Department of Otorhinolaryngology, Goethe University, Frankfurt, Germany.
Otol Neurotol. 2013 Jan;34(1):61-5. doi: 10.1097/MAO.0b013e318277a44e.
The combination of electrical and acoustical hearing (EAS) is the aim of successful hearing preservation in patients with low-frequency residual hearing who receive a cochlear implant. With adequate surgical treatment and electrode arrays designed for hearing preservation, partial hearing preservation can nowadays be achieved in the majority of patients. Over recent years, the number of patients with EAS has increased, and device failures within this group are a problem that will need to be addressed. It remains unclear how reliably hearing can be preserved during revision surgery. The outcome of 3 subjects requiring cochlear reimplantation after surgery for hearing preservation is presented and discussed. Our aim was to investigate the influence of electrode reinsertion on hearing preservation.
Three patients with measurable residual hearing were implanted with a flexible, free-fitting electrode array in 3 different centers.
Two subjects received a 31.5-mm array inserted 24 mm into the cochlea, whereas a third was treated with a 24-mm array, which was inserted 21 mm into the cochlea. In all cases, hearing was preserved at the initial operation. All of these subjects subsequently represented with device problems, and reimplantation was performed.
Hearing preservation was measured using preoperative and postoperative pure tone audiograms. In addition, speech perception with the implant was evaluated before and after reimplantation surgery.
Reimplantation was feasible in all subjects also in cases where a slightly deeper reinsertion was performed. Speech understanding scores after reimplantation were comparable to those seen after the first intervention.
Revision surgery in patients with preserved hearing after cochlear implantation does not necessarily lead to loss of natural residual hearing, and patients can continue to benefit from the combination of electric and acoustic hearing. Even deeper insertion is possible without hearing loss within residual frequencies.
对于低频残余听力患者，通过电声联合（EAS）是成功保留听力的目标，他们需要接受人工耳蜗植入。通过适当的手术治疗和为保留听力而设计的电极阵列，现在大多数患者都可以实现部分听力保留。近年来，接受 EAS 的患者数量有所增加，而该组患者的设备故障是一个需要解决的问题。目前尚不清楚在修复手术中听力能可靠保留多久。本文介绍并讨论了 3 名需要进行耳蜗再植入手术以保留听力的患者的结果。我们的目的是研究电极重新插入对听力保留的影响。
3 名有可测量残余听力的患者在 3 个不同中心植入了灵活的、适配的电极阵列。
2 名患者接受了 31.5 毫米的阵列，插入耳蜗 24 毫米，而第 3 名患者接受了 24 毫米的阵列，插入耳蜗 21 毫米。在所有情况下，初次手术时听力都得到了保留。所有这些患者随后都出现了设备问题，需要进行再植入。
使用术前和术后纯音听力图测量听力保留情况。此外，在再植入手术前后，还评估了植入物的言语感知能力。
所有患者均可行再植入手术，即使电极插入深度稍深也可行。再植入手术后的言语理解评分与首次干预后的评分相当。
对于接受过耳蜗植入术且保留了听力的患者，进行修复手术不一定会导致自然残余听力丧失，患者仍可以受益于电声联合。即使更深地插入电极也不会导致残余频率内的听力损失。
