乳突根治术后人工耳蜗植入患者再植入病例分析

Case Analysis of Cochlear Implant Reimplantation after Radical Mastoidectomy

目的分析乳突根治术后人工耳蜗植入(CI)患者因电极脱落行人工耳蜗再植入的原因及手术方法。方法2017年5月至2020年10月对3例乳突根治术后行CI的患者行人工耳蜗再植入术,分析其再植入的原因、手术方法、术后并发症及听觉言语康复效果。结果3例患者均因耳蜗电极脱出乳突根治术腔,其中2例因“挖耳”致电极脱出,1例原因不清,复查时发现。3例患者均同侧耳顺利再植入电极,其中2例取腹部脂肪行术腔填塞、外耳道封闭,1例保留原开放式术腔,用骨粉和肌骨膜瓣加固覆盖电极。人工耳蜗再植入术后6个月,3例患者听觉行为分级(CAP)得分分别为9、6、7分,言语可懂度分级(SIR)得分均为5分,有意义听觉整合量表(MAIS)得分均为40分;听力均恢复至再植入前水平;2例患者随访超1年,1例患者随访7个月,均未再出现电极脱出,无术腔感染、面瘫、胆脂瘤复发、外耳道盲端裂开等并发症。结论乳突根治术后人工耳蜗再植入手术应根据患者具体情况,选择合适的手术方式;术中要注意保护面神经等重要结构,尽早选择同侧耳再植入,可以避免对患者听觉言语康复效果的影响。

Objective To study the causes and surgical methods of cochlear implant reimplantation after radical mastoidectomy.Methods Three cases of cochlear implant reimplantation after radical mastoidectomy were collected in our department from May 2017 to October 2020.The causes,surgical methods,postoperative complications and postoperative auditory and speech rehabilitation were investigated.Results In 3 patients,cochlear electrode extrude in the radical mastoidectomy cavity,in 2 cases,the electrode extrusion caused by"picking ears",and 1 case was found in the outpatient review.The electrodes were reimplanted successfully in the ipsilateral ear of all the 3 patients.Among them,abdominal fat was taken to enclose the surgical cavity in 2 cases,while the original open surgical cavity was retained in 1 patient,and the electrodes were covered with bone meal and musculoskeletal flap.Six months after cochlear reimplantation,the CAP scores of the three patients were 9,6 and 7,respectively,the SIR scores were all 5,and the MAIS scores were all 40.Hearing was restored to the level before reimplantation.2 patients were followed up for more than 1 year,and 1 patient was followed up for 7 months.No electrode prolapse occurred again,and no complications such as intraoperative cavity infection,facial paralysis,recurrence of cholesteatoma,and rupture of blind end of external auditory canal were found.Conclusion The reimplantation of cochlear implant after radical mastoidectomy is complicated,and it is important to protect the facial nerve and other important structures during the operation.The surgeon should be experienced and make timely judgment and treatment during the operation.The appropriate surgical method should be selected according to the patient's specific situation.Early ipsilateral ear reimplantation can avoid the negative effects on auditory and speech rehabilitation of patients.