lack of non-surgical comparison groups limit causal interpretation. Additionally, the relationship between tinnitus relief and hearing improvement remains uncertain. Further multicenter, prospective studies with appropriate control groups are warranted to clarify prognostic factors.