软与半软微窥镜对耳蜗鼓阶检查效果

Inspecting the cochlear scala tympanic with flexible and semi-flexible micro-endoscope

目的：通过软与半软微窥镜对耳蜗鼓阶检查，探讨软与半软微窥镜对内耳检查的效果。方法：选择15例人工耳蜗手术患者，在打开耳蜗后，使用1mm直径半软微窥镜到达耳蜗鼓阶内9mm深度，0．5mm软窥镜到达耳蜗鼓阶内25mm深度，进行耳蜗内检查，术中录像，将检查效果进行比较。结果：15例患者，先使用0．5mm直径软微窥镜到达耳蜗鼓阶内15～25mm深度，全程清晰度较差，不能发现耳蜗内细微结构；使用1mm直径半软微窥镜到达耳蜗鼓阶内9mm深度，发现3例耳蜗鼓阶内侧骨螺旋板有钙化物沉积，1例耳蜗鼓阶外侧壁见肉芽样软组织，其余11例未发现耳蜗鼓阶内病变。结论：0．5mm直径软微窥镜检查耳蜗鼓阶，可达到耳蜗内2圈的深度，但清晰度较差，难以发现耳蜗鼓阶内的病变；1mm直径半软微窥镜可以清晰地辨认耳蜗鼓阶内表面结构，发现病变，但达到的深度仅为9mm左右，无法进行耳蜗全程检查。

Objective：Flexible and semi-flexible micro-endoscopes were used in cochlear scala tympani inspection , to explore their application in inner ear examination. Method： Fifteen profound hearing loss patients preparing for cochlear implant were included in this study. During the operation, micro- endoscopy was performed after opening the cochlear scala tympani. And 1 mm diameter semi-flexible micro-endoscope could go as deep as 9 mm into the cochlear scala tympani, while 0.5 mm diameter flexible micro-endoscope could go as deep as 25 mm. The inspecting results were compared with video recording. Result： Using 0.5 mm flexible micro-endoscope, we canould check cochlear scala tympani with depth range of 15-25 mm, but the video imaging was not clear enough to examine the microstructure in the cochlear. With 1 mm diameter semi-flexible micro-endoscope, we could reach 9 mm deep into the cochlear. During the examination, we found 3 cases with calcification deposit in osseous spiral lamina, 1 case with granulation tissue in the lateral wall of scala tympani, no abnormal findings in the other 11 cases. Conclusion： Inspecting the cochlear scala tympani with 0.5 mm flexible micro-endoscope, even though we can reach the second circuit of the cochlear, it is difficult to find the pathology in the cochlear because of the poor video imaging. With 1 mm semi-flexible micro-endoscope, we can identify the microstructure of the cochlear clearly and find the pathologic changes, but the inserting depth was limited to 9 mm with limitation to examine the whole cochlear.