Comparing Transcanal Endoscopic Ear Surgery to Post-Auricular Microscope-Guided Surgery in Pediatric Ossiculoplasty: Hearing Outcomes and Post-Operative Pain.
Otol Neurotol
; 42(10): e1648-e1651, 2021 12 01.
Article
em En
| MEDLINE
| ID: mdl-34172655
ABSTRACT
OBJECTIVE:
This study compares post-operative hearing outcomes and morbidity after pediatric total ossicular replacement prosthesis (TORP) ossiculoplasty with transcanal totally endoscopic ear surgery (TEES) versus a post-auricular microscope-guided (PAM) approach. PATIENTS Forty-four children who underwent ossiculoplasty with titanium TORP after previous cholesteatoma surgery. INTERVENTION Ossiculoplasty using TEES or PAM approach. MAIN OUTCOMEMEASURES:
Hearing outcome after ossiculoplasty was determined by post-operative air-bone gap (ABG) on audiogram nearest to 1âyear after surgery. Post-operative morbidity was measured by total number of opiate doses the child received during hospital stay, along with the highest documented post-operative pain score. Comparisons were made with Mann-Whitney U test.RESULTS:
Hearing data were available for 41 patients 21 had undergone TEES (median preoperative ABG 39âdB) and 20 had PAM surgery (median preoperative ABG 39âdB). Post-operatively at 1âyear, ABG closed significantly in each group (TEES 21âdB, pâ=â0.003; PAM 23âdB, pâ=â0.01), and there was no difference between groups (pâ=â0.6). 57% who underwent TEES and 50% who underwent PAM surgery experienced serviceable hearing post-operatively, defined as air conduction pure-tone average (PTA)â≤â30âdB HL. Visual analogue pain scores from 0 (no pain) to 10 (worst pain imaginable) were available for 13 who underwent TEES and 18 who underwent PAM surgery. In children undergoing TEES, only two reported pain above 0, with the highest pain score being 4. Children undergoing PAM surgery had a median pain score of 3 (median differenceâ=â3, pâ<â0.001). Children undergoing TEES required fewer weight appropriate doses of opiate analgesic (medianâ=â0) than children who underwent PAM surgery (medianâ=â1) (median differenceâ=â1, pâ=â0.003). Children undergoing TEES had a significantly shorter surgical time (median 135âmin) than those who underwent PAM surgery (median 168âmin) (median differenceâ=â33âmin, pâ=â<0.006).CONCLUSION:
Hearing outcomes in TORP ossiculoplasty are similar in TEES and PAM surgery, and TEES may decrease post-operative pain.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Prótese Ossicular
/
Substituição Ossicular
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
Limite:
Child
/
Humans
Idioma:
En
Revista:
Otol Neurotol
Assunto da revista:
NEUROLOGIA
/
OTORRINOLARINGOLOGIA
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Canadá