17例人工耳蜗再植入原因分析

目的总结17例人工耳蜗患者耳蜗再植入的原因，探讨降低耳蜗再植入风险的方法，提高患者手术治疗满意度及术后听力言语康复水平。方法回顾性分析2012年11月—2018年7月解放军总医院海南医院17例采用面隐窝入路圆窗再植入人工耳蜗患者的临床资料,分析其再植入原因。结果17例患者均顺利完成耳蜗再植入手术,再植入术后随访观察患者满意度高，人工耳蜗助听听阈大幅改善，言语分辨能力明显提高，患者听力言语康复效果提升。17例人工耳蜗再植入原因分别为:植入体故障6例；植入体不工作2例；植入体受撞击后损坏2例；植入体接收刺激器移位1例; 植入体接收刺激器部位破裂1例；皮瓣感染3例，其中1例为右侧感染后原植入体同侧再植入，皮瓣感染切口无法愈合后右侧植入体取出后行左侧人工耳蜗植入；电极未完全植入1例；应患者要求取出旧植入体同侧再植入新型植入体1例。结论人工耳蜗再植入原因复杂多样,选择合适材料的植入体、避免剧烈撞击、执行严格的无菌操作以及进行准确的人工耳蜗植入术前评估是避免人工耳蜗再植入的关键。     

人工耳蜗再植入的病因及治疗

目的　回顾人工耳蜗植入后再植入的发生原因、时间及治疗。方法　回顾2015年1月~2018年6月我科实施的人工耳蜗植入术,回顾分析其中因各种原因需要二次植入人工耳蜗的33个病例,分析其临床特点。结果　需要取出原植入体并行二次人工耳蜗植入的患者共33例,占所有患者总量的6.16%;33例患者从第一次植入至接受第二次人工耳蜗植入的时间间隔平均27.27个月;发生原因中手术相关占3.03%,并发症相关为9.09%,植入体故障占57.57%,助听效果差为30.30%;人工耳蜗再次植入手术,除1例因中耳炎而在对侧植入外其余患者均同期、同侧植入。结论　人工耳蜗再次植入的发生率较低,植入体故障和人工耳蜗助听效果差是导致人工耳蜗再植入的主要原因,人工耳蜗的再植入并不影响耳蜗植入的成功率。     

人工耳蜗再植入病例分析

目的 报告人工耳蜗再植入的常见原因、手术方法及再植入术后患者听力语言康复情况.方法 2007年5月～2010年11月北京友谊医院采用面隐窝进路为23例患者行人工耳蜗再植入,分析其再植入原因及手术方法.结果 23例患者均顺利完成人工耳蜗再植入,再植入术后患者听力言语康复效果满意或正在康复机构接受康复.再次植入的原因分别为:电极植入下鼓室1例;植入体部分破碎1例;电极部分脱出1例;电极从外耳道后壁穿出1例,磁铁移位1例;耳蜗底转骨化致植入失败1例;皮瓣或切口感染4例;耳蜗植入体故障7例;原因不明者3例;电极阻抗无限大2例;左侧耳蜗植入后无反应再植入右侧1例.结论 人工耳蜗再植入的原因多样且较复杂,再植入手术需要注意蜗内纤维化和骨化导致电极植入困难的问题.术前准确评估及患者术后避免头部剧烈碰撞是避免人工耳蜗再植入的关键.     

34例人工耳蜗植入术后再次手术患者的原因和处理方法分析

目的分析人工耳蜗植入术后再次手术患者的原因及处理方法。方法回顾性分析2009年1月~2017年12月1 693例接受人工耳蜗植入术后再次手术的34例(2.01%,34/1 693)患者的临床资料,分析导致再次手术的原因及处理方法。结果 34例中,皮下积液、感染12例(0.71%,12/1 693),皮瓣感染坏死4例(0.24%,4/1 693),植入体移位7例(0.41%,17/1 693),人工耳蜗损坏、故障5例(0.30%,5/1 693),外耳道后壁穿孔2例(0.12%,2/1 693),脑脊液耳漏2例(0.12%,2/1 693),异位植入1例(0.06%,1/1 693),排异反应1例(0.06%,1/1 693)。12例皮下积液、感染的患者均行切开引流、清理病变后保留人工耳蜗;4例皮瓣感染坏死患者均行皮瓣转移修复术,3例取出人工耳蜗并于对侧植入新人工耳蜗,1例保留人工耳蜗;7例植入体移位的患者5例手术复位,2例取出人工耳蜗,其中1例同侧再次植入人工耳蜗;5例人工耳蜗损坏、故障的患者均取出损坏的人工耳蜗,同侧重新植入同型号新人工耳蜗;2例外耳道后壁穿孔的患者均行外耳道后壁修补术,1例取出人工耳蜗,1例保留,均于对侧植入新人工耳蜗;2例脑脊液耳漏的患者堵塞耳蜗造瘘口后均取出人工耳蜗;1例异位植入的患者重新植入新人工耳蜗;1例排异反应的患者清理病灶后保留人工耳蜗。结论人工耳蜗植入术后再次手术的原因有患者自身原因、植入体原因及人工耳蜗植入手术原因,需根据不同原因进行相应的处理。     

人工耳蜗植入术的并发症及处理

目的总结和分析人工耳蜗植入术并发症,探讨并发症发生的原因、临床处理方法及预后,为避免该类并发症的发生提供临床参考。方法现对中国人民解放军联勤保障部队第九四〇医院2010年5月—2019年4月由同一术者完成的497例（498耳）人工耳蜗植入术,对其发生原因进行回顾性分析。结果24 例发生并发症(24／497),占4.8％,其中眩晕9例,骨膜下血肿2例,感染或过敏1例,外耳道皮肤破裂1例,面神经及鼓索神经损伤各1例,死亡1例,术后脑脊液耳鼻漏合并颅内感染1例,术中电钻钻头断裂至鼓阶内1例,植入体局部斑秃2例、电极未植入耳蜗1例、磁铁移位2例,装置故障1例。结论如何降低人工耳蜗植入手术严重并发症的发生,目前仍然是人工耳蜗植入亟待解决的问题。     

再次人工耳蜗植入术相关情况分析

目的通过总结31例再次人工耳蜗植入术中所发现的问题，总结经验并探讨再次耳蜗植入的注意事项方法分析2005年3月～2012年12月北京大学人民医院31例行再次人工耳蜗植入患者手术中出现的问题。结果31例患者均顺利完成人工耳蜗再植入，再次植入的原因不同，其中外伤（13例）、中耳乳突炎（2例）、产品更新换代（1例）、其他不明原因的（15例）。术中发现植入体周围骨质包裹的(11例)，植入体周围炎性反应（4例），乳突骨化的（5例），伴有中耳乳突炎的（4例），面神经隐窝软组织阻塞的（9例），耳蜗开窗口小，需要扩大开窗的（4例）。术后伤口延迟愈合的（3例）。结论植入体周围的炎症反应、中耳乳突炎、耳蜗开窗周围纤维结缔组织增生等会加大再次耳蜗植入手术难度，首次手术时应尽量避免能引起此类问题的操作，如胶、丝线、肌肉或颞肌筋膜固定电极等。同时中耳乳突炎可能是导致二次手术的一个较重要原因，应尽量预防。     

人工耳蜗植入术后感染的因素及其生物学特点研究

目的:分析人工耳蜗植入术后感染的因素及其生物学特点,探讨如何减少术后感染及感染后的治疗措施。方法:回顾性分析2001-07-2011-10期间我院人工耳蜗植入中心接受耳蜗植入的患者发生术后感染的情况。结果:由同一术者完成的316例人工耳蜗植入手术,术后有5例发生感染,外院术后感染转来1例,共6例,均经治疗后痊愈,其中1例术后8年因植入体电极支撑小柱等因素感染取出植入体。结论:人工耳蜗植入术后感染致病菌多为金黄色葡萄球菌、铜绿假单胞菌等。细菌生物膜的形成是人工耳蜗植入术后感染的关键环节,采用化学制剂清除细菌生物膜,能够控制人工耳蜗术后感染,特别是皮瓣感染。人工耳蜗植入术后发生感染时并不一定非要取出植入体。采用积极围手术期干预,积极治疗术后感染,及时采取有效措施,是人工耳蜗植入术后言语康复的有效保障。     

人工耳蜗植入手术远期并发症的临床处理

目的总结和分析人工耳蜗植入患者术后的远期并发症,探讨并发症的发生原因、临床处理方法和预后。方法对2002年3月~2016年11月在北京大学第三医院由作者潘滔完成人工耳蜗植入手术且随访资料完整的280例患者进行回顾性研究。结果在所有研究对象中,出现各类远期并发症(发生于术后3个月之后的并发症)共6例,总发生率为2.1%,并发症出现时间最早为术后4个月,最晚为术后5年。其中术后远期中耳炎合并植入体周围感染3例,发生率1.1%,经过抗生素及对症治疗后痊愈。植入体装置故障2例,发生率0.7%,行植入体取出及同侧再植入。皮瓣感染及坏死1例,发生率0.4%,先后4次行耳后清创、皮瓣转移术,仍不能控制感染,遂行植入体取出、乳突清创、皮瓣转移成形术并同期行对侧人工耳蜗植入,最终痊愈。以上出现远期并发症的患者经过上述治疗干预后均预后良好。结论即使人工耳蜗植入患者术后恢复良好,远期的并发症仍值得关注,及时的发现和处理可挽救或避免进一步的危害后果。     

人工耳蜗植入术后皮瓣相关并发症的临床特点及处理方法分析北大核心CSCD

目的探讨人工耳蜗植入术后发生皮瓣相关并发症患者的临床特点及处理方法。方法回顾性分析2002年10月至2016年12月在我科接受人工耳蜗植入手术的679例患者,术前常规检查包括听力学、影像学及小儿肢体、智力发育评估,均符合人工耳蜗植入手术适应症。筛选术后发生皮瓣相关并发症的患者,分析其临床特点、处理过程及预后情况。结果皮瓣相关并发症6例,发生率0.88%,植入年龄最小1岁,最大2岁9个月,仅1例无植入体外露,其余5例均有皮瓣坏死及植入体外露,清创术中均发现植入体周围及深面较多炎性肉芽组织生长。施行人工耳蜗植入手术至发生并发症的时间间隔最短13天,最长1年6个月。经全身应用抗生素、局部换药(包括伤口置管冲洗、放置引流片、抗生素溶液湿敷)、清创及皮瓣转移整复术治疗后,痊愈2例;经多次清创及皮瓣转移整复术治疗无效,最终取出植入体4例。结论人工耳蜗植入术后皮瓣相关并发症发生率低,伴有皮瓣坏死及植入体外露的病例预后不良。主要原因包括切口/皮瓣设计不合理、外伤、细菌生物膜与异物反应等。局部换药、清创及皮瓣转移整复术治疗并不能完全解决皮瓣感染的问题,大部分患者需面临最终取出植入体的结果。手术至发生皮瓣感染的时间越短,保留植入体的可能性越大。     

再次人工耳蜗植入术

目的 通过总结6例再次人工耳蜗植入术中所发现的问题,总结经验并探讨注意事项。方法 与常规的人工耳蜗植入术基本相同,采用“H”型切口切开肌骨膜,有助于缩短手术时间。结果 全部病例均能顺利地再次完全植入电极,再次手术的原因有1例是首次手术未能植入正确的部位;1例是外伤造成植入体断裂;4例植入体不能正常工作,但原因不明。结论 手术切口不宜过小;参照电极应该放在骨膜下;固定植入体的骨床周围要光滑;不要使用不可吸收的缝线;要在抽出旧电极后迅速植入新电极;开机后需要3-4周的时间适应新的电极。     

Cochlear implant failures and revision.

OBJECTIVE: To review cases involving implant failure and revision surgery in a large cochlear implant program. STUDY DESIGN: Retrospective case series. SETTING: Cochlear implant program in an academic medical center. PATIENTS: Adults and children who underwent revision cochlear implantation (n = 58). INTERVENTION: Diagnosis and explantation of failed cochlear implants, with subsequent reimplantation. Assessment of implant function and speech perception. MAIN OUTCOME MEASURES: Device type, time from implantation to revision, cause of failure, performance with original implant versus revision, number of electrodes placed, and surgical challenges related to reimplantation. RESULTS: Forty-five patients initially implanted at this program and 13 patients implanted elsewhere underwent revision surgery. The institutional device failure rate was 3.7% and the overall revision rate was 5.1%. Reasons for implant revision included documented internal device failure (46%), scalp flap complications (17%), optimization of electrode placement (13%), unexplained deterioration of performance (12%), technology upgrade (10%), and intratemporal pathology (3%). Revision surgery typically involved only minor anatomic challenges, but five patients required circumodiolar drillout procedures to improve electrode position. Electrode insertion was equal or deeper in 53 of 58 cases. Speech perception ability decreased in only three patients. CONCLUSIONS: Management of implant failures and performance of revision surgery are becoming increasingly important in cochlear implant programs. Outcomes are generally excellent. Revision implantation is a safe and appropriate procedure that should be pursued in a timely fashion when patients experience cochlear implant failure.     

Reference function of old electrical stimulation electrode in cochlear-reimplantation in children

ObjectivesTo explore the causes of cochlear implantation and reference function of old electrical stimulation electrode in cochlear reimplantation in children.MethodsThe causes, surgical methods and problems found during the operations of 24 cases of cochlear reimplantation in Henan Children's Hospital from June 2016 to April 2018 were analyzed.ResultsTwenty-three cases successfully completed the surgery of cochlear-reimplantation, and the remaining one case had approximately 1/3 of the anterior end of the residual cochlear electrode due to high resistance at the time of withdrawal of the electrodes. The causes of re-implantation were implant equipment failure (eleven cases), elevated impedance values of all electrodes after head trauma (two cases), and implant prolapse together with the electrode caused by a traffic accident (one case).ConclusionThe old stimulus electrode can provide an important reference to reduce the risk of operation and ensure the success of the reoperation.     

Chronic suppurative otitis media following paediatric cochlear implantation

The objective of this study was to report and discuss the management of chronic suppurative otitis media (CSOM) following cochlear implantation in children. The study was a retrospective review of 650 patients receiving an implant at two paediatric tertiary referral centres for cochlear implantation. Nine patients were identified who developed CSOM following cochlear implantation (incidence 1.38%). The mean time interval between implantation and symptom development was 3.66 years (range 2-8 years) and the mean time interval between implantation and CSOM surgery was 5.02 years (range 2.2-8 years). All patients presented with otorrhoea and/or abscess formation over the implant site. Two patients underwent a modified radical mastoidectomy and seven underwent a combined approach tympanoplasty, three of whom required posterior canal wall reconstruction with cortical bone and one with cartilage. In four cases it was possible to remove the cholesteatoma without removing the implant. All but two patients were fitted with a contralateral implant. In the explanted ears the cochlear implant electrode was cut at the cochleostomy site, which was then covered with muscle. Chronic suppurative otitis media following cochlear implantation may occur either as a result of a posterior canal wall defect related to surgery or possibly de novo. Attempts should be made to save the implant, but explantation with reimplantation of the contralateral ear may be the only option. In these cases the intracochlear part of the electrode array should be left in situ to facilitate possible future reimplantation. Surgical options for management of CSOM should be individualized and may include both canal-wall up and canal-wall down techniques. To reduce the incidence of CSOM following implantation the authors recommend: (1) prompt treatment and careful follow-up of patients with a history of otitis media with effusion, (2) avoidance of excessive thinning of the posterior canal wall during mastoidectomy and (3) reconstruction of any accidental trauma to the annulus or posterior canal wall during posterior tympanotomy.     

Intracochlear misdirected implantation of a cochlear implant

This paper discusses a rare complication of an intracochlear misdirection of the electrode of a cochlear implant in a 55-year-old male. The patient received a cochlear implant using the mastoid-saving surgical approach. Intraoperative measurements showed impedance and NRT reactions suggesting a reasonable function of the inner ear and the implant. Postoperatively our patient suffered from passing vertigo. Postoperative CT scans revealed a misdirection implantation of the cochlear implant into the vestibular part of the inner ear. A deformed implant was removed and a reimplantation was successfully performed after enlarging and reshaping the cochleostomy. Our patient now enjoys all the benefits of an optimal functioning cochlear implant. Intracochlear misdirection of the electrode can occur even when intraoperative measurements seem to be normal. When a patient suffers from unexplained vertigo after cochlear implantation with a poor function of the implant a misdirection of the active electrode must be considered. New high resolution peroperative three-dimensional imaging techniques can probably help to avoid such insertion failures.     

Intracochlear misdirected implantation of a cochlear implant

This paper discusses a rare complication of an intracochlear misdirection of the electrode of a cochlear implant in a 55-year-old male. The patient received a cochlear implant using the mastoid-saving surgical approach. Intraoperative measurements showed impedance and NRT reactions suggesting a reasonable function of the inner ear and the implant. Postoperatively our patient suffered from passing vertigo. Postoperative CT scans revealed a misdirection implantation of the cochlear implant into the vestibular part of the inner ear. A deformed implant was removed and a reimplantation was successfully performed after enlarging and reshaping the cochleostomy. Our patient now enjoys all the benefits of an optimal functioning cochlear implant. Intracochlear misdirection of the electrode can occur even when intraoperative measurements seem to be normal. When a patient suffers from unexplained vertigo after cochlear implantation with a poor function of the implant a misdirection of the active electrode must be considered. New high resolution peroperative three-dimensional imaging techniques can probably help to avoid such insertion failures.     

368例人工耳蜗植入手术分析

目的探讨人工耳蜗植入手术的操作程序,以提高手术效率及手术安全性。方法回顾性分析人工耳蜗植入手术368例,手术均采用经后鼓室径路。术中行电极阻抗测试和神经反应遥测,术后拍耳蜗位X线平片判断电极植入情况,术后一个月开机调试及跟踪随访。结果所有患者电极全部顺利植入,人工耳蜗装置工作状态正常。术后3天1例出现迟发型面瘫,用激素保守治疗后逐渐恢复,术后45天1例患儿发生外耳道炎,术后2个月1例出现乳突及耳后骨膜下脓肿,术后7个月1例由于头部外伤致植入体损坏更换植入体,经积极处理后均恢复良好。全部病例术后随访24个月无永久性面瘫、植入体移位及脑膜炎等严重并发症发生,但术后4年3例患儿出现植入体外露合并皮肤感染。结论熟练掌握手术技巧并根据个体特点进行人工耳蜗植入手术对于提高植入成功率、重建听觉、减少手术并发症有着非常重要的意义,术后的长期随访甚至终生随访是必要的。     

Chronic suppurative otitis media following paediatric cochlear implantation

Abstract

The objective of this study was to report and discuss the management of chronic suppurative otitis media (CSOM) following cochlear implantation in children. The study was a retrospective review of 650 patients receiving an implant at two paediatric tertiary referral centres for cochlear implantation. Nine patients were identified who developed CSOM following cochlear implantation (incidence 1.38%). The mean time interval between implantation and symptom development was 3.66 years (range 2–8 years) and the mean time interval between implantation and CSOM surgery was 5.02 years (range 2.2–8 years). All patients presented with otorrhoea and/or abscess formation over the implant site. Two patients underwent a modified radical mastoidectomy and seven underwent a combined approach tympanoplasty, three of whom required posterior canal wall reconstruction with cortical bone and one with cartilage. In four cases it was possible to remove the cholesteatoma without removing the implant. All but two patients were fitted with a contralateral implant. In the explanted ears the cochlear implant electrode was cut at the cochleostomy site, which was then covered with muscle. Chronic suppurative otitis media following cochlear implantation may occur either as a result of a posterior canal wall defect related to surgery or possibly de novo. Attempts should be made to save the implant, but explantation with reimplantation of the contralateral ear may be the only option. In these cases the intracochlear part of the electrode array should be left in situ to facilitate possible future reimplantation. Surgical options for management of CSOM should be individualized and may include both canal-wall up and canal-wall down techniques. To reduce the incidence of CSOM following implantation the authors recommend: (1) prompt treatment and careful follow-up of patients with a history of otitis media with effusion, (2) avoidance of excessive thinning of the posterior canal wall during mastoidectomy and (3) reconstruction of any accidental trauma to the annulus or posterior canal wall during posterior tympanotomy. Copyright © 2006 John Wiley & Sons, Ltd.     

Cochlear reimplantation

OBJECTIVE: A small number of multichannel cochlear implant (CI) recipients require reimplantation. This study describes the causes of failure, surgical technique, and hearing outcomes in a consecutive series of 16 patients undergoing reimplantation of multichannel devices. We hypothesize that reimplantation is safe and that hearing results are at least as good as those measured following primary implantation. STUDY DESIGN: Retrospective analysis of consecutive clinical series. METHODS: Chart analysis of 191 consecutive CI operations performed at the University of Miami Ear Institute between 1990 and 1997 revealed 16 patients who received a second multichannel device. All but one had a minimum follow-up of 1 year after reimplantation. Ten of these patients had initial implantation performed by us, and six were initially operated on elsewhere. Main outcomes of the initial procedure were compared with those of the reimplantation, including electrode insertion length, number of channels programmed, and audiometric results. In addition, cause of failure and relevant surgical findings at the second procedure are described. RESULTS: There were no surgical complications after reimplantation surgery. Device failure was the most frequent cause for reimplantation. Time between initial implantation and failure ranged from 0 to 46 months (mean, 22.4 mo; median, 23 mo). Common intraoperative findings include mastoid fibrosis, bone growth at the cochleostomy, and skin flap breakdown. Following reimplantation, mean length of insertion, number of channels actively programmed, and speech recognition scores were at least as good as findings before initial implant failure. CONCLUSION: CI reimplantation is safe and effective.     

Cochlear implant revision surgeries in children

IntroductionThe surgery during which the cochlear implant internal device is implanted is not entirely free of risks and may produce problems that will require revision surgeries.ObjectiveTo verify the indications for cochlear implantation revision surgery for the cochlear implant internal device, its effectiveness and its correlation with certain variables related to language and hearing.MethodsA retrospective study of patients under 18 years submitted to cochlear implant surgery from 2004 to 2015 in a public hospital in Brazil. Data collected were: age at the time of implantation, gender, etiology of the hearing loss, audiological and oral language characteristics of each patient before and after cochlear implant surgery and any need for surgical revision and the reason for it.ResultsTwo hundred and sixty-five surgeries were performed in 236 patients. Eight patients received a bilateral cochlear implant and 10 patients required revision surgery. Thirty-two surgeries were necessary for these 10 children (1 bilateral cochlear implant), of which 21 were revision surgeries. In 2 children, cochlear implant removal was necessary, without reimplantation, one with cochlear malformation due to incomplete partition type I and another due to trauma. With respect to the cause for revision surgery, of the 8 children who were successfully reimplanted, four had cochlear calcification following meningitis, one followed trauma, one exhibited a facial nerve malformation, one experienced a failure of the cochlear implant internal device and one revision surgery was necessary because the electrode was twisted.ConclusionThe incidence of the cochlear implant revision surgery was 4.23%. The period following the revision surgeries revealed an improvement in the subject's hearing and language performance, indicating that these surgeries are valid in most cases.