原发性镫骨手术后听力不良结局的预测因素：来自瑞典耳硬化症手术质量登记处的研究
Predictors of Poor Hearing Outcomes Following Primary Stapes Surgery: A Study From the Swedish Quality Register for Otosclerosis Surgery.
文献信息
| PMID | 42974840 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Andreas Björsne |
| 作者单位 | Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Region Västra Götaland. |
| 期刊 | Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology |
| SCI 分区 | Q2 |
| IF | 1.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 识别与耳硬化症原发性镫骨手术后听力未改变或恶化相关的术前和围手术期因素。
研究设计： 基于登记处的研究。
地点： 瑞典全国耳硬化症手术质量登记处，涵盖在县级和大学医院实施的手术。
患者： 2009年至2020年间共有1813例成人患者接受原发性镫骨手术，并具有完整的术前和术后1年听力检查资料。
干预： 原发性镫骨手术。
主要结局指标： 术后一年听力未改变或恶化，定义为以下一项或多项：气导（AC）阈值改善≤5 dB［0.5、1、2和4 kHz纯音平均（PTA4）］；骨导恶化≥10 dB（PTA4）；气骨导差（ABG）增加≥0 dB（PTA4）；或高频阈值（PTA 4、6、8 kHz）恶化≥15 dB。
结果： 7%的病例出现听力未改变或恶化。多因素logistic回归确定，术前ABG较小［≤23.8 dB；比值比（OR）=2.3，P<0.001］、AC阈值较低（≤45.0 dB HL；OR=2.1，P=0.002）、年龄较大（55至64岁：OR=2.1，P=0.007；≥65岁：OR=2.3，P=0.012）以及镫骨切除术（与镫骨开窗术相比）（OR 3.5，P=0.025）是听力未改变或恶化的预测因素。
结论： 术前ABG较小、基线AC阈值较好以及年龄较大是听力未改变或恶化的关键预测因素。这些发现强调了仔细选择患者和进行咨询的重要性，尤其是对于轻度传导性听力损失或高龄个体。
英文摘要
OBJECTIVE: To identify preoperative and perioperative factors associated with unchanged or worsened hearing after primary stapes surgery for otosclerosis.
STUDY DESIGN: Registry-based study.
SETTING: Nationwide Swedish Quality Register for Otosclerosis Surgery including procedures performed at county and university hospitals.
PATIENTS: A total of 1813 adult patients underwent primary stapes surgery between 2009 and 2020 with complete preoperative and 1-year postoperative audiometry.
INTERVENTION: Primary stapes surgery.
MAIN OUTCOME MEASURES: Unchanged or worsened hearing one year postoperatively defined as one or more of the following: air conduction (AC) threshold improvement ≤5 dB [pure tone average for 0.5, 1, 2, and 4 kHz (PTA4)]; bone conduction deterioration ≥10 dB (PTA4); increased air-bone gap (ABG) ≥0 dB (PTA4); or worsening of high-frequency thresholds (PTA 4, 6, 8 kHz) ≥15 dB.
RESULTS: Unchanged or worsened hearing occurred in 7% of cases. Multivariate logistic regression identified smaller preoperative ABG [≤23.8 dB; odds ratio (OR)=2.3, P <0.001], lower AC thresholds (≤45.0 dB HL; OR=2.1, P=0.002), older age (55 to 64 y: OR=2.1, P=0.007; ≥65 y: OR=2.3, P=0.012), and stapedectomy (compared with stapedotomy) (OR 3.5, P=0.025) as predictors of unchanged or worsened hearing.
CONCLUSIONS: Smaller preoperative ABG, better baseline AC thresholds, and older age emerged as key predictors of unchanged or worsened hearing. These findings highlight the importance of careful patient selection and counseling, particularly for individuals with mild conductive hearing loss or of advanced age.