Pasanisi E, Bacciu A, Vincenti V, Guida M, Barbot A, Berghenti M T, Bacciu S
Dipartimento di Scienze Otorino-Odonto-Oftalmologiche e Cervico-Facciali, Sezione di Otorinolaringoiatria e Microchirurgia Otologica e Otoneurologica, Università di Parma.
Acta Otorhinolaryngol Ital. 2002 Jun;22(3):127-34.
Cochlear ossification, considered until only a few years ago as a contraindication for cochlear implants (C.I.), may now be managed by means of a wide variety of surgical techniques. In cases with massive ossification, the drill-out circummodiolar technique described by Gantz et al. in 1988 and successively modified by Balkany et al. in 1997 may be adopted. The technique of electrode insertion in the scala vestibuli, perfected by Steenerson et al. in 1990, may be used when cochlear ossification has spread no further than the scala tympani. Other methods call for a groove to be drilled along the proximal tip of the basal turn of the cochlea (Cohen and Waltzman, 1993), the insertion of electrodes through the middle cranial fossa (Colletti et al., 2000), or the utilization of a double electrode array (Bredberg et al., 1997, Lenarz et al., 2001). This study reports the experience conducted at the Cochlear Implants Centre of the Otorhinolaryngoiatrics, Otological and Otoneurological Microsurgery Section of the University of Parma in a group of 15 patients who underwent C.I. in the presence of varying degrees of ossification. In 3 cases the ossification was limited to the region of the round window and a few millimetres of the scala tympani; cochleostomy was performed anteriorly and inferiorly to the anterior niche of the round window. In 11 cases (of which 3 of pediatric age), the ossification had spread to the horizontal portion of the scala tympani; in these cases, the electrodes were inserted in the scala vestibuli. The scala vestibuli was opened by drilling anteriorly to the round window and superiorly to the spiral ligament. In the only case of massively ossified cochlea, it was possible to partially insert the electrodes in a circum-modiolar tunnel. In the 12-month follow-up hearing test, the 3 patients with ossification of the round window region and the first millimetres of the scala tympani respectively averaged 61.6% in recognizing 2-syllable words and 59% in recognizing words embedded in phrases. The averages on the 12-month follow-up hearing test in the 8 adult patients who received the implant in the scala vestibuli were 80.6% in recognizing 2-syllable words and 89.1% in recognizing words in phrases. The 3 pediatric patients were classified on the Geers and Moog scale, which situated 2 of them in the 6th category of perception and 1 of them in the 4th category of perception. As regards the only case of massive cochlear ossification, the patient underwent surgery recently, and the sole follow-up available is the one conducted after only 3 months; the vowel identification average was 55%; the average on the VCV test was 31%; and the 2-syllable word recognition average was 20%.
直到几年前，耳蜗骨化还被视为人工耳蜗植入（C.I.）的禁忌证，而如今可通过多种外科技术进行处理。对于骨化严重的病例，可采用1988年甘茨等人描述、并于1997年由巴尔卡尼等人相继改良的磨除环蜗技术。当耳蜗骨化仅蔓延至鼓阶时，可采用1990年斯特内森等人完善的电极插入前庭阶技术。其他方法包括沿耳蜗底转近端尖端钻孔（科恩和瓦尔兹曼，1993年）、经中颅窝插入电极（科莱蒂等人，2000年）或使用双电极阵列（布雷德伯格等人，1997年；莱纳尔兹等人，2001年）。本研究报告了帕尔马大学耳鼻喉科、耳科学和耳神经学显微手术科人工耳蜗植入中心对一组15例存在不同程度骨化的患者进行人工耳蜗植入的经验。3例患者的骨化局限于圆窗区域及鼓阶的几毫米范围；在圆窗前龛的前下方进行了耳蜗造瘘术。11例患者（其中3例为儿童）的骨化已蔓延至鼓阶的水平部分；在这些病例中，电极插入前庭阶。通过在圆窗前方和螺旋韧带上方钻孔打开前庭阶。在唯一一例耳蜗严重骨化的病例中，电极得以部分插入环蜗隧道。在12个月的随访听力测试中，圆窗区域及鼓阶最初几毫米骨化的3例患者识别双音节词的平均正确率为61.6%，识别短语中单词的平均正确率为59%。8例在前庭阶植入人工耳蜗的成年患者在12个月随访听力测试中识别双音节词的平均正确率为80.6%，识别短语中单词的平均正确率为89.1%。3例儿童患者按照吉尔和穆格量表进行分类，其中2例处于第6类感知水平，1例处于第4类感知水平。至于唯一一例耳蜗严重骨化的病例，该患者近期接受了手术，目前仅有的随访是术后3个月的随访；元音识别平均正确率为55%；VCV测试平均正确率为31%；双音节词识别平均正确率为20%。
