耳蜗骨化患者的人工耳蜗植入术

Cochlear implantation in patients with cochlear ossification

目的:探讨耳蜗骨化患者手术的技巧及术后效果。方法:回顾我科1997-2011年期间共29例耳蜗骨化的患者行人工耳蜗植入术。术前影像学及植入前骨化状况及电生理评估患者耳蜗功能。术后对患者进行言语评估及听觉行为分级标准和言语可懂度分级标准评估术后效果。结果:在29例耳蜗骨化患者中骨化程度为Ⅱ级的患者19例,骨化程度为Ⅰ级的患者4例,骨化程度Ⅲ级的患者4例。其中耳蜗骨化Ⅰ、Ⅱ级的患者中17例电极完全植入耳蜗,其余6例为部分植入电极。耳蜗骨化Ⅲ级的患者全部为部分植入。耳蜗植入术后大部分患者取得了较好的听力及语言的能力。结论:耳蜗骨化患者在完善术前评估的基础上可以完成人工耳蜗植入术并且部分患者可以取得较好的术后效果。术中电刺激听觉诱发电位的检测为评估残存螺旋神经的功能提供了一个很好的方法。

Objective： To investigate cochlear implantation surgical techniques and postoperative results in patients with cochlear ossification. Method：Twentynine cochlear ossification patients with cochlear implantation in our department were retrospectively studied during 1997- 2011. Preoperative imaging and electrophysiological assessment were done to classify the cochlear ossification of all the patients. Categories of auditory performance and speech intelligibility rating were detected to assess the outcome of cochlear implant postoperatively. Result： Among 29 cases with cochlear ossification, 19 cases were grade Ⅱ , 4 cases were gradeⅡ, 4 cases were grade Ⅲ ,and 2 cases were apical turn ossification. Among 23 patients with cochlear ossification grade Ⅰ and Ⅱ, 37 cases were totally cochlear array insertion, and 6 cases were partial cochlear array insertion. Patients with cochlear ossification grade Ⅲ were all partial cochlear array insertion. Most patients achieved good hearing and language ability after cochlear implantation. Conclusion： Cochlear implantation can be successfully performed on the basis of systematic preoperative assessment and some patients can achieve good postoperative results in patients with cochlear ossification. Intraoperative electrical stimulation of the auditory evoked response provides a good method to assess the residual spiral nerve function.