Orús Dotú César, Venegas Pizarro María del Prado, De Juan Beltrán Julia, De Juan Delago Manolo
Sección de Otología, Servicio de ORL, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
Acta Otorrinolaringol Esp. 2010 Mar-Apr;61(2):106-17. doi: 10.1016/j.otorri.2009.10.014. Epub 2010 Feb 6.
Cochlear implants are, for many reasons, expirable electronic devices and occasionally may have to be replaced. The surgical cochlear reimplantation technique is not substantially different from the initial implantation but does have some peculiarities. These peculiarities are analyzed in this paper not only from the point of view of surgical technique but also with respect to the complications involved and the functional auditive outcome obtained.
An accurate description of the surgical findings, peculiarities of the surgical technique and complications found during the process of cochlear reimplantation. An evaluation of the audiometric functional outcome of the reimplantation.
A descriptive retrospective review of 34 reimplantations in the same ear, carried out at our department during the period between 1993 and 2008, in 27 patients in a tertiary hospital by the same team of seniors surgeons. The cochlear implants replaced were 2 Ineraid (Smith & Nephew Richards, TN), 23 Laura (Philips Hearing Implants), 8 nucleus 24K (Cochlear Corp., Englewood, CO), 1 Clarion (r) (Advanced Bionics, Sylmar, CA).
The rate of reimplantation in the same ear was 18.5% per patient. The most frequent reason in our series was internal failure of the device (14 cases). Other causes were substitution for a technological update (7 cases), misplacement of electrodes (8 cases), necrosis/infection of the skin flap with exposure of the implant (3 cases) and external injuries (2 cases). The most important surgical findings were partial mastoidectomy reossification, absence of ossification in the posterior tympanostomy and the permeability of the basal turn of the cochlea when it housed the electrodes. A complete reintroduction of the electrodes was achieved in 25 patients and a partial one in 2 patients. The rate of complications generated was similar in reimplantation and in virgin ear implantation, except for when the original implant was an Ineraid device.
The surgical technique of reimplantation and multireimplantation technique has characteristic peculiarities at each step, but in general terms, its complexity is similar to that of implantation in virgin ears and the rate of complications is also similar. The introduction of the new electrodes is simple and complete in the immense majority of cases, given that the cochlea remains permeable, as long as it houses the electrodes; otherwise it tends to become reossified. The functional auditory outcome of the new implant is in relation with its capacities. If they are equal to those of the initial implant then the auditory outcome will be similar and if they are better, then so will the outcome be, with the exception of ears with long periods of auditive deprivation.
由于多种原因，人工耳蜗是有使用期限的电子设备，偶尔需要更换。再次植入耳蜗的外科技术与初次植入并无本质区别，但确实有一些特殊之处。本文不仅从外科技术的角度，还从相关并发症及所获得的听觉功能结果方面对这些特殊之处进行了分析。
准确描述再次植入耳蜗过程中的手术发现、手术技术特点及并发症。评估再次植入后的听力功能结果。
对1993年至2008年期间在一家三级医院由同一组资深外科医生为27例患者进行的同一耳34次再次植入手术进行描述性回顾研究。所更换的人工耳蜗有2个Ineraid（史赛克耳鼻喉，田纳西州）、23个Laura（飞利浦听力植入公司）、8个Nucleus 24K（科利耳公司，科罗拉多州恩格尔伍德）、1个Clarion（先进生物科技公司，加利福尼亚州西尔玛）。
同一耳的再次植入率为每位患者18.5%。在我们的系列病例中，最常见的原因是设备内部故障（14例）。其他原因包括因技术更新而更换（7例）、电极位置不当（8例）、皮瓣坏死/感染伴植入物外露（3例）和外伤（2例）。最重要的手术发现是部分乳突切除术再骨化、后鼓室造口术无骨化以及耳蜗基底转在容纳电极时的通透性。25例患者实现了电极完全重新植入，2例患者部分重新植入。再次植入时产生的并发症发生率与初次植入时相似，但原植入物为Ineraid设备时除外。
再次植入和多次再次植入技术在每个步骤都有其独特的特点，但总体而言，其复杂性与初次植入相似，并发症发生率也相似。在绝大多数情况下，只要耳蜗在容纳电极时保持通透，新电极的植入就简单且完整；否则它往往会重新骨化。新植入物的听觉功能结果与其性能相关。如果其性能与初次植入物相同，那么听觉结果将相似；如果性能更好，那么结果也会更好，但长期听力剥夺的耳朵除外。
