Qiu Shengyang, Gray Roger F, Kumar Sanjiv, Axon Patrick
Department of Ear Nose and Throat Surgery, Addenbrookes Hospital, UK.
Cochlear Implants Int. 2012 Aug;13(3):188-92. doi: 10.1179/146701011X12962268235788. Epub 2011 Jun 29.
Scalp pneumocoele is a rare complication of cochlear implantation surgery. We present the largest case series to date; consisting of four cases over 8 years from one centre. The presentation, diagnosis, and management of each case are reviewed. Previously unreported complications of pneumocoeles are highlighted.
Three of our four cases, consisting of two adults (aged 53 and 81 years) and one child (aged 26 months), developed scalp pneumocoeles within the first 3 months of implantation. Another child (aged 10) developed pneumocoele 7 years after surgery. The common diagnostic features include a soft, non-tender, fluctuant swelling over the receiver/stimulator package. In all cases, pneumocoeles were triggered by Valsalva's or Toynbee's manoeuvres. Complications include infection (case one) and reduction in cochlear implant (CI) function (cases three and four), secondary to displacement of the receiver/stimulator package or electrode displacement.
INTERVENTION/TECHNIQUE: Diagnosis is made from clinical history and examination. Aspiration results in reduction of pneumocoeles. This is not necessary for smaller pneumocoeles as they may resolve spontaneously. Additional investigations may reveal complications of pneumocoeles, such as X-rays for implant displacement, and inflammatory marker to detect signs of infection. To prevent the recurrence of pneumocoeles, patients are advised to avoid Valsalva's or Toynbee's manoeuvres. There were no recurrences of pneumocoeles.
Post-cochlear implantation pneumocoeles can be associated with harmful complications such as infection and CI dysfunction. The mechanism of pneumocoele formation is discussed, and strategies for its prevention are examined.
头皮气囊肿是人工耳蜗植入手术的一种罕见并发症。我们呈现了迄今为止最大的病例系列；由一个中心在8年期间的4例病例组成。对每个病例的临床表现、诊断及处理进行了回顾。强调了此前未报告的气囊肿并发症。
我们的4例病例中，3例包括2名成年人（年龄分别为53岁和81岁）及1名儿童（年龄为26个月），在植入后的前3个月内出现了头皮气囊肿。另一名儿童（年龄为10岁）在手术后7年出现气囊肿。常见的诊断特征包括接收器/刺激器包上方柔软、无压痛、波动感的肿胀。在所有病例中，气囊肿均由瓦尔萨尔瓦动作或图因比动作诱发。并发症包括感染（病例一）以及人工耳蜗（CI）功能减退（病例三及病例四），继发于接收器/刺激器包移位或电极移位。
干预/技术：根据临床病史和检查进行诊断。抽吸可使气囊肿缩小。对于较小的气囊肿无需进行抽吸，因为它们可能会自行消退。进一步检查可能会发现气囊肿的并发症，如用于检查植入物移位的X线检查，以及用于检测感染迹象的炎症标志物。为防止气囊肿复发，建议患者避免瓦尔萨尔瓦动作或图因比动作。气囊肿未复发。
人工耳蜗植入术后气囊肿可能与感染和CI功能障碍等有害并发症相关。讨论了气囊肿形成的机制，并研究了其预防策略。
