内耳畸形患者的人工耳蜗植入术

Cochlear implantation in patients with inner ear malformations, clinical analysis of 25 cases

目的 探讨内耳畸形患者人工耳蜗植入手术的方法和临床经验。方法 1997～ 2 0 0 1年共实施多导人工耳蜗植入术 180例 ,其中伴有双侧内耳畸形患者 2 5例。就其不同原因所致内耳畸形患者的人工耳蜗植入手术特点及术后开机调试特点与耳蜗形态正常的人工耳蜗植入进行了比较。结果 ( 1)所有内耳畸形患者人工耳蜗植入术后都有听觉 ;( 2 )内耳畸形人工耳蜗术中容易出现“镫井喷” ,其中Mondini畸形术中出现“镫井喷”的现象比其他畸形多见 ;( 3)植入电极大部分完全插入蜗内 ,少数遗留蜗外电极 ;( 4)术后无面瘫、脑脊液瘘等并发症 ;( 5 )术后开机调试发现部分数值比正常形态耳蜗植入偏高 ,但听阈无明显区别。 ( 6 )经过语言康复训练 ,听力及言语能力均有不同程度的提高。结论 伴有内耳发育畸形患者的深度感音性聋可以行人工耳蜗植入 ,植入效果与耳蜗发育正常患者的人工耳蜗植入效果基本一致。

Objective To explore the clinical experience of multi-channel cochlear implantation in patients with bilateral inner ear malformations. Method Multi-channel cochlear implantation was conducted among 180 patients from 1997 to 2001. Twenty-five of them, being with inner ear malformations, were given hearing and speech rehabilitation including sound detection, word discrimination, auditory comprehension and spoken language skill development. A follow-up lasting 4～24 months was conducted after the operation. A retrospective analysis was performed among these 25 patients to observe the surgical outcomes and mapping characteristics after surgery. Results (1) All patients restored their auditory sensations after the operation. (2) Stapedial gusher was found in 13 cases with inner ear malformations, especially those with Mondini malformation, much more frequently than among the patients with other malformations. (3) Most of the action electrodes were inserted in the 'cochleostomy' in full length, only 2 pairs of them remained outside of the 'cochleostomy'. (4) No serious complications occurred after implantation. (5) The impedance of the electrodes, T level and C level were higher in the 25 cases than in the normal cochlear implantation, however, with the hearing similar hearing threshold. (6) After training, the abilities of speech discrimination and spoken language were improved in comparison with those before operation. Conclusion The cochlear implantation can be performed safely in patients with bilateral inner ear malformations. The primary outcome of cochlear implantation in hearing rehabilitation is similar for both the patients with inner ear malformations and those with normal cochlear structure.