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。

Primary and Staged Cochlear Implantation in Patients with Middle Ear Infection:A Case Analysis

Objective To report authors’experience with cochlear implantation in patients with middle ear infection.Methods Clinical data from cochlear implantation patients with middle ear infection at the PLA General Hospital from December 2000 to March 2019 were retrospectively analyzed,including middle ear diseases,surgical methods,types of surgical cavity packing,outcomes and postoperative complications.Results Primary implantation was performed in 11 cases,including 5 cases with stable chronic suppurative otiti media,2 cases with active suppurative otiti media and 4 cases with middle ear cholesteatoma.Implantation was staged in 9 cases,including 6 cases with active chronic suppurative otitis media and 1 case with stable suppurative otiti media and 2 cases with middle ear cholesteatoma.One patient had a prolapsed electrode 9 years after staged implantation.All other cases achieved satisfactory results regardless of clinical features and surgical methods.Conclusion For patients with middle ear infections,staged cochlear implantation is safer than primary implantation,which should be done only in select cases with limited and mild lesions.The surgical method should be selected on the basis of complete removal of middle ear lesions with a minimal scope of surgical disturbances.