人工耳蜗再植入病例分析

An Analysis of Revision Cochlear Implantation Cases

【摘要】目的报告人工耳蜗再植入的常见原因、手术方法及再植入术后患者听力语言康复情况。方法2007年5月～2010年11月北京友谊医院采用面隐窝进路为23例患者行人工耳蜗再植入，分析其再植入原因及手术方法。结果231例患者均顺利完成人工耳蜗再植入，再植入术后患者听力言语康复效果满意或正在康复机构接受康复。再次植入的原因分别为：电极植入下鼓室1例；植入体部分破碎1例；电极部分脱出1例；电极从外耳道后壁穿出1例，磁铁移位1例；耳蜗底转骨化致植入失败1例；皮瓣或切口感染4例；耳蜗植入体故障7例：原因不明者3例；电极阻抗无限大2例；左侧耳蜗植入后无反应再植入右侧1例。结论人工耳蜗再植入的原因多样且较复杂，再植入手术需要注意蜗内纤维化和骨化导致电极植入困难的问题。术前准确评估及患者术后避免头部剧烈碰撞是避免人工耳蜗再植入的关键。

Objective To analyze the common causes and operation methods of revision cochlear implantation and to study the postoperative hearing and speech rehabilitation of the patients. Methods From May 2007 to Novemger 2010, the revision cochlear implantation was performed in 23 patients at Beijing Friendship Hospital. The causes and methods of implantation were analyzed. Results The 23 patients received the cochlear implantation through the transmastoid facial recess approach. The causes of revision implantation were different for the 23 cases, including 1 case with the electrodes inserted into the hypotympanum, 1 case with partly ruptured implant, 1 case of electrode emersion,1 case with the electrode extruding from the posterior wall of external auditory canal, 1 case of magnet displacement, 1 case of unsuccessful implantation due to cochlear basal turn ossification, 4 case of skin flap or incision infection, 7 cases of device failure, 2 cases with infinite electrode impedence, 1 case who had no response to the implant on the left ear and then received the cochlear implantation on the right ear, and 3 cases of unknown reason. Conclusion The causes for revision cochlear implantation are different and complicated. Intracochlear fibrosis and ossification can make the electrode insertion more difficult, so more attention shall be given to this problem during the revision implantation. The key to avoid revision implantation is the accurate preoperative evaluation and prevention of the severe impact to the patient＇s head.