不同类型人工耳蜗植入术13例分析

目的　探讨人工耳蜗植入手术的相关问题 .方法　2 0 0 0 - 12 / 2 0 0 2 - 0 3人工耳蜗植入手术 13(男 5 ,女 8)例 ,年龄 2～ 18岁 .其中语前聋 11例 ,语后聋 2例 ,先天性聋 8例 ,药物性聋 5例 ;所有病例无遗传史 ,有高热病史 2例 ,脑膜炎病史 1例 ,腮腺炎病史 2例 ;11例术前有超过 1a的正规语训及大于3mo的助听器配戴史 ,2例未经正规语训及配戴助听器 .术前听力学检查 2 6耳中 2 5耳 ABR>10 0 d B、1耳 >90 d B,鼓室图均为 A型曲线 ,畸变产物耳声发射未引出 .双侧半规管麻痹 2例 ,颞骨薄层 CT扫描耳蜗畸形 2例 .所有患者均行右侧人工耳蜗植入手术 ,术中面神经监测 .其中植入澳大利亚Neuclear2 4型人工耳蜗 10例 ,奥地利 Med4 0 +2例 ,美国Clarion人工耳蜗 1例 ,患者术后 1～ 1.5 mo开机调试及跟踪随访 .结果　耳蜗植入成功 12例 ,1例因耳蜗硬化电极未能全部植入 ,8例术后 3d有轻度眩晕 ,无其他手术并发症发生 .开机调试后所有患者均能听到声音 .术后随访 ,已有 3例入正常学校上学 .结论　根据不同类型的人工耳蜗采用不同的手术方式 ,讨论了手术相关问题及术后电极定位等 .

Clinical analysis of surgery in 13 cases receiving different types of cochlear implants

AIM To investigate the issues associated with cochlear implantation. METHODS A retrospective studywas undertaken of 13 cases who underwent cochlear implantation with ages from 2 to 18 years. There were 11 cases with prelingual deafness and 2 with postlingual deafness. The cause of deafness was congenital in 8 cases and drug induced in 5. All cases had no genetic factors related to their hearing loss. However, 2 cases suffered from high fever, 1 from meningitis, and 2 from parotitis, before the operation. Eleven children had been on a systematic lingual skill program for more than 1 year, and had used hearing aids for longer than 3 mo before the implantation. The rest two had neither the course nor the hearing aids. Preoperative auditory tests showed: ABR>100 dB in 25 of the 26 ears, >90 dB in 1 ear. Tympanogram of Type A was found in all cases, and DPOAE were absent as well. Two children had bilateral canal paralyses, and the high resdution CT scan demonstrated cochlear malformation in another two children. All children received dextral cochlear implantation with facial nerve monitoring intraoperatively, and ten of them had Neuclear 24 device (Australia), two Med40+ device (Austria), and one Clarion device (U.S.). Initial stimulation of the implant was undertaken roughly 1~1.5 mo after the implantation, and follow up was given afterwards. RESULTS Full insertion was accomplished in 12 cases; in 1 case, not all the electrodes were inserted because of cochlear ossification. Except for an episode of slight vertigo in eight children in the 3 days following the implantation,no significant surgical complications were encountered. All children responded to the initial stimulation of the implant. During follow up, 3 children attended public school. CONCLUSION Different surgical methods should be taken for different types of cochlear implants. The implant surgery, especially postoperative imaging and evaluation of the electrode position by using x ray, are dicussed.