人工耳蜗植入术后炎性反应的临床分析

Clinical analysis of cochlear implants related inflammatory reaction

目的：总结分析人工耳蜗植入术后与植人体相关的炎性反应的临床特点、治疗方法，分析可能的发病机制和相关因素。方法：行人工耳蜗植入的825例患者中13例术后发生与植入体相关的炎性反应，对其局部症状、体征及治疗过程和转归情况进行介绍和总结。结果：术后出现与植入体相关的炎性反应的发生率为1．58％，初发时间在术后2个月～11年。其中植入体局部非感染性炎性反应6例，发生率为0．73％，表现为植人侧耳后隆起、头皮下积液，局部有波动感，听声效果变差，穿刺抽液培养无细菌生长，加压包扎及应用糖皮质激素、抗组胺药物治疗有效；术后皮瓣感染性炎症7例，发生率为0．85％，因外伤或术侧耳急性化脓性中耳炎所致，除2例因感染迁延最终取出植入体外，其余5例通过抗感染及转皮瓣修复后治愈。结论：因手术部位及患者身体条件具有特殊性，人工耳蜗植入术后可能出现与植入体本身相关的非感染和感染性炎性反应，需要对此有充分的认识和技术准备。

This article discusses the clinical features and treatment methods of the inflammatory re- action associated with cochlear implants, and analyzes the possible pathogenesis and related factors. Method： We retrospectively analyzed postoperative inflammation cases from February 2002 to October 2013 among 825 cochlear implantation patients. Their symptoms, signs and treatment processes and outcomes were described and summa- rized. Result：Incidence of implants related inflammatory reaction was 1.58 %. The onset time ranged from 2 months to 11 years post-operatively. There were 6 cases of implants related non-infectious inflammation, with an incidence of 0.73~/00 （6 of 825）. Post auricular swelling and subcutaneous non-infectious discharge were found in all these 6 cases. Pressure dressing with bandage and steroid, antihistamine medications was effective. There were 7 cases of post auricular infection, with an incidence of 0.85 %, resulted from flap trauma or acute otitis media. Antibiotics and drainage was used for them to treat the infection, and rotation scalp flaps were used to cover the exposed de- vice. Five of these cases were cured hut cochlear implants had to be removed out in the other 2 cases of staphylo- coccus aureus infection. Conclusion： Cochlear implantation surgery is safe and effective for profound deafness. However, the implants-related non-infectious and infectious inflammatory reaction impacts the effect of cochlear implants, even lead to removal of the implants.