RESUMEN
OBJECTIVES: Review experience using a titanium TORP with a footplate shoe; compare early and long-term hearing results and complications with those obtained using a TORP alone. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral neurotologic private practice. PATIENTS: Patients undergoing total ossicular replacement with a titanium prosthesis (total ossicular reconstruction prosthesis [TORP]); 74 with a TORP + footplate shoe and 62 with TORP alone. INTERVENTION: Ossicular chain reconstruction with a titanium TORP. MAIN OUTCOME MEASURES: Short- and long-term air-bone gap (ABG), change in ABG from preoperative to postoperative and from postoperative to last recorded follow-up, sensorineural hearing loss. RESULTS: The shoe group had a smaller mean postoperative ABG (17.7 dB versus 21.6 dB, p ≤ 0.048) and a greater average amount of closure in ABG (21.9 dB versus 13.2 dB, p ≤ 0.004), but there was no significant difference in percentage of patients achieving a postoperative ABG of 20 dB or lesser (57.4% versus 61.6%). There were no differences between groups at long-term follow-up or in amount of change in ABG from postoperative to last audiogram or in amount of change in sensorineural hearing from preoperative to postoperative. Although surgical factors (number of previous surgeries, and presence of a cavity) impacted outcomes, there were no interactions with prosthesis group and no differences in complications between groups. CONCLUSION: Ossicular reconstruction still presents challenges. A titanium prosthesis with a "shoe" for stabilization may offer advantages. Results in this study consistently favored the TORP + shoe group,although not all differences achieved statistical significance. A larger study might better define possible advantages of the shoe prosthesis for specific subgroups of patients.
Asunto(s)
Pérdida Auditiva Sensorineural/cirugía , Prótesis Osicular , Reemplazo Osicular/instrumentación , Titanio , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Audiometría , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reemplazo Osicular/métodos , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenAsunto(s)
Conducto Auditivo Externo/patología , Enfermedades del Oído/patología , Exostosis/patología , Pérdida Auditiva Conductiva/etiología , Conducto Auditivo Externo/cirugía , Enfermedades del Oído/complicaciones , Enfermedades del Oído/cirugía , Exostosis/complicaciones , Exostosis/cirugía , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Colesteatoma del Oído Medio/cirugía , Timpanoplastia , Adulto , Colesteatoma , Colesteatoma del Oído Medio/patología , Oído Medio/patología , Femenino , Pérdida Auditiva Conductiva/complicaciones , Pérdida Auditiva Conductiva/etiología , Humanos , Apófisis Mastoides/cirugía , Procedimientos Quirúrgicos Otorrinolaringológicos/métodosRESUMEN
OBJECTIVE: Determine whether more conservative management for surgical salvage after failed radiation leads to better facial nerve outcomes. STUDY DESIGN: "Retrospective" review using prospectively planned database. SETTING: Private practice, tertiary neurotology/neurosurgery referral center. PATIENTS: A series of 73 patients with vestibular schwannoma, who underwent primary radiosurgery with no other intervention and then surgical salvage tumor removal using the translabyrinthine approach. INTERVENTION(S): Translabyrinthine craniotomy for vestibular schwannoma salvage surgery after failed radiation, with either gross total or partial tumor removal. MAIN OUTCOME MEASURES: Long-term (1 yr) House-Brackmann (H-B) facial nerve grade and change in facial nerve grade from before to after surgery. RESULTS: Of the 73 patients, 79.5% had gross total removal, 5.5% had planned partial resection (subtotal or near total), and 15.1% had intraoperatively elected partial removal with most of these being near total removal. At 1 year of follow-up, good facial nerve function (H-B I/II) was found in 50% of patients with gross total removal and 85.7% of those with partial removal (p ≤ 0.03). The H-B grade was maintained postoperatively in 45.8% and 78.6% of the 2 groups, respectively (p ≤ 0.037), with 21.7% of the total removal group having unsatisfactory outcomes (H-B V or VI) compared with 7.1% of patients with partial removal. To date, no patient has required additional treatment. CONCLUSION: Failed radiosurgery is an increasing indication for salvage surgery in patients with posterior fossa tumors. A conservative approach with a willingness to perform partial and near-total tumor removals leads to better facial nerve outcomes with no current evidence of treatment compromise.