Polak Marek, Ulubil S Arif, Hodges Annelle V, Balkany Thomas J
University of Miami Ear Institute, Miami, FL, USA.
Arch Otolaryngol Head Neck Surg. 2006 Apr;132(4):398-404. doi: 10.1001/archotol.132.4.398.
To find if patients experiencing postsurgical facial nerve stimulation caused by underlying disease process (ie, otosclerosis) can improve their hearing performance with their cochlear implant by reimplantation and by an optimal programming strategy.
Retrospective analysis.
Academic tertiary referral center.
Two cochlear otosclerosis patients with resistant facial nerve stimulation (FNS). Both patients were initially implanted with Nucleus 22 devices (Cochlear Corporation, Englewood, Colo) and they developed FNS after a period of use. Owing to the decreasing number of active electrodes, concurrent decreases in speech understanding occurred.
Various programming approaches were used to address the FNS. Both subjects ultimately received Nucleus 24 devices. One was reimplanted in the same ear, and the other was implanted in the opposite ear. Both have been followed up for 8 months following the reimplantation.
Cochlear implant programming levels, cochlear implant performance, and facial nerve stimulation.
The FNS was managed for more than 3 years through optimized programming. However, the FNS progressed until performance dropped below acceptable levels. Reimplantation was believed to be the only option for improvement. After reimplantation and programming, both subjects showed immediate improvement in speech discrimination. One user increased his consonant-nucleus-consonant word score from 12% preoperatively to 42%, and the other's performance increased from 0% to 86%.
Our results suggest that having more programming options with newer devices is critical in otosclerotic or ossified users who experience FNS. Also, reimplantation may be a useful tool to improve performance.
探究因潜在疾病进程（如耳硬化症）而经历术后面神经刺激的患者，能否通过重新植入和优化编程策略来提高其人工耳蜗的听力表现。
回顾性分析。
学术性三级转诊中心。
两名患有顽固性面神经刺激（FNS）的人工耳蜗植入耳硬化症患者。两名患者最初均植入了Nucleus 22装置（科利耳公司，科罗拉多州恩格尔伍德），使用一段时间后出现了FNS。由于有效电极数量减少，言语理解能力也随之下降。
采用多种编程方法来解决FNS问题。两名受试者最终均接受了Nucleus 24装置。其中一名在同一耳进行了重新植入，另一名则植入了对侧耳。重新植入后，两名患者均接受了8个月的随访。
人工耳蜗编程水平、人工耳蜗性能及面神经刺激情况。
通过优化编程，FNS得到了3年多的控制。然而，FNS仍在进展，直至性能降至可接受水平以下。重新植入被认为是改善的唯一选择。重新植入和编程后，两名受试者的言语辨别能力均立即得到改善。一名使用者的辅音-元音-辅音单词得分从术前的12%提高到了42%，另一名使用者的表现则从0%提高到了86%。
我们的结果表明，对于经历FNS的耳硬化症或骨化患者，使用更新的装置拥有更多编程选项至关重要。此外，重新植入可能是提高性能的有效手段。
