Auris, nasus, larynx · 2026
Survival analysis of initially inserted Kobayashi plugs in patulous Eustachian tube: A retrospective study of 297 ears.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Oshima Takeshi, Yoshida Marin, Oshima Hidetoshi, Shindo Hideshi, Hirai Ryoji
Аннотация
OBJECTIVES: Kobayashi Plug Surgery (KPS) is widely performed in Japan for refractory patulous Eustachian tube (PET). However, the duration of retention and long-term stability of the initially inserted plug have not been fully evaluated. Therefore, this study aimed to analyze plug retention (plug survival) and assess the validity of preoperative sonotubometry (ST) probe tone levels as an indicator for plug size selection.
METHODS: A retrospective review was conducted of 237 patients (297 ears) who underwent initial KPS between January 2020 and August 2025. Ears were categorized by initial plug size: group A (size 3), group B (size 4), and group C (size ≥5). Plug removal or replacement (upsizing or downsizing) was defined as an event, and survival was analyzed using the Kaplan-Meier method. Multivariate Cox regression and Weibull parametric models were applied to identify predictors of plug survival. Preoperative ST values were compared among groups and correlated with postoperative outcomes.
RESULTS: At initial surgery, size 4 plugs were most frequently used (61%). During follow-up, 42 events occurred (14.1%). Kaplan-Meier analysis showed a mean survival time of 900.6 days and a 75% survival time of 1076 days, with no significant differences among groups (log-rank test, p = 0.61). Weibull analysis revealed a shape parameter (β) <1, indicating high early postoperative risk followed by long-term stability. Cox regression showed no significant effects of plug size, age, or ST values on survival. Among the 181 ears treated with a size 4 plug, 96 were followed for more than one year without events, and 92 of these were classified as long-term favorable cases. Preoperative ST values differed among size groups but did not predict postoperative course, particularly in size 4 cases.
CONCLUSION: KPS demonstrated durable long-term effectiveness, with most plugs remaining stable beyond the early postoperative period. While ST levels guide initial size selection, long-term outcomes appear influenced by additional anatomical and clinical factors, underscoring the need for complementary diagnostics and individualized follow-up.
METHODS: A retrospective review was conducted of 237 patients (297 ears) who underwent initial KPS between January 2020 and August 2025. Ears were categorized by initial plug size: group A (size 3), group B (size 4), and group C (size ≥5). Plug removal or replacement (upsizing or downsizing) was defined as an event, and survival was analyzed using the Kaplan-Meier method. Multivariate Cox regression and Weibull parametric models were applied to identify predictors of plug survival. Preoperative ST values were compared among groups and correlated with postoperative outcomes.
RESULTS: At initial surgery, size 4 plugs were most frequently used (61%). During follow-up, 42 events occurred (14.1%). Kaplan-Meier analysis showed a mean survival time of 900.6 days and a 75% survival time of 1076 days, with no significant differences among groups (log-rank test, p = 0.61). Weibull analysis revealed a shape parameter (β) <1, indicating high early postoperative risk followed by long-term stability. Cox regression showed no significant effects of plug size, age, or ST values on survival. Among the 181 ears treated with a size 4 plug, 96 were followed for more than one year without events, and 92 of these were classified as long-term favorable cases. Preoperative ST values differed among size groups but did not predict postoperative course, particularly in size 4 cases.
CONCLUSION: KPS demonstrated durable long-term effectiveness, with most plugs remaining stable beyond the early postoperative period. While ST levels guide initial size selection, long-term outcomes appear influenced by additional anatomical and clinical factors, underscoring the need for complementary diagnostics and individualized follow-up.