人工耳蜗植入术围手术期处理及注意事项

目的 探讨人工耳蜗植入手术的围手术期处理方法及注意事项,旨在提高人工耳蜗植入成功率及术后言语效果, 减少失误及并发症。方法 回顾性分析61例人工耳蜗植入手术患者病历资料, 总结术前检查筛选、围手术期并发症及其处理、术后调机等多方面的注意要点。结果 本组患者61例, 包括语前聋、语后聋、大前庭导水管综合征、 Mondini畸形、合并存在大前庭导水管综合征及Mondini畸形、合并脑白质异常和再植入这几种不同情况, 术后均取得良好效果。结论 人工耳蜗植入术的前提是术前一定要对患者进行准确有效的评估, 进行植入手术时操作规范化、流程化, 但同时要兼顾不同患者的个体性差异, 术后系统调机和听觉言语康复训练也十分重要。     

自制凹面形头皮拉钩在人工耳蜗植入术中的应用

目的 提高人工耳蜗植入成功率,减少并发症,优化手术过程。方法 将不锈钢凹面勺打磨成凹面形头皮拉钩,应用于120例人工耳蜗植入术中。结果 120例患者应用新型凹面勺头皮拉钩,证明其能充分暴露手术视野,避免拉钩与钻头摩擦,导致钻头耗损及产生金属屑,减少术者体力消耗及头皮组织挫伤。结论 利用不锈钢凹面勺制作的人工耳蜗头皮拉钩可行,疗效良好。     

高度近视合并白内障患者植入不同人工晶状体术后黄斑区视网膜厚度的变化

目的 研究高度近视合并白内障植入不同后房型人工晶状体对眼底黄斑结构的影响。方法 对高度近视合并白内障患者68例(78眼)施行白内障超声乳化吸出联合人工晶状体植入术,根据植入的人工晶状体不同分为三组:Bigbag组28眼、MA60MA组26眼和PMMA组24眼。观察患者术后1周、1个月、3个月的最佳矫正视力,术后第1周、1个月、3个月黄斑厚度的变化及术后并发症等指标。结果 所有手术眼术后矫正视力(best-corrected visual acuity, BCVA)均有不同程度提高,Bigbag组术后1周、1个月黄斑厚度显著小于MA60MA组和PMMA组,组间比较差异均有统计学意义(P<0.05),术后3个月时三组黄斑厚度与术前比较没有明显差异(P>0.05),术后均未见严重并发症。结论 超声乳化吸出联合针对近视眼设计的人工晶状体植入术可以有效改善高度近视白内障患者的视力,对后囊膜起到稳定的支撑作用,有利于眼内轴向空间结构的稳定,减轻手术对眼后段的影响。     

Ex-PRESS引流器植入术治疗青光眼的临床观察

目的 研究Ex-PRESS引流器植入术对青光眼患者眼内压和角膜内皮细胞数的影响。 方法 选取收治的62例青光眼患者,对照组患者31例(33眼),行复合式小梁切除术;研究组患者31例(35眼),行Ex-PRESS引流器植入术。 结果 研究组患者手术总成功率(88.57%)较对照组(66.67%),差异有统计学意义(P<0.05);术后6个月,研究组患者视力改善情况优于对照组,且研究组患者视力提高比例(85.71%)高于对照组(60.61%),差异具有统计学意义(P<0.05);与术前相比,两组患者术后眼压均下降(P<0.05),且术后1、3、6个月研究组患者的眼压低于对照组(P<0.05);术后1、3、6个月两组患者的角膜内皮细胞数较术前均下降(P<0.05),两组患者间角膜内皮细胞数比较差异无统计学意义(P>0.05);研究组患者并发症发生率(17.14%)低于对照组(45.45%),差异有统计学意义(P<0.05)。 结论 Ex-PRESS引流器植入术对青光眼患者的角膜内皮细胞数的影响与复合式小梁切除术相当,远期降眼压效果优于小梁切除术。     

微创人工耳蜗植入术及常规人工耳蜗植入术临床比较

目的通过微创人工耳蜗植入术与常规人工耳蜗植入术的临床效果比较,探讨微创人工耳蜗植入术的临床优势。方法回顾性分析121例人工耳蜗植入患者,根据人工耳蜗植入术式的不同分为微创人工耳蜗植入术组(微创组)及常规人工耳蜗植入术组(常规组),比较两组患者的手术时间、电极植入情况、手术切口及并发症的不同,分析两种术式之间的特点。结果 121例人工耳蜗电极均全植入鼓阶,成功率100%。微创组与常规组的平均手术总时间分别为89.53±12.42分钟、92.30±14.16分钟,电极植入平均用时分别为112.16±16.01秒、117.05±26.90秒,平均电极植入次数分别为1.07±0.26次、1.22±0.49次。两组的手术总时间无明显差别(P>0.05),电极植入用时亦无明显差别(P>0.05),微创组平均电极植入次数较常规组少(P<0.05)。微创组及常规组的手术切口长度分别为2.53±0.12cm、8.30±0.56cm,微创组的手术切口长度明显小于常规组(P<0.05)。微创组术后未发现皮下血肿及感染,常规组术后出现皮下血肿3例(4.76%),微创组术后皮下血肿率与常规组比较无明显变化(P>0.05)。微创组和常规组的术后眩晕出现率分别为5.88%、21.83%,微创组术后眩晕率低于常规组术后眩晕率(P<0.05)。结论与常规人工耳蜗植入术相比较,微创人工耳蜗植入术在手术时间不增加的前提下,可确保电极位于鼓阶,并具有外形美观,手术切口小,术中创伤小,术后并发症少等优点。     

人工耳蜗植入术295例语言康复临床分析

目的 研究耳蜗植入术后听觉言语康复效果及其影响因素。 方法 采用听觉行为分级(CAP)、言语可懂度分级(SIR)及视频和录音言语清晰度分析法分别对295例人工耳蜗植入术后患者进行听觉言语康复效果评估。 结果 2例蜗神经细小合并内耳畸形患者开机听阈为45 dB,其余听阈为25~40 dB。单因素分析结果显示:术前助听器的佩戴、植入年龄、植入后时间、术前残余听力、内耳畸形程度、脑白质病变对CAP及SIR差异有统计学意义;手术方法、中耳炎、Waardenburg综合征对CAP、SIR差异无统计学意义。多因素Logistic回归分析结果显示:植入后时间、脑白质病变与CAP、SIR显著相关。 结论 大部分患者可从人工耳蜗植入术中获得满意效果,其听觉言语康复程度受多种因素的影响。     

人工耳蜗植入后对侧耳是否联合使用助听器声调识别的对比研究

目的 探讨人工耳蜗植入后对侧耳联合使用助听器对声调识别的影响;同时探讨人工耳蜗开机时间、康复训练时间、听障儿童的学习能力等因素对声调识别的影响。 方法 选择3~7岁的人工耳蜗植入儿童27例,采用《言语听觉反应评估》(EARS)中的“封闭式声调测试”作为测试材料,分别单独使用人工耳蜗(CI)和在人工耳蜗对侧耳联合使用助听器(CIHA)在安静和噪声两种环境下进行声调识别的测试,使用SPSS 17.0对测试结果进行统计学分析。 结果 无论在安静环境还是噪声环境下,CIHA的声调测试成绩均优于CI,此优势在噪声环境下更明显;人工耳蜗开机时间、康复训练时间较长者声调测试成绩均优于较短者;听障儿童的希-内学习能力测试结果学习能力DIQ≥100与DIQ<100者声调测试成绩差异无统计学意义。 结论 建议听障儿童人工耳蜗植入后对侧耳联合使用助听器,但助听器需要优化和调整。     

单侧人工耳蜗植入术前后双耳残余听力变化的初步研究

目的 通过观察单侧人工耳蜗植入术后儿童双耳残余听力情况,分析其变化趋势,探讨各种可能的影响因素。 方法 将29例单侧人工耳蜗植入的重度极重度感音神经性耳聋儿童纳入研究,根据术前颞骨CT分为A组(有大前庭导水管综合征)和B组(非大前庭导水管综合征),分别于术前、术后1周、开机时、术后半年定期进行裸耳纯音测听,比较植入耳残余听力保存情况及非植入耳残余听力的变化。 结果 患儿术前双耳均不同程度存在残余听力,术后均定期行纯音测听或行为测听,各频率仍部分存有残余听力,主要分布在低频区,且随频率升高其残余听力保留率逐渐下降,各频率残余听力保留率之间差异有统计学意义(Wald χ2=16.980, P=0.001);植入耳与非植入耳各频率残余听力保留率之间差异有统计学意义(Wald χ2=10.031, P=0.002);术前后各时间节点残余听力保留率之间差异无统计学意义(Wald χ2=3.384, P=0.336); AB两组之间残余听力保留率之间差异无统计学意义(Wald χ2=0.906, P=0.341)。 结论 人工耳蜗植入对植入耳残余听力的保留主要分布在低频区;随着植入时间的延长,残余听力可以基本保持;少部分患儿行单侧植入后对非植入耳残余听力有影响;前庭导水管扩大症患儿行单侧耳蜗植入术后,非植入耳残余听力在短期内可有波动。     

970例人工耳蜗植入患者的术后并发症分析

目的 分析人工耳蜗植入术后并发症发生的特点,为预防及处理并发症提供临床经验及参考。方法 回顾2013年11月～2020年11月970例在四川省八一康复中心医院行人工耳蜗植入术患者的临床资料,对其进行分析。结果 85例（8.8%）患者出现术后并发症,6例患者出现2种并发症,其中眩晕26例,急性中耳炎14例、皮下血肿21例、面神经麻痹1例、异位植入2例、皮肤感染7例、植入体装置故障20例。结论 人工耳蜗植入术后并发症并不高,远期并发症主要为植入体装置故障,积极处理术后并发症,大部分保守治疗可痊愈。     

客观视觉质量分析系统测量人工晶体伪调节力的临床研究

目的 运用双通道视觉质量分析系统(OQAS)测量白内障患者人工晶体植入术后的伪调节力, 并与传统的主观检测手段进行对比, 比较三种方法的差异性和一致性。方法 于济南第二人民医院眼科门诊随机选择30例(30眼)年龄相关性白内障患者, 手术植入同类型两袢单焦点非球面人工晶体, 术后1个月用OQAS检查、离焦法、推进法测量每位白内障患者人工晶体植入术后的伪调节力。结果 OQAS检查、离焦法、推进法测得的人工晶体伪调节力平均值分别为2.34D、2.5D和2.93D;OQAS检查与离焦法差异无统计学意义, OQAS检查与推进法的测量值差异有统计学意义(P<0.05)。结论 OQAS检查测量的伪调节力相对较小, 其测量结果与离焦法所测结果数值相近。     

耳大神经阻滞对人工耳蜗植入术后患儿苏醒期谵妄的影响

目的 评价耳大神经阻滞对七氟烷全麻人工耳蜗植入术患儿苏醒期谵妄(ED)的影响。 方法 择期七氟烷全麻下单侧人工耳蜗植入术患儿80例,0~6岁,ASA分级Ⅰ~Ⅱ级。采用随机数字表法分为耳大神经阻滞组(A组)和对照组(B组)。麻醉诱导后,A组在超声引导下耳大神经周围注入0.2%罗哌卡因1 mL,B组在切口周围注射2%利多卡因2 mL。七氟烷维持麻醉。术后使用儿童麻醉苏醒期谵妄量表(PAED)评估ED发生率,使用面部、腿部、活动、哭泣和安慰程度量表(FLACC)评估术后疼痛。PAED≥13分或FLACC≥4分者,给予芬太尼0.5 μg/kg静脉注射。记录患儿七氟烷平均用药浓度、ED持续时间、拔管时间、麻醉后恢复室(PACU)停留时间、芬太尼总用药量、护士满意度评分和术后24 h内不良反应发生率。 结果 与B组比较,A组ED发生率(P=0.036)和PAED(P=0.024)评分降低,FLACC评分(P=0.008)和FLACC≥4分的比率(P=0.006)降低,芬太尼补救镇痛率(P=0.011)降低,PACU停留时间(P=0.040)缩短,护士满意度(P=0.021)得到改善(P均<0.05),PAED≥13分的比率(P=0.289)、ED持续时间(P=0.962)、拔管时间(P=0.913)和术后不良反应发生率(P呕吐=0.737;P呛咳=0.487;P低氧=1.000)差异无统计学意义(P均>0.05)。 结论 耳大神经阻滞能降低七氟烷全麻人工耳蜗植入术后儿童苏醒期谵妄的发生率、减轻术后疼痛且不增加术后不良反应发生率。     

Complications of cochlear implant surgery in children and adults

BACKGROUND: In a retrospective analysis we evaluated the complication rate in 697 patients after cochlear implantation between 1985 and 1995 (366 children, 331 adults; 604 Nucleus, 50 Clarion and 42 other implants). RESULTS: Intraoperatively in 74 cases (10.6%) total or partial cochlear obliteration was found, a CSF gusher occurred in 7 cases. Minor complications such as seroma (8 adults), wound infections (14 patients), emphysema, and swelling were successfully treated with conservative methods and drugs. Seven (2.1%) adults showed facial nerve palsy postoperatively with incomplete recovery only in 2 of them (0.6%). No permanent facial nerve palsy was observed in children. Cholesteatoma developed in 18 adults (5.4%), which was treated by revision surgery. CONCLUSIONS: In conclusion, cochlear implant surgery is a safe procedure with a low complication rate. However, Cochlear implantation should be performed by well experienced ear surgeons who can properly handle intraoperative and postoperative problems. The patients should be informed about the typical risks of ear surgery including implant removal due to infection or technical defects, facial nerve palsy, vertigo and, especially in adults, increased tinnitus.     

Long-term complications after cochlear implantation

Objective

Cochlear implantation has become an effective treatment for many profoundly deaf patients. As with any surgical procedure, a proportion of patients suffer postoperative complications. The aim of this study was to analyze long-term postoperative complications in patients with cochlear implants with a view to improve clinical interventions and propose a consensus for reporting complications.

Methods

A total of 406 cases received cochlear implants between December 1985 and April 2007 at Tokyo Medical University (TMU) Hospital. We retrospectively reviewed case notes from 366 patients who had undergone cochlear implantation (215 adults and 151 children) after excluding 40 patients of re-implantation including 13 cases implanted initially at other hospitals. Life-threatening, major and minor complications were examined retrospectively.

Results

Major complications occurred following cochlear implantation in 32 patients (8.7%) who had received their initial implant at TMU Hospital. Revision surgery was required for 30 patients. The mean age at implantation was 33 years 6 months (range, 1 year 9 months to 83 years; median, 37 years). The main etiology of deafness was unknown or progressive (113, 52.6%) in adults and congenital (132, 87.4%) in children. The cause of deafness was meningitis in 41 cases (11.2%), and 26 cases (7.1%) were diagnosed with idiopathic sudden deafness.Flap-related problems (including middle ear infection and/or flap necrosis) developed in 13 cases (3.6%), with 12 cases (7 adults, 5 children) requiring re-implantation. Electrode slip-out occurred in 8 patients (7 adults, 1 child). All adult cases in whom electrodes slipped out underwent implantation before 1994, while the child (1 pediatric case) was operated in 2003. All cases required re-implantation and most cochlear implantations were performed using the modified split-bridge technique after 1997. Six patients (4 adults, 2 children) experienced device failure. Four patients experienced electrode problems. Non-surgical major complications included 1 patient with permanent facial nerve paralysis as a result of thermal injury in 1995.The total number of minor medical and surgical complications was 27, representing 7.4% of all operations.

Conclusion

Many cases of major complications, including electrode problems and facial paralysis, excluding traumatic device failure were considered avoidable by strict operative and postoperative procedures. Some cases of flap infection and traumatic device failure may not be able to be avoided completely, and every possible care should be taken by implant patients and others involved.     

Cochlear implant complications in 403 patients: Comparative study of adults and children and review of the literature

ObjectivesThe purpose of this study was to assess the postoperative complications related to cochlear implants and to discuss the differences observed between adult and paediatric populations. Cochlear implant complications were defined as any pathological events observed during the postoperative period, whether or not they were directly related to the surgical technique. We therefore recorded all complications, in the broad sense of the term, ranging from acute otitis media to cochlear explantation.Study designRetrospective analysis of cochlear implant patients.Material and methodsAll surgical procedures (unilateral or bilateral cochlear implantation, revision surgery) performed in our institution between March 1993 and January 2013 were reviewed. This population comprised 168 adults (median age at the time of implantation: 51.9 years), and 235 children (median age at the time of implantation: 4.5 years). All postoperative complications were classified as either major (requiring surgical revision or hospital management) or minor (requiring conservative management).ResultsThe global complication rate was 19.9% (80/403 cases), comprising 5% of major complications (20 cases) and 14.9% of minor complications (60 cases). This complication rate was significantly higher in the adult population (P = 0.004).ConclusionCochlear implantation is a safe hearing rehabilitation surgical technique associated with a low complication rate. However, surgeons must be familiar with these complications in order to ensure optimal prevention. Minor complications were mainly infectious in children (acute otitis media) and cochleovestibular in adults (tinnitus and vertigo). Major complications were mostly reimplantation following revision surgery or device failure. Only the minor complication rate was significantly higher in the adult population.     

Intracranial complications of cochlear implantation.

OBJECTIVE: To describe intracranial complications after cochlear implantation in the pediatric and adult populations. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: A chart review of the intracranial complications and their management in 345 patients undergoing cochlear implantation was undertaken. INTERVENTIONS: Variables, including age, sex, implant manufacturer, cause of deafness, intraoperative findings, and postoperative complications, were collected and analyzed. MAIN OUTCOME MEASURE: Presence of intracranial complication of cochlear implantation. RESULTS: There were 134 Nucleus-22 (Cochlear, Englewood, CO) devices, 50 Nucleus-24 devices, 118 Med-El (Durham, NC) devices, and 43 Advanced Bionics Corporation (Sylmar, CA) devices in 151 adults and 194 children. There was a 9.3% overall complication rate, with most (59%) being related to device failure. There were three intracranial complications (<1%), two in elderly individuals and one in a child. Two minor dural defects with cerebrospinal fluid leak at the site of the receiver/stimulator recess in Med-El devices were repaired intraoperatively with temporalis fascia. One elderly patient experienced an acute extensive subdural hematoma after Nucleus-24 implantation, which was treated successfully with immediate evacuation. CONCLUSION: Intracranial complication rates associated with cochlear implantation are low, although potentially very serious. Surgeons should be aware of intracranial complications, especially in older individuals, and take immediate appropriate action.     

Surgical considerations in cochlear implantation in children and adults: a review of 342 cases in Vienna

CONCLUSIONS: Our data represent the experience of the largest cochlear implant program in Austria. In conclusion, cochlear implantation is a safe procedure, associated with a low rate of intra- and postoperative complications. Nevertheless, patients should be informed about possible problems and especially about the risk of a reoperation due to device failure. OBJECTIVES: To evaluate the cause of deafness, the intraoperative findings and the complication rate for all cochlear implant operations performed consecutively between 1994 and 2003 at Vienna General Hospital. MATERIAL AND METHODS: Including all surgeries for bilateral implantation and revision, a series of 342 operations performed on 164 adults (age range 14.5-81 years; mean age 50.79 years) and 128 children (age range 0.75-14 years; mean age 5.00 years) was retrospectively analyzed. RESULTS: The etiology of deafness was predominantly congenital or progressive (66.89%). The routine mastoidectomy approach was chosen in 300 patients (87.72%) and the suprameatal approach in 42 (12.28%). Intraoperatively, 4 children (2.53%) had a cerebrospinal fluid fistula and 35 patients (10.23%) showed cochlear ossification. Three adults (1.63%) and two children (1.27%) had facial nerves with an aberrant course. The overall complication rate was 12.2%, the rate of major complications was 4.97% and the rate of minor complications was 4.09%. There were no cases of either postoperative meningitis or facial nerve palsy. Both flap necrosis and electrode dislocation occurred in one adult patient (0.54%), but in none of the children. Formation of cholesteatoma was found in one adult (0.54%) and one child (0.63%). The rate of device failure was 7.07% for adults and 13.92% for children.     

Vestibular dysfunction after cochlear implantation: a national multicenter clinical study

Vertigo and dizziness are the most common complications of cochlear implantation. Data of a multicentric study about clinical aspects and cost utility were collected for vertigo and dizziness: incidence, clinical and treatment were analyzed among 469 adults and children. Results demonstrated that 16% of adults and 3% of children experienced dizziness postoperatively. In a few cases a specific mechanism as perilymphatic fistula was identified. In other cases the mechanism underlying delayed vertigo remains speculative and endolymphatic hydrops was suggested.     

基于品管圈出院计划管理对耳畸形再造术后康复的影响

目的 探讨基于品管圈出院计划管理对耳畸形再造术后患者康复的影响。 方法 选择于哈尔滨医科大学附属第一医院行耳畸形再造术的先天性小耳畸形患者107例,根据护理方法的不同分为观察组57例与对照组50例,两组均于全麻下行耳畸形再造术,对照组术后给予常规出院计划管理,观察组给予基于品管圈的出院计划管理,记录两组术后康复情况。 结果 术后3个月观察组与对照组再造耳郭优良率分别为100%(57/57)、88.0%(44/50),观察组再造耳郭优良率高于对照组(χ2=7.246, P=0.007)。观察组与对照组并发症发生率分别为3.5%(2/57)、20.0%(10/50),观察组并发症发生率低于对照组(χ2=7.275, P=0.007)。观察组与对照组术后3个月疼痛评分分别为(0.76±0.22)、(1.72±0.44)分,两组比较差异有统计学意义(t=9.133, P<0.001)。观察组与对照组术后3个月睡眠评分分别为(6.49±2.85)、(9.19±3.11)分,两组比较差异有统计学意义(t=5.922, P=0.014)。相较于对照组,观察组圈员解决问题能力、自信心、积极性、责任心等均明显提高,可运用品管圈活动解决工作中存在的问题。 结论 基于品管圈的出院计划管理能促进耳畸形再造术后患者的康复,减少并发症的发生,改善患者的疼痛与睡眠障碍症状,提高护理质量。     

Vestibular symptoms in children with enlarged vestibular aqueduct anomaly

OBJECTIVE: The objective of this study is to describe the vestibular symptoms in pediatric patients with enlarged vestibular aqueduct (EVA) anomaly. METHODS: Retrospective chart review of pediatric and adult patients with EVA anomaly who were treated at the University of Utah Hospital or Primary Children's Medical Center, between 1995 and 2005. Radiographs were reviewed to confirm the diagnosis. Comparisons were made between adult and pediatric patients. RESULTS: Thirty-two patients were included in the study, 17 females and 15 males. Twenty-one patients were under the age of 18 and 11 patients were age 18 or older. On initial audiometric evaluation at a tertiary hospital, the pure tone average in the right ear was 75.0 dB and the pure tone average in the left ear was 80.4 dB. The incidence of vestibular symptoms in adult patients was 45.5% and in pediatric patients was 48.0%. Fourteen patients underwent cochlear implantation. Four patients (28.6%) who previously denied vestibular symptoms experienced post-operative vertigo after cochlear implantation. CONCLUSIONS: About half of the patients with EVA in our series experienced vestibular symptoms. Pediatric patients in our series experienced vertigo and vestibular symptoms with equal frequency when compared to adult patients. Some patients with EVA undergoing cochlear implantation experienced vestibular symptoms in the post-operative period.     

鼓膜微管置入术治疗中耳不张76例临床分析

目的 分析鼓膜微管置入术治疗中耳不张的临床疗效。 方法 选取76例中耳不张患者,根据Dornhffer的综合分析法分级分为两组各38例,A组为Ⅰ、Ⅱ级中耳不张患者,B组为Ⅲ、Ⅳ级中耳不张患者,对比两组术前、术后1周、1个月、6个月纯音听阈测听及声导抗结果,比较两组的治疗效果,观察并发症发生情况和复发情况。 结果 两组在术前和经过鼓膜微管置入术治疗后1周、1个月、6个月的纯音听阈测听结果变化趋势存在统计学差异(P均<0.05)。两组从治疗前到经手术治疗后1周、1个月、6个月的声导抗检查变化趋势均存在统计学差异(P均<0.05)。A组总有效36例(94.74%),B组总有效30例(78.95%),两组总有效率比较,差异有统计学意义(P<0.01)。A组并发症发生0例、复发0例,B组并发症发生2例(5.26%)、复发3例(7.89%),两组并发症发生率及复发率比较,差异有统计学意义(P均<0.05)。 结论 鼓膜微管置入术对Ⅰ、Ⅱ级中耳不张患者临床效果较好,能有效降低并发症发生率及复发率。