伴慢性中耳炎语后聋患者人工耳蜗植入的疗效研究

Cochlear Implantation in Postlingual Deaf Patients with chronic otitis media

目的探讨伴有慢性中耳炎的语后聋患者人工耳蜗植入的手术方法及术后的听觉康复效果。方法对2015.6至2017.6在我院住院接受人工耳蜗植入的63例语后聋患者进行研究,其中植入耳伴有慢性中耳炎患者17例,针对慢性中耳炎病变情况采取不同术式,不伴慢性中耳炎语后聋患者46例作为对照组。用听觉分级行为标准(Categorise of Auditory Performance,CAP)、言语可懂度分级标准(Speech Intelligibility Rating,SIR)进行术后效果评估,分析并比较两组患者手术并发症及术后疗效。结果术后随访两组患者均未发现中耳炎相关并发症,统计两组患者术前、术后6个月、术后12个月的CAP和SIR值,两组患者CAP和SIR测试结果较术前显著提高(P<0.01),但两组间比较差异无统计学意义(P>0.05)。结论伴有慢性中耳炎语后聋患者不是人工耳蜗植入术的禁忌证,根据病变程度制定个性化的手术方案,一期行人工耳蜗植入术是安全的,伴有慢性中耳炎语后聋患者术后言语康复情况、对声音的自发性觉察能力与无慢性中耳炎语后聋患者术后无明显差异。

Objective To report cochlear implantation in postlingual deaf patients with chronic otitis media.Methods Clinical data from 63 postlingual deaf patients who underwent cochlear implantation between June 2015 and June 2017,including 17 with chronic otitis media and 46 without,were retrospectively analyzed.Choice of surgical techniques was based on the condition of the middle ear.The auditory classification criteria(CAP)and Speech Intelligibility Rating(SIR)were used in postoperative evaluation.Postoperative complications and auditory performance were compared between patients with chronic otitis media and those without.Results Cochlear implantations were successfully performed in all 63 cases without any chronic otitis media related complications.Postoperative CAP and SIR scores were significantly better than before implantation(P<0.01),and showed no significant difference between patients with and those without chronic otitis media.Conclusion Chronic otitis media is not an absolute contraindication for cochlear implantation.Selection of a surgical technique appropriate for the type of chronic otitis media can reduce the incidence of complications.Hearing or speech rehabilitation does not appear to be affected by chronic otitis media.