先天性内耳畸形患者多通道人工耳蜗植入的效果观察

Multi-channel cochlear implants in patients with congenital inner ear malformation

目的 :探讨多通道人工耳蜗在先天性内耳畸形患者植入的效果。方法 :对 1 6例先天性内耳畸形患者 (畸形组 ,Mondini畸形 1 2例 ,大前庭导水管综合征 4例 ) ,2例经前庭窗植入电极 ,3例经鼓岬植入电极 ,1 1例经圆窗龛前上缘植入电极。 2例术中发生镫井喷。以 1 0例耳蜗发育正常的植入者作为对照组 ,进行术后效果对比。结果 :畸形组与对照组术中和术后并发症差异无显著性意义。术后听阈畸形组多数患者达到 30～ 4 0dBHL ,与正常组相似 ,仅少数患者听阈稍高。经统计学分析差异无显著性意义 (P >0 .0 5 )。听觉语言康复效果畸形组多数与对照组接近。结论 :多通道人工耳蜗植入适用于绝大多数先天性内耳畸形的患者 。

Objective:To report the use of multi channel cochlear implants in patients with congenital inner ear malformation, including classification of malformation, preoperative imaging and hearing findings, CI surgery and postoperative outcomes of hearing and speech recognition.Method:Multi channel cochlear implantation surgeries had been performed in selected 16 cases with congenital malformation in our hospital from May 1995 to May 2002. Among them, 12 cases were Mondini malformations, 4 cases were large vestibular aqueduct syndrome. Appropriate surgical approaches were performed to accommodate each kind of anatomical abnormalities. Electrodes were inserted by oval window in 2 cases, by promontory in 3 cases and by round window nick in 11 cases. 'Gush' occurred in 2 of 16 cases. The postoperative outcomes of 10 cases with cochlear malformation were compared with 10 cases with normal cochlea (control group).Result:The intraoperative and postoperative complications in CI surgery of cochlear malformation had no significant difference in comparison with normal cochlea (control group). Postoperative hearing threshold of most cases were 30～40 dB HL, which similar with normal cochlea. Only a few have a bit higher hearing threshold. There was no statistically significant difference between the group of malformation and the control group (P> 0.05 ). Most of them received the similar hearing and speech recovering benefit from cochlear implantation to patients with normal inner ears.Conclusion:Multi channel cochlear implantation could be performed in the majority of patients with congenital inner ear malformation. Postoperative outcomes of hearing and speech were satisfied.