Luntz M, Teszler C B, Shpak T, Feiglin H, Farah-Sima'an A
Department of Otolaryngology-Head and Neck Surgery, Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Laryngoscope. 2001 Sep;111(9):1614-8. doi: 10.1097/00005537-200109000-00023.
To evaluate and compare the timing of surgery, intraoperative findings, and otitis media-related outcome of cochlear implantation in children who are otitis-prone with their counterparts who are not otitis-prone.
Prospective.
Children referred for cochlear implantation were assigned to a non-otitis-prone group (group A: normal otoscopy on their first visit after referral) or an otitis-prone group (group B: current or a recent history of otitis media at referral). Group B patients were managed using a structured protocol aimed at preimplantation otitis media control. The study reviewed pre-, intra-, and postoperative data.
Of the 18 children studied, 8 were assigned to group A (mean age at referral, 40.6 mo) and 10 to group B (mean age at referral, 31.6 mo). For otitis media control, all otitis-prone children underwent ventilating tube insertion (various numbers of procedures before implantation). Only one otitis-prone child required cortical mastoidectomy also. Time from referral to implantation was similar in the two groups (mean, 6.6 mo). High-resolution computed tomography data showed mastoid pneumatization to be significantly smaller in the otitis-prone group, but the facial recess was not smaller in this group. During implantation, 10 children had inflamed middle ear mucosa. Seven of these belonged to group B. All of these seven children had a round window niche obliterated by the inflamed mucosa, which had to be removed for round window membrane identification. After implantation, only one child had drainage through the ventilating tube for more than 1 week. Two children in group B developed otitis media (1 year postimplantation) that was overcome within 1 week. There were no otitis media-related complications.
If a structured protocol is used for the control of otitis media before cochlear implantation, otitis media should not require a delay in implantation. In otitis media-prone children, the round window niche is often obscured by inflamed mucosa. Its removal is mandatory for identification of the round window membrane. After cochlear implantation, otitis media is not a frequent occurrence.
评估并比较易患中耳炎儿童与不易患中耳炎儿童人工耳蜗植入的手术时机、术中发现以及与中耳炎相关的结果。
前瞻性研究。
将转诊接受人工耳蜗植入的儿童分为不易患中耳炎组（A组：转诊后首次就诊时耳镜检查正常）和易患中耳炎组（B组：转诊时患有或近期有中耳炎病史）。B组患者采用旨在控制植入前中耳炎的结构化方案进行管理。该研究回顾了术前、术中和术后数据。
在研究的18名儿童中，8名被分配到A组（转诊时平均年龄40.6个月），10名被分配到B组（转诊时平均年龄31.6个月）。为控制中耳炎，所有易患中耳炎的儿童均接受了通气管插入术（植入前进行了不同次数的手术）。只有一名易患中耳炎的儿童还需要进行皮质乳突切除术。两组从转诊到植入的时间相似（平均6.6个月）。高分辨率计算机断层扫描数据显示，易患中耳炎组的乳突气化明显较小，但该组的面神经隐窝并不小。植入过程中，10名儿童的中耳黏膜有炎症。其中7名属于B组。这7名儿童的圆窗龛均被炎性黏膜闭塞，为识别圆窗膜必须将其去除。植入后，只有一名儿童通过通气管引流超过1周。B组有两名儿童（植入后1年）患中耳炎，在1周内痊愈。没有与中耳炎相关的并发症。
如果在人工耳蜗植入前采用结构化方案控制中耳炎，则中耳炎不应导致植入延迟。在易患中耳炎的儿童中，圆窗龛常被炎性黏膜遮盖。为识别圆窗膜必须将其去除。人工耳蜗植入后，中耳炎并不常见。
