伴有分泌性中耳炎的人工耳蜗植入适应证与手术时机

Cochlear implantation in patients with secretory otitis media

目的探讨伴有分泌性中耳炎的人工耳蜗植入手术适应证与手术时机。方法对26例伴有分泌性中耳炎的重度或极重度耳聋患儿行人工耳蜗植入手术，术前对分泌性中耳炎进行必要的非手术治疗，选择手术适应证和手术时机。人工耳蜗植入术中清理分泌性中耳炎病变、通畅引流，术后定期随访，同步进行人工耳蜗植入效果的评估。结果26例伴有分泌性中耳炎的人工耳蜗植入者均进行单侧耳手术，手术一次成功，其中左耳5例，右耳21例。术后1个月开机调试，26例均有主观电听觉。术后随访13个月～4．3年，分泌性中耳炎痊愈19例，鼓膜形态正常、声导抗检查为A型鼓室压曲线；分泌性中耳炎好转7例，鼓膜轻度浑浊内陷，声导抗呈C型鼓室压曲线；无鼓膜穿孔、中耳粘连或分泌性中耳炎急性发作病例。结论伴有分泌性中耳炎的人工耳蜗植入手术在严格掌握手术适应证的前提下，应及早手术，以争取术后听觉言语康复的最佳时期；通过术前必要的药物治疗、术中的病变处理与术后的治疗以及密切随访，都可以避免并发症的发生，达到人工耳蜗植入的预期效果。

Objective To evaluate the indications and surgery time of cochlear implantation in patients with otitis media with effusion （OME）. Methods Cochlear implantation was performed in 26 patients with bilateral profound sensorineural hearing loss and OME. Non-Surgical Treatment was conducted for OME before the following implantation. According to the standards of the indications and surgery time, surgery was carried out. During the process of surgery operation, related lesions of OME were completely removed and proper drainage was then constructed. After the surgery, the patients were regularly followed up, and the effective of cochlear implantation was evaluated. Results Unilateral ear of 26 patients was successfully operated. Among them, 5 cases were left ears and the remaining was right ears. All implant devices worked normally after 1 month. Had been followed up from 13 months to 4. 3 years, 19 patients with OME were healed and the remaining was turning better. No evidence showed phenomenon of the eardrum perforation and acute attack of OME. Conclusions Once the indications of cochlear implantation in patients with OME are guaranteed, the surgery should be conducted as early as possible. The complications of cochlear implantation in patients with OME can be effectively avoided through proper treatment in different stages.