Analysis of the short-term and long-term effect of Er-yttrium aluminum garnet laser in stapes surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the short-term and long-term effect of Er-yttrium aluminum garnet (Er-YAG) laser in stapes surgery.</p><p><b>METHODS</b>There were 86 patients operated by the Er-YAG laser stapedotomy from 2001 to 2007 were analyzed retrospectively, with 23 male, 63 female and 13 double ears and with the average age of 48 years old, ranging from 12 to 78. All of 99 ears suffered deafness of conduction. The average air-bone-gap (ABG) of all patients before surgery was (37.4+/-9.0) dB HL (ranging from 13.7 to 58.7 dB). The patients followed-up over 6 weeks after the surgery was regarded as the short-term result, while over one year follow-up as the long-term effect (according to the standard of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery). The followed-up average time was (26.3+/-15.8) months (range from 14 to 73 months). The pre-post-operation average bone conduction auditory threshold of 2 kHz and 4 kHz were observed. The data of the patient whether or not has the symptoms of tinnitus and dizzy and the lasted days were also recorded.</p><p><b>RESULTS</b>After surgery, short-term ABG of 99 ears was (15.7+/-8.7) dB, matched-pairs t test with the numbers of before surgery, t=22.79, P<0.01. The results of 45 ears (45.5%) with ABG<10 dB or air conduction improved more than 30 dB were regarded as excellence. The air conduction of 88 ears (88.9%) improved more than 15 dB was regarded as utility. With 82 ears (82.8%) followed-up more than 1 year, the average ABG was (11.7+/-6.8) dB, matched-pairs t test with the numbers of before surgery, t=23.37, P<0.01, compared with the short-term visit result [(15.3+/-9.2) dB, 82 ears], t=4.82, P<0.01, both of which were considered statistically extremely significant. Among them, 50 ears (61.0%) have the excellent effect while 74 ears with (90.2%) ABG<20 dB. The average bone conduction auditory threshold in 2 kHz was (34.5+/-15.0) dB before surgery, matched-pairs t test with short-term visit result (33.4+/-15.9) dB, t=1.96, P=0.026 14, with long-term visit result (32.7+/-15.2) dB, t=3.24, P=0.000 87, all of which had the significant difference, manifest that the Cohort's notch had been improved after the surgery. The data of bone conduction auditory threshold of 4 kHz with long-term following-up result matched-pairs t test with that of surgery before, t=0.76 (P>0.05), which showed the change of the bone conduction had no statistics difference. There were 55 ears had the persistent tinnitus before surgery, in which 42 ears (76.4%) with no the tinnitus, 13 ears with same to that of preoperative, and 3 ears (3.0%) with remaining tinnitus after surgery but who had not it preoperation and all disappeared after 2 - 3 days. There were 12 ears (12.1%) with light dizzy after surgery, but their live could deal with himself and the average dizzy lasted 2.3 days.</p><p><b>CONCLUSIONS</b>Er-YAG laser stapes surgery is safe to the inner ear, and it primal free from the imminent risk in stapes surgery, so the effect can be affirmed.</p>

Effect of multi-technique of intact canal and scute rebuilding in treatment of middle ear cholesteatoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To assess the results of multi-technique with intact canal and scute rebuild operation for middle ear cholesteatoma.</p><p><b>METHODS</b>Analysis of 113 cases (males 60, females 53, with mean 42.7 years old), of which with double ears of 11 cases, and totally 124 ears (11 ears for one review, an ear for third time review, and totally 137 operations) was retrospectively performed. Ten cases less than 19 years old were operated from September 2001 to January 2006 for middle ear cholesteatoma as well as ossiculoplasty with intact canal and scute rebuild etc multi-technique. All cases were followed up for a mean (36.58 +/- 20.47) months.</p><p><b>RESULTS</b>There were 118 ears (95.2%) without cholesteatoma recurrence. Six ears were found cholesteatoma recurrence. Other 6 post-operation ears with drum re-perforation and hearing drop were re-operated. The pre-operation air-bone gap (ABG, average of 0.5, 1, 2 kHz) of 124 ears, with in initial 112 ears, was (33. 61 +/- 12.35) dB, while that of post-operation ABG was (13.58 +/- 9. 27) dB, by partnership t test, t = 18.35, P < 0.01. The pre-operation ABG in reviewed 12 ears at the first pre-operation was (38.83 +/- 12.43) dB, but post-operation ABG (10.38 +/- 8.99) dB, by partnership t test, t = 5.38, P = 0.00022. The ABG closure to within 20 dB was tested in 100 ears while ABG over 20 dB but air conduct (AC) in 40 dB was in 6 ears, and then as succeed was in 106 ears (85.5%). ABG closure within 10 dB was in 50 ears and though ABG over 10 dB but ABG reduced over 30 dB was in 9 ears (59/124, 47.6%) as which as best result. Bone conduct (BC) threshold was tested of 21 ears (16.93%) with raise 1-9 dB, of 42 ears (33.9%) with no change and of 61 ears (49.2%) with descend 1-28 dB. Of 10 cases less than 19 years old post-operation ABG was (8.80 +/- 5.27) dB, which indicated that all cases was as succeed.</p><p><b>CONCLUSIONS</b>Using intact canal and scute rebuild etc multi-technique a normal canal, hearing improvement and very low recurrent could be gained for middle ear cholesteatoma, especially in juvenile and children. The multi-technique should be almost no damage for hearing bone conduct.</p>