中耳炎性病变患者的人工耳蜗植入

Cochlear implantation in patients with otitis media-related diseases

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。

Objective To evaluate the indications, surgical techniques and complications of cochlear implantation in patients with otitis media-related diseases. Methods Retrospective study of the data collected from patients receiving cochlear implantation. Totally 866 cases of cochlear implantation were performed in Peking Union Medical College Hospital from May 1995 to February 2006. Among which, 41 patients with otitis media-related diseases were grouped into 5 types： chronic secretory otitis media（ 13 cases）, silent （subclinical） otitis media （18 cases）, dry eardrum perforation （1 case）, bilateral cholesteatoma of middle ear （2 cases） and middle ear granuloma （7 cases）. Seven cases were accompanied with deformities of middle ear and （or） inner ear. Pedicled aponeurosis of occipitofrontalis muscle was transplanted to cover and protect the inserted electrodes and facial nerve in a patient with bilateral cholesteatoma after radical mastoidectomy. Results All the 41 patients with otitis media-related diseases were successfully implanted in one stage or staged operations and followed up uneventfully for 5 months to 6 years and 11 months. All implant devices had worked normally and all patients had performed well. Conclusions Patients with chronic secretory otitis media, silent （subclinical） otitis media, middle ear granuloma or dry ear-drum perforation could be operated in one stage or staged procedures safely and effectively. Patients with bilateral cholesteatoma could be implanted after radical removal of related lesions. Pedicled aponeurosis of occipitofrontalis muscle could be transplanted in cases of mastoid bowl to cover and protect the inserted electrodes and the exposed facial nerve and with easy access to observe the mastoid cavity. Active suppurative otitis media was contraindicated for cochlear implantation. Long-term following-up was essential for better evaluation of the outcomes of cochlear implantation in patients with otitis mediarelated diseases.