[Subtotal petrosectomy - indications, surgical technique, experiences in Pécs].

Abstract:

:Introduction: Subtotal petrosectomy (STP) has been known for decades and it is considered being on the borderline between ear and skull-base surgery. Due to its excessive radicalism and adverse effects on hearing, it has been a forgotten surgical technique until recently. Over the last decade, due to its many benefits and the ability to combine it with modern hearing rehabilitation methods, STP has reappeared, providing a definitive solution to a number of problematic middl-ear disorders. Aim: In our retrospective clinical study, we wanted to highlight the effectiveness of STP, analyzing the efficiency of this surgery for the first time in domestic patient records, and to report our own experiences to date. Method: We processed data from 45 surgeries on our 44 patients. In addition to presenting the various surgical indications, we review the steps of the operation, analyze the audiological results, including the various methods of hearing rehabilitation, and also analyze the complications that have occurred. Our results are also summarized in the light of international professional literature. Results: Of our 44 patients, 23 were female and 21 were male. Patients had a mean age of 44.6 ± 20.5 years and a mean follow-up of 23 ± 16 months. Of our patients, 25 (57%) had undergone at least two previous unsuccessful ear operations, and 6 (14%) had deafness before surgery. The most common indication was chronic otitis media with cholesteatoma. 13 patients underwent 14 cochlear implantations (23%), in addition 6 patients received bone anchored hearing aids (BAHA) (14%), and 2 patients (5%) underwent VSB (Vibrant Soundbridge) placement against the round window membrane. Complications occurred in 11 of our patients, the most common of which was cerebrospinal fluid leak (5 cases, 11%) and wound dehiscence (3 cases, 7%). Data from 3 patients were available for processing the audiological results. Conclusion: STP is an extremely favorable surgical solution for a number of middle-ear pathologies that have previously caused major problems. The main reason for its growing popularity is that it can be combined with a number of modern, effective methods of hearing rehabilitation. Orv Hetil. 2020; 161(14): 544-553. :Absztrakt: Bevezetés: A subtotalis petrosectomia (STP) évtizedek óta ismert, de túlzott radikalitása és a hallásra gyakorolt kedvezőtlen hatása miatt a közelmúltig szinte feledésbe merült műtét a fülsebészet és az agyalapi sebészet határán. Az elmúlt évtizedben ez a beavatkozás számos előnye, valamint az új hallásrehabilitációs módszerekkel való kombinálhatósága miatt újra előtérbe került, hiszen számos problémás, a középfület érintő megbetegedésre nyújt végleges megoldást. Célkitűzés: Retrospektív klinikai tanulmányunkban a STP eredményességére kívántuk felhívni a figyelmet, hazai beteganyagon első alkalommal elemezve a műtét eredményességét, közreadva eddigi tapasztalainkat. Módszer: 44 betegünkön elvégzett 45 műtét adatait dolgoztuk fel. A sokrétű műtéti indikáció bemutatása mellett áttekintjük a műtét egyes lépéseit, elemezzük az audiológiai eredményeket – kitérve a különféle hallásrehabilitációs módszerekre is –, s elemezzük az előfordult komplikációkat is. Eredményeinket a nemzetközi szakirodalom tükrében is górcső alá vesszük. Eredmények: 44 betegünk közül 23 volt nő, 21 férfi. A betegek átlagéletkora 44,6 ± 20,5 év volt, átlagos követési idejük pedig 23 ± 16 hónap. Betegeink közül 25 (57%) korábban legalább két sikertelen fülműtéten esett át, 6 beteg (14%) a műtétet megelőzően már siket volt. A leggyakoribb indikáció a krónikus cholesteatomás otitis media volt. 13 betegen 14 cochlearis implantációt (23%) végeztünk, ezenfelül 6 alkalommal csontvezetéses implantátumot (BAHA) (14%) helyeztünk be; 2 betegnél (5%) kerekablak-VSB (Vibrant Soundbridge)-implantációra került sor. Komplikáció 11 betegünknél jelentkezett, ezek közül a leggyakrabban a liquorfistula (5 eset, 1%) és a sebszétválás (3 eset, 7%) fordult elő. Az audiológiai eredmények feldolgozására 3 betegünk adatai álltak rendelkezésre. Következtetés: A STP rendkívül hasznos műtéti megoldás számos, korábban jelentős problémát okozó fülészeti kórképben. Egyre növekvő népszerűségének hátterében az áll, hogy kombinálható számos modern, új hallásrehabilitációs módszerrel. Orv Hetil. 2020; 161(14): 544–553.

journal_name

Orv Hetil

journal_title

Orvosi hetilap

authors

Gerlinger I,Molnár K,Nepp N,Tóth I,Tóth T,Szanyi I,Bakó P,Pap I

doi

10.1556/650.2020.31691

subject

Has Abstract

pub_date

2020-04-01 00:00:00

pages

544-553

issue

14

eissn

0030-6002

issn

1788-6120

journal_volume

161

pub_type

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