中耳炎性病变患者的人工耳蜗植入

目的探讨伴中耳炎性病变的患者进行人工耳蜗植入的适应证、手术方法和术后并发症的发生情况。方法对1995年5月至2006年2月完成的866例人工耳蜗植入术的临床资料进行回顾性分析。术前或术中发现伴中耳乳突炎性病变患者共41例，其中男17例，女24例，年龄1岁3个月-38岁，平均10岁2个月；左耳人工耳蜗植入18例，右耳植入23例，均为单侧植入。其中慢性分泌性中耳炎13例，隐蔽性中耳炎18例，中耳炎后遗症鼓膜穿孔1例，双侧胆脂瘤中耳炎2例，中耳乳突肉芽肿7例。中耳炎性病变伴内耳、中耳畸形7例。对于双侧胆脂瘤中耳炎乳突根治术后患者，设计采用了带蒂翻转帽状腱膜法保护植入电极和面神经。结果41例患者经 Ⅰ期或分期手术，术后随访时间5个月至6年11个月，平均未发现耳部炎性并发症，装置工作良好。结论慢性非化脓性中耳炎、中耳乳突肉芽肿、中耳炎后遗症伴鼓膜穿孔者可采用Ⅰ期或分期方法行人工耳蜗植入。胆脂瘤中耳炎在彻底去除病变基础上可分期行人工耳蜗植入术。对于乳突根治术后没有足够组织覆盖保护植入电极的病例，可采用带蒂翻转帽状腱膜方法。存在活动性中耳乳突炎症者为手术禁忌证。中耳炎性病变患者人工耳蜗术后应长期随访。     

中耳乳突炎性病变的人工耳蜗植入术

目的探索双侧重度感音神经性聋合并中耳乳突炎性病变人工耳蜗植入手术方法.方法 29例不同类型中耳乳突炎患者行人工耳蜗植入手术,根据炎症病变程度采用Ⅰ期手术26例,分期手术3例.非化脓性及慢性中耳炎静止期者,行完壁式乳突根治术,清除病灶,保留骨性外耳道,同期行人工耳蜗植入;化脓性中耳炎者,行完壁式或开放式乳突根治术,清除病灶保留骨性外耳道或重建外耳道后上壁,获得干耳后,Ⅱ期行人工耳蜗植入.结果 29例中耳乳突不同炎症病变患者经Ⅰ期或分期手术,人工耳蜗电极均顺利植入.随访2～8年,无炎症病变复发,开机后人工耳蜗工作正常,无电极裸露、脱出.结论中耳乳突炎性病变经正确的手术措施干预后,可行人工耳蜗植入.强调依据病变程度和范围个性化处理.     

迷路纤维化的诊断及人工耳蜗植入3例分析

目的：探讨迷路纤维化的影像学诊断及对人工耳蜗植入术的效果。方法：结合文献复习，报告3例迷路纤维化患者行人工耳蜗植入术的临床资料。结果：术前CT扫描3例均未发现异常。1例术前MRI提示耳蜗基底间纤维状，1例术后提示对侧耳蜗纤维化。2例病变较轻者成功地进行了人工耳蜗植入术，术后恢复良好；1例因病变严重电极未能植入。结论：MRI在迷路纤维化的诊断中有重要价值。慢性化脓性中耳炎为迷路纤维化的病因之一。慢性化脓性中耳炎一期手术清理中耳病变后，具有进行人工耳蜗植入的可行性。     

岩骨次全切除术的临床应用

目的探讨岩骨次全切除术的外科技术要点及其在治疗颞骨病变中的应用和疗效。方法回顾性分析2013年4月-2018年7月于北京协和医院耳鼻喉科行岩骨次全切除术的22例(23耳)患者的临床资料。这些患者中胆脂瘤9例,其中3例为术后复发,慢性化脓性中耳炎4例,脑脊液耳漏1例,其他良性肿瘤6例,外耳道鳞癌术后、放疗后复发1例,颅底黄曲霉感染1例。术后行颞骨增强MRI规律随访。结果保留耳囊19耳,切除耳囊4耳;封闭外耳道9耳,不封闭外耳道14耳。以切除病变为目的19耳,其中1例同期植入振动声桥,2例同期切除病变后植入耳蜗,其中1例为听神经瘤,1例为开放性乳突根治术术后人工耳蜗植入后电极外露取出耳蜗并再次植入;所有患者术后规律随访0.5-5年,1例患者术后5年发现胆脂瘤复发,其余患者均未见复发。5耳为清创引流同期切除病变,术后半年内均干耳,其中1例为双侧放射性中耳炎右耳清创术后4月右耳植入人工耳蜗,左耳行岩骨次全切。1例为行脑脊液漏修补,术后随访9月未见复发。结论岩骨次全切除术可用于彻底切除的颞骨内胆脂瘤、颅中窝底良性、低度恶性肿瘤的颅外部分的切除,颞骨岩部感染的清创干耳。可根据病变灵活决定是否切除耳囊及封闭术腔,对于保留耳囊的患者可同期植入人工听觉装置改善听力。     

中耳感染性疾病Ⅰ期和分期人工耳蜗植入病例分析

目的总结中耳感染性疾病患者人工耳蜗植入(Cochlear Implant,CI)的临床经验。方法对2000年12月-2019年3月在解放军总医院行CI伴中耳感染性疾病患者的临床资料进行回顾性研究。对Ⅰ期或Ⅱ手术患者的中耳病变性质和范围、手术方式、术腔填塞物种类、手术疗效以及术后并发症等进行总结分析。结果术后随访9个月-10年,Ⅰ期植入11例,其中,慢性化脓性中耳炎静止期5例,活动期2例,中耳胆脂瘤4例(胆脂瘤范围较小,或有完整包膜)。Ⅱ期植入9例,其中,慢性化脓性中耳炎活动期6例,静止期1例;中耳胆脂瘤2例(胆脂瘤范围较大,或包绕正常组织,不易完整清除)。分期植入组中有1例耳蜗植入术后9年电极脱出。其余病例通过结合病例特点,采用不同手术方式均取得满意的治疗效果。结论对于中耳感染性疾病的患者,人工耳蜗分期植入相对于同期植入更加安全。Ⅰ期植入应尽可能选择病变较轻,病灶局限易完整清理的病例,术式选择应在彻底清除病灶的基础上尽量选择损伤范围较小的术式。     

感音神经性聋并分泌性中耳炎患者一期人工耳蜗植入

目的探讨感音神经性聋并慢性分泌性中耳炎患者一期人工耳蜗植入的可行性。方法对就诊于中山大学孙逸仙纪念医院耳鼻咽喉科的2例慢性分泌性中耳炎并双侧极重度感音神经性聋患者行一期人工耳蜗植入术,观察植入效果及听力言语康复情况。结果 2例患者术中均顺利植入电极,术后随访均无分泌性中耳炎复发,听力言语能力恢复效果好。结论对于合并慢性分泌性中耳炎的感音神经性聋患者,在清除病变的基础上,同期行人工耳蜗植入是可行的。     

人工耳蜗植入前、后中耳炎性病变的处理--附6例报告

目的总结人工耳蜗植入前中耳炎性病变,以及植入后中耳、内耳感染的治疗经验.方法术前2例分泌性中耳炎伴乳突粘膜病变和1例慢性中耳炎选择一期手术;1例中耳乳突炎,1例胆脂瘤行分期手术.5例患者耳后切口经面神经隐窝入路植入电极,1例乳突根治术后术中借卵圆窗和鼓岬定位耳蜗钻孔部位植入电极,术中均进行电极阻抗测试和听神经遥测反应测试.结果1例术后中耳炎伴迷路炎经保守治疗痊愈.所有患者植入耳蜗工作正常,随访10-40月未见与中耳炎相关的并发症.结论极重度感音神经性聋伴分泌性中耳炎患者,原则上应分期手术;合并中耳乳突炎者,也应分期手术,完壁式和经典式乳突根治,根据病情均可选用.但中耳炎静止期鼓膜小穿孔者,可考虑一期手术.     

人工耳蜗植入术前的影像学检查

目的 :探讨CT和MRI检查对人工耳蜗植入术前评估的价值。方法 :对 2 6例感音性耳聋患者均采用颞骨轴位高分辨率CT螺旋扫描、MR水成像及内耳三维重建。结果 :1 8例先天性感音性耳聋患儿中检出Mondini畸形Ⅰ型 1例 (2耳 ) ,Ⅱ型 1例 (2耳 ) ,内耳纤维化 1例 (2耳 ) ;5例语后聋患者中检出慢性化脓性中耳炎 1例 (2耳 ) ,内耳骨化 1例 (2耳 )。结论 :对于人工耳蜗植入术的术前评估 ,CT检查具有重要价值 ,必不可少 ,MRI检查是必要的补充。对内耳的三维重建 ,MRI优于CT。     

影像学评估对耳蜗骨化患者人工耳蜗植入手术及术后效果的影响

目的探讨影像学评估对耳蜗骨化患者人工耳蜗植入手术及术后效果的影响。方法回顾性研究解放军总医院2009～2012年间7例耳蜗骨化的人工耳蜗植入患者的影像学检查结果、手术方式等资料,总结分析其术后康复效果。结果术前颞骨高分辨率CT和MRI检查,特别是耳蜗MRI仿真内窥镜可判断耳蜗骨化范围及程度。植入时1例患者因一侧耳蜗完全骨化而失败,另一侧植入顺利,其余6例均手术顺利,无手术并发症。人工耳蜗开机后7例患者均有听觉反应,但CAP）及SIR分级不同（因病例数量少未做统计学分析）。结论耳蜗骨化患者的术前影像学评估需将颞骨高分辨率CT和MRI结合,MRI仿真内窥镜重建可清晰显示耳蜗病变程度及范围。对于耳蜗轻度骨化患者,经典面神经隐窝入路一圆窗龛前方开窗术可顺利植入电极。人工耳蜗植入术可以作为伴有耳蜗骨化的极重度感音性聋患者的治疗手段,术后康复效果影响因素较多。     

哈尔滨医科大学附属第二医院耳鼻咽喉头颈外科

耳科开展乳突根治手术和各种类型的鼓室成形手术治疗慢性化脓性中耳炎；颞内段面神经减压术和面神经移植术治疗周围性面瘫：1999年开展了颞颈联合进路颈静脉球体瘤切除术：2002年开展了经迷路后进路听神经瘤切除术，均取得良好疗效。2002年开展了全省第1例人工耳蜗植人手术，并于2004年建立了人工耳蜗植入基地，目前已经为近70例患者成功植入了人工耳蜗，成功率为100％。人工耳蜗植人手术开展的同时也带动了听力学检测技术的发展，能够配合完成人工耳蜗植入术前听力学评估、术中监测及术后开机调试，使人工耳蜗植人工作更加完善。     

Cochlear implantation in a patient with eosinophilic otitis media

Eosinophilic otitis media is an intractable middle ear disease with gelatinous mucoid fluid containing eosinophils associated with bronchial asthma and nasal allergy that sometimes induces deterioration of sensorineural hearing loss. Here, we report a case of eosinophilic otitis media in a 50-year-old woman who received a Nucleus 22 multi-channel cochlear implant in the right ear at the age of 42 years. She had received treatment for bronchial asthma, chronic sinusitis with nasal allergy and otitis media with effusion since the age of 30 years and had noted bilateral sudden deafness and vertigo at the age of 35 years. Preoperative CT and MRI showed cochlear ossification in the left ear, in which mastoidectomy was performed as treatment of eosinophilic otitis media. Long-term follow-up revealed that cochlear implant is indicated for deafness induced by eosinophilic otitis media, and an early decision for cochlear implant surgery is necessary. Steroid administration was remarkably useful in controlling eosinophilic otitis media in patients with bronchial asthma and chronic sinusitis with nasal allergy.     

Cochlear implantation in atelectasis and chronic otitis media: long-term follow-up.

OBJECTIVE: To report the long-term results of cochlear implantation in cases with chronic otitis media or atelectasis using a single surgical technique performed in a single cochlear implant center. PATIENTS: Nine patients who were implanted using the blind-pit closure of the external ear canal technique (4 patients with adhesive otitis media and 5 with radical mastoid cavities). Follow-up ranged from 18 months to 12 years (mean, 7.05 yr). INTERVENTION: The surgical procedure was performed in 2 stages. The first stage included canal wall down or lowering any high facial ridge in previous mastoidectomies, removal of all skin, and blind-pit closure of the external ear canal without mastoid cavity obliteration or eustachian tube obliteration. Cochlear implantation was performed 6 months after the first surgical procedure. RESULTS: All operations were uneventful, and during cochlear implantation, as a second stage, no epithelia or other problems were encountered. No serious complications were encountered during the follow-up period. One case had a minor disruption of the external canal closure that was reclosed successfully under local anesthesia. All patients were using the device at the last follow-up interval with no device problems. CONCLUSION: Blind-sac closure of the external ear canal without obliteration is a rather safe surgical procedure in cases with chronic otitis media or atelectasis. Meticulous surgical technique and proper patient selection are of paramount importance. However, a 2-stage procedure may not always be necessary and might best be confined to those patients who have active inflammatory disease at the primary procedure.     

The use of subtotal petrosectomy in cochlear implant candidates with chronic otitis media

Cochlear implants (CI) candidates with chronic otitis media require special attention and management. The need of opening of the inner ear creates potential routes of spread of infection to subarachnoid spaces and lead to meningitis. The aim of the study was to analyse the technique and complications of subtotal petrosectomy (SP) in cochlear implant candidates with chronic otitis media at three different CI centres. A retrospective study was carried out in three Territory Referral Hospitals. The centres follow Fisch’s philosophy and surgical techniques of SP. The study group consisted of 19 patients, 4 men and 15 women, aged 12–82 years. All patients underwent SP with either primary or staged CI implantation. Indications for single or a staged management, difficulties during surgery and complications were analysed. Skin and muscle flap design in primary and revision cases as well as imaging follow-up strategy are discussed. In 14 patients implantation was performed in a single stage and in 5 cases in two stages. Follow-up ranged from 8 months to 10 years. All the patients use their implants and there were no major nor minor complications. The use of subtotal petrosectomy with cochlear implants is a safe and efficient technique when strict surgical steps and rules are applied. Closure of the external ear canal after previous meatoplasty can be challenging and extreme care dissecting the skin flaps is required. In patients with extensive cholesteatoma, active discharge from the ear with resistant bacteria or an “unstable” situation, the procedure can be staged.     

中耳乳突炎性改变对人工耳蜗置入的影响

目的：探讨中耳乳突炎性改变对人工耳蜗置入术的影响。方法：9例行人工耳蜗置入术患者均伴有中耳乳突炎性改变。1例乳突根治术后Ⅱ期行人工耳蜗置入及应用耳廓软骨一软骨膜复合物重建并加强后鼓室外侧壁及外耳道后壁;1例慢性中耳炎伴鼓膜穿孔Ⅰ期行人工耳蜗置入及应用耳廓软骨一软骨膜复合物重建鼓膜;3例隐性中耳乳突炎,Ⅰ期行改良乳突开放术并人工耳蜗置入术;3例硬化型乳突伴鼓室粘连,Ⅰ期行鼓室探查并人工耳蜗置入术;1例慢性中耳乳突炎伴松弛部内陷袋形成,Ⅰ期行上鼓室开放及软骨一软骨膜复合物重建上鼓室外侧壁并人工耳蜗置入术。结果：术中所有的电极均顺利置入,并经术中检测电极完好,电阻测试效果满意。术后伤口均甲级愈合,1个月后均开机成功。随访无并发症。结论：对于慢性中耳乳突炎的患者,若欲行Ⅱ期人工耳蜗置入术,Ⅰ期中耳乳突手术应尽可能保留相关解剖结构。对于隐性中耳乳突炎的患者在确保鼓窦乳突、上鼓室、咽鼓管口三处引流均通畅的前提下可行Ⅰ期人工耳蜗置入。对于病变局限的上鼓室胆脂瘤,有经验的术者可以选择Ⅰ期手术,但一定要慎重。感染因素很可能在乳突汽化不良及不明原因先天性感音神经性聋的发病中起着重要的作用。对于乳突硬化、乙状窦前移严重的患者可选择经外耳道鼓岬开窗。对于人工耳蜗置入术时的鼓膜修补术,上鼓室外侧壁或外耳道后壁重建选择软骨一软骨膜复合物可以提高成功率,加固鼓膜避免内陷及电极脱出。     

Cochlear implantation after subtotal petrosectomies

Among cochlear implant candidates there are patients who have abnormal middle and/or inner-ear conditions that make them unsuitable for implantation. Insertion of a foreign body may also be contraindicated in the setting of an existing or potential intracranial communication, or when the ear is prone to infection. Five patients presented with such unfavorable conditions. These included a Mondini dysplasia with persistent cerebrospinal fluid leak, an atretic mastoid with meningocele, chronic otitis media, a transverse petrous bone fracture, and a temporal bone adenoma. All patients underwent subtotal petrosectomies and cochlear implantations. In four cases implantation was performed concomitantly with subtotal petrosectomy, while the remaining case required a two-stage procedure. No complications occurred. The technique is described in detail, and the cases and the indications for surgery are discussed. By obliterating and isolating the tympanomastoid cleft from the outer environment and utilizing the technique of subtotal petrosectomy, a broader spectrum of patients can now be implanted safely. Received: 22 November 1996 / Accepted: 24 June 1997     

Cochlear implant explantation as a sequela of severe chronic otitis media: case report and review of the literature.

INTRODUCTION: In the 1980s, intracranial and inner ear infections were feared complications in patients with recurrent or chronic otitis media (COM) who had undergone cochlear implantation. Current studies show a low incidence of such complications. We present a case of a patient who developed severe COM requiring cochlear explantation. CASE: Our patient had a previous cleft palate repair and as a three-year-old was implanted with a Nucleus-24 implant. She developed chronic otorrhea in the implanted ear, which was managed by her pediatrician until her cochlear implant stopped functioning. Radiographic imaging revealed erosion of the cochlea and extrusion of the distal electrode medially in the petrous apex. SETTING: Tertiary care university hospital. INTERVENTION/RESULTS: The patient underwent cochlear explantation, subtotal petrosectomy, obliteration of ear, and intravenous antibiotic therapy. One month later she was implanted in the contralateral ear. CONCLUSION: COM poses potentially severe complications in patients receiving cochlear implants. Patients receiving cochlear implants who are at high risk for COM require follow-up for an extended period of time.     

Management options for cochlear implantation in patients with chronic otitis media

ObjectivePatients with chronic otitis media with/without cholesteatoma present a significant challenge to safe cochlear implantation (CI). The aim of our study is to describe our experience and propose management options for CI in patients with chronic otitis media.Study designRetrospective case study.SettingTertiary academic center.Subject and methodsWe enrolled the 9 ears of 8 subjects who received CI in the ear with chronic otitis media from 2006 to 2013 by a single surgeon. CI was performed as a single-stage or staged operation with mastoid surgery according to the activity of ear infection.ResultsSix patients had bilateral chronic otitis media and 2 patients had long history of sensorineural hearing loss at contralateral ear. CI was performed with simultaneous radical mastoidectomy with closure of the EAC as a single-stage in 3 ears with a history of previous open cavity mastoidectomy and no active discharge. Staged CI was performed in 6 ears, after radical mastoidectomy with closure of the EAC in 3 ears and after intact canal wall mastoidectomy in 3 ears, due to active inflammation or complications related to otitis media. In one patient, wound infection had occurred, and implant was removed along with implantation at contralateral ear. Other subjects showed no evidence of recurrence.ConclusionDecision whether implantation as a single-stage or staged operation depends on the presence of active inflammation. Single-stage CI with proper mastoid surgery can be performed in patients without active inflammation. Staged procedure need to be done in ears with active inflammation. Proper application of mastoid surgery leads to safe CI for patients with chronic otitis media.