耳蜗骨化与人工耳蜗植入

目的 探讨耳蜗骨化状态下人工耳蜗植入手术的经验及分析术后效果.方法 北京同仁医院自1996年开展多道人工耳蜗植入手术以来,截止到2006年12月已开展手术600余例,遇到双侧耳蜗骨化患者7例.其中4例有明确的脑膜炎病史,3例耳蜗骨化原因不明.3例为耳蜗完全骨化;1例鼓阶完全骨化,前庭阶未受累;1例耳蜗部分骨化;2例耳蜗部分纤维化.总结术前、术中及术后的处理原则、方法及术后康复效果.结果 1例术中出现镫井喷,但比其他内耳畸形术中出现镫井喷的程度轻微;4例电极完全插入耳蜗内,2例植入部分电极,1例家属放弃植入;术后无面神经麻痹、脑脊液瘘等并发症;术后开机调试发现部分患者T值、C值比正常形态耳蜗植入偏高(因病例数量少未做统计学分析),但听阈无明显区别.术后语训听力及言语能力均有不同程度的提高.结论 对于耳蜗部分骨化患者,术中只要将其骨化成分自鼓阶内清除后可顺利植入电极;对于完全骨化患者可以将围绕蜗轴的鼓阶顶壁钻开,将电极嵌入骨槽内即可.脑膜炎后出现重度感音性聋应考虑耳蜗骨化的可能,常规颞骨CT及MRI检查,一旦确诊应尽快手术,以免耳蜗完全骨化.人工耳蜗植入术可以作为伴有耳蜗骨化的深度感音性聋患者的治疗和康复手段.

Cochlear implantation in the ossified cochlear

OBJECTIVE: To explore the problems and describe clinical experiences associated with multichannel cochlear implantation in patients with cochlear ossification. METHODS: Seven cochlear implant cases with bilateral cochlear ossification from 1996 to 2006 in Beijing Tongren Hospital were retrospectively reviewed, 4 of which were the consequence of meningitis. Three patients' cochlear were completely ossified, 1 patient's tympanic scala was completely ossified, 1 patient's cochlear was partially ossified, and 2 patients' cochlear were partially fibrotic. This article addressed the components of the preoperative evaluation, surgical decision-making, and specific techniques for cochlear implant array insertion in all kinds of ossified cochlea. RESULTS: Gusher was found in 1 case but less serious than that with inner ear malformations. The electrodes were inserted in the cochleostomy in full length in 4 cases, 1 case gave up, and the cochlear implant array were partially inserted in the remains. No serious complications occurred after implantation. All patients had auditory sensations. The impedance of the electrodes, the T level, C level and the hearing threshold were slightly higher than that of the normal cochlear implantation. CONCLUSIONS: The key influencing factor of ossified cochlear patients were the degree of the disease and whether the electrode implanted completely or not. So, the profound sensorineural hearing loss patients after meningitis should be paid more attention. Patients with ossified cochlear could be benefit from cochlear implantation.