Analysis of the effectiveness of hearing solutions for congenital malformation of the middle and outer ear (CMMOE)

Abstract

Background

There are no reports about comprehensive comparative analysis of the effects after various hearing surgery solutions for congenital malformation of the middle and outer ear (CMMOE).

Aims/objectives

To analyze the improvement of Average Air-Conduction Threshold (AACT) of pure tone after various hearing surgery solutions for CMMOE and provide a reference for the selection of accurate hearing solutions.

Materials and methods

A retrospective analysis of 159 cases (170 ears) with CMMOE submitted to various ear surgery solutions, including: (1) Three situations of outer ear canal (OEC): ① atresia 85 ears, ② stenosis 28 ears, and ③ normal 57 ears. (2) Three commonly used hearing solutions: eardrum repair 53 ears, Porp 44 ears and Piston 32 ears implantation. (3) Three OEC situations with different hearing solutions: type I. Reconstruction of OEC (r-OEC), type II. r-OEC and/or different tympanoplasty, including ① eardrum repair, ② release of ossicular chain, ③ Porp implantation, and ④ Torp implantation, type III. Piston implantation with fenestration of the inner ear. Compare AACT of postoperative short term (0.5 years) or long term (0.5–10 years) and preoperative in the speech frequency range of 0.5–4 kHz to assess efficacy. If the sample number ≥10, and not subject to normal distribution, the Kruskal–Wallis multi-sample rank sum test is used for the comparison of multiple groups and Wilcoxon’s rank sum test for two groups, with P < 0.05 being statistically significant. If the sample size <10, the standard of clinical efficacy is one frequency improvement value ≥15 dB HL, or 10 dB HL ≤2 frequency improvements <15 dB HL at 0.125–8 KHz.

Results

Intra-group comparison of AACT: (1) three situations of OEC: atresia, stenosis and normal all had P < 0.05 postoperatively in short term, while in long term only the normal group had P < 0.05. (2) Three commonly used hearing solutions: eardrum repair, Porp and Piston implantation all had P < 0.05 in short and long terms, except for eardrum repair P >0 .05 in long term. (3) Three OEC situations with different hearing solutions: 1) Atresia of OEC: Porp and Piston implantation, r-OEC and release of ossicular chain were effective in short term and were not effective in long term, and the eardrum repair was not effective in both short and long term. 2) Stenosis of OEC: eardrum repair, Porp and Piston implantation were effective in short and long term. r-OEC P >0 .05 for short and long term, Torp implantation was not effective in long term, 3) Normal of OEC: Porp, Torp and Piston implantation were all P < 0.05 in short and long term except for Torp >0.05 in long term, and release of ossicular chain is both short and long term clinically effective. The AACT values of postoperative in long term for three groups of atresia, stenosis, normal of OEC are over 58.7 dB HL (except Porp implantation 52.5 dB HL), 51.3 dB HL (except Porp implantation 42.5 dB HL), and 37.5 dB HL (except Torp implantation are 32.6 dB HL), respectively.

Conclusions and significance

Intra-group comparison of AACT. (1) Three groups of the atresia, stenosis and normal of OEC are all effective in short term, while in long term only the normal group is effective. (2) The three most commonly used surgical solutions of eardrum repair, Porp and Piston implantation are effective in short and long terms, except for long term eardrum repair. (3) Three OEC situations with different hearing solutions: some of surgical solutions were effective in short term or long term for CMMOE, but based on the AACT values of postoperative in long term for three OEC situations, it is better to choose a hearing device for atresia of OEC, comprehensive review of surgical or hearing device for stenosis of OEC. Surgery can be considered for normal OEC.

Chinese Abstract

背景

目前尚无针对中耳和外耳先天性畸形 (CMMOE) 的各种听力手术的术后效果进行综合对比分析的报道。

目的

分析针对CMMOE进行的各种听力手术后纯音平均气导阈值(AACT)的改善情况, 为选择准确的听力解决方案提供参考。

材料和方法

对159例(170耳)接受各种耳部手术的CMMOE病例进行了回顾性分析, 包括: (1)外耳道(OEC)的三种情况: ①闭锁85只耳, ②狭窄28只耳, ③正常耳57例。 (2)三种常用的听力解决方案: 鼓膜修复53只耳、Porp 植入44只耳、Piston 植入32只耳。 (3) 三种不同听力解决方案的OEC情况: I型, OEC重建(r-OEC)；II型, r-OEC 和/或不同的鼓室成形术, 包括 ① 鼓膜修复, ② 听骨链释放, ③ Porp 植入, ④ Torp 植入；III型, 内耳窗的Piston植入。 术后短期AACT比较(0.5年)或长期比较(0.5-10年), 以及术前AACT比较在言语频率范围0.5-4kHz内评估疗效。 如果样本数在10及以上, 且不服从正态分布, 则用 Kruskal-Wallis多样本秩和检验进行多组比较, 用Wilcoxon秩和检验进行两组比较, p < .05 具有统计学意义。 如果样本数少于10, 则临床效率标准是, 在0.125–8kHz范围内, 一个频率改善值≥15dB HL, 或10dB HL ≤2个频率改善值<15dB HL 。

结果

AACT组内比较: (1)OEC的三种情况: 闭锁、狭窄和正常, 术后短期内均为 p < .05, 而长期来看, 只有正常组 p < .05。 (2)三种常用的听力解决方案: 鼓膜修复、Porp 和Piston植入, 短期和长期情况下均为 p < .05, 除了鼓膜修复以外, 其长期情况下 p > .05 。 (3) 三种 OEC 情况不同的听力解决方案: (1)OEC闭锁: Porp植入和Piston植入, r-OEC和听骨链释放短期有效, 但长期无效, 鼓膜修复无论是短期还是长期都没有效果。 (2) OEC狭窄: 鼓膜修复、Porp植入和Piston植入在短期和长期均有效。 r-OEC在短期和长期均为p > .05, Torp长期植入效果不佳, (3)OEC正常: Porp植入、Torp植入和Piston植入短期和长期 均为p < .05。除 Torp植入长期 p > .05 外, 听骨链释放在短期和长期临床均有效。闭锁组、狭窄组、OEC正常组的术后3年远期AACT值均分别超过58.7dB HL(Porp植入组52.5dB HL除外), 51.3dB HL(Porp 植入除外 42.5dB HL), 37.5dB HL(Torp 植入除外, 均为 32.6dB HL)。

结论和意义

AACT 的组内比较。 (1)三组OEC(闭锁组、狭窄组和正常组)在短期内均有效, 但长期只有正常组有效。(二)鼓膜修复、Porp植入、Piston植入这三种最常用的手术方案短期和长期均有效, 除了长期耳膜修复外。 (3) 三种 OEC 情况有不同的听力解决方案: 一些手术解决方案在短期或长期内对于CMMOE都有效, 但根据三种 OEC 情况的长期术后 AACT 值, OEC闭锁最好选择助听器, OEC 狭窄需要全面审查手术或助听器。 对于 OEC正常情况, 可以考虑手术。

Keywords:

• Congenital malformation of the middle and outer ear (CMMOE)
• Outer ear canal (OEC)
• Tympanoplasty
• Average air-conduction threshold (AACT) of pure tone

Disclosure statement

None.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by the National Clinical Medical Center Special Project [Grant No. 202100003] and National Logistics Support Department Special Family Planning Project [Grant No. 22JSZ14].