Wootten Christopher T, Backous Douglas D, Haynes David S
Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-8605, USA.
Laryngoscope. 2006 Nov;116(11):2055-9. doi: 10.1097/01.mlg.0000240286.43289.87.
The objectives of this retrospective review were to determine the incidence of cerebrospinal fluid (CSF) otorrhea from the cochleostomy during cochlear implant surgery, to recognize patients at risk, and to determine the appropriate preoperative, postoperative and intraoperative management.
A chart review from two cochlear implant centers was performed to determine the incidence of CSF otorrhea, patients at risk, and appropriate management.
The incidence of CSF gusher is low, encountered in approximately 1% of patients undergoing cochlear implant surgery, and is seen in equal incidence in children and adults in our series. Preoperative imaging was predictive in only 50% of cases. Mechanisms for otorrhea in specific cochlear malformations and in those in which no apparent malformation exists are discussed. Successful implantation is expected in most cases. Intraoperative management may require complete packing of the middle ear space in addition to the cochleostomy to control CSF leak. Lumbar drain is rarely necessary. Outpatient management is possible in the majority of cases. Vaccination and antibiotic prophylaxis is essential.
CSF otorrhea can be encountered in cochlear malformations and in cochleas without apparent malformation. Successful implantation without short-term or long-term complications is expected.
本回顾性研究的目的是确定人工耳蜗植入手术中蜗窗造口导致脑脊液耳漏的发生率，识别有风险的患者，并确定适当的术前、术后及术中管理措施。
对两个人工耳蜗植入中心的病历进行回顾，以确定脑脊液耳漏的发生率、有风险的患者及适当的管理措施。
脑脊液耳漏发生率较低，在接受人工耳蜗植入手术的患者中约1%会出现，在我们的系列研究中，儿童和成人的发生率相同。术前影像学检查仅在50%的病例中具有预测性。讨论了特定耳蜗畸形及无明显畸形情况下耳漏的机制。大多数情况下有望成功植入。术中管理除蜗窗造口外可能还需要完全填塞中耳腔以控制脑脊液漏。很少需要腰大池引流。大多数病例可进行门诊管理。接种疫苗和预防性使用抗生素至关重要。
耳蜗畸形及无明显畸形的耳蜗均可出现脑脊液耳漏。有望成功植入且无短期或长期并发症。
