Alexiades G, Roland J T, Fishman A J, Shapiro W, Waltzman S B, Cohen N L
Department of Otolaryngology, New York University School of Medicine, New York, NY, USA.
Laryngoscope. 2001 Sep;111(9):1608-13. doi: 10.1097/00005537-200109000-00022.
OBJECTIVES/HYPOTHESIS: The most common indication for cochlear reimplantation is device failure. Other, less frequent indications consist of "upgrades" (e.g., single to multichannel), infection, and flap breakdown. Although the percentage of failures has decreased over time, an occasional patient requires reimplantation because of device malfunction. The varying designs of internal receiver/stimulators and electrode arrays mandate an examination of the nature and effects of reimplantation for the individual designs. The purpose of the current study was to investigate the reimplantation of several implant designs and to determine whether differences in surgical technique, anatomical findings, and postoperative performance exist.
Retrospective chart review.
The subjects were 33 of 618 severely to profoundly deaf adults and children who had implantation at the New York University Medical Center (New York, NY) between February 1984 and December 2000. The subjects had previously had implantation with either a single-channel 3M/House (House Ear Institute, Los Angeles, CA) or 3M/Vienna (Technical University of Vienna, Vienna, Austria) device or with one of the multichannel Clarion (Advanced Bionics, Sylmar, CA), Ineraid (Smith & Nephew Richards, TN), or Nucleus (including the Contour) devices (Cochlear Corp., Englewood, CO) before reimplantation.
Length of use before reimplantation ranged from 1 month to 13 years and included traumatic and atraumatic (electronic) failures, as well as device extrusion or infection. Results indicated that postoperative performance was either equal to or better than scores before failure. None of the devices explanted caused damage that precluded the implantation of the same or an upgraded device. These findings support the efficacy and safety of internal implant designs as related to the maintenance of a functional cochlea for the purpose of reimplantation.
Cochlear reimplantation can be performed safely and without decrement to performance. The number of implanted electrodes at reinsertion were either the same or greater in all cases.
目的/假设：人工耳蜗再次植入最常见的指征是设备故障。其他不太常见的指征包括“升级”（如单通道升级为多通道）、感染和皮瓣坏死。尽管随着时间推移，故障百分比有所下降，但仍有偶尔的患者因设备故障需要再次植入。内部接收器/刺激器和电极阵列的设计各不相同，因此需要针对个别设计检查再次植入的性质和影响。本研究的目的是调查几种植入设计的再次植入情况，并确定手术技术、解剖学发现和术后表现是否存在差异。
回顾性病历审查。
研究对象为1984年2月至2000年12月期间在纽约大学医学中心（纽约州纽约市）接受植入手术的618名重度至极重度聋成年和儿童中的33例。这些研究对象在再次植入前曾植入过单通道3M/House（加利福尼亚州洛杉矶市豪斯耳科研究所）或3M/维也纳（奥地利维也纳技术大学）设备，或多通道Clarion（加利福尼亚州西尔玛市先进生物科技公司）、Ineraid（田纳西州史密斯&奈普理查兹公司）或Nucleus（包括Contour）设备（科利耳公司，科罗拉多州恩格尔伍德市）中的一种。
再次植入前的使用时长从1个月至13年不等，包括创伤性和非创伤性（电子）故障以及设备外露或感染。结果表明，术后表现等于或优于故障前的得分。所有取出的设备均未造成妨碍再次植入相同或升级设备的损伤。这些发现支持了内部植入设计在为再次植入而维持功能性耳蜗方面的有效性和安全性。
人工耳蜗再次植入可以安全进行，且不会降低性能。所有病例中再次植入时的植入电极数量相同或更多。
