Department of Otorhinolaryngology and Facial Plastic Operations, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany.
Neuroradiology. 2013 Jul;55(7):895-911. doi: 10.1007/s00234-013-1177-2. Epub 2013 Apr 19.
Active middle ear implants (aMEI) are being increasingly used for hearing restoration in congenital aural atresia. The existing gradings used for CT findings do not meet the requirements for these implants. Some items are expendable, whereas other important imaging factors are missing. We aimed to create a new grading system that could describe the extent of the malformation and predict the viability and challenges of implanting an aMEI.
One hundred three malformed ears were evaluated using HRCT of the temporal bone. The qualitative items middle ear and mastoid pneumatization, oval window, stapes, round window, tegmen mastoideum displacement and facial nerve displacement were included. An anterior- and posterior round window corridor, oval window and stapes corridor were quantified and novelly included. They describe the size of the surgical field and the sight towards the windows.
The ears were graded on a 16-point scale (16-13 easy, 12-9 moderate, 8-5 difficult, 4-0 high risk). The strength of agreement between the calculated score and the performed implantations was good. The comparison of the new 16-point scale with the Jahrsdoerfer score showed that both were able to conclusively detect the high-risk group; however, the new 16-point scale was able to further determine which malformed ears were favorable for aMEI, which the Jahrsdoerfer score could not do.
The Active Middle Ear Implant Score for aural atresia (aMEI score) allows more precise risk stratification and decision making regarding the implantation. The use of operative corridors seems to have significantly better prognostic accuracy than the Jahrsdoerfer score.
主动中耳植入物（aMEI）越来越多地用于先天性听骨畸形的听力恢复。现有的 CT 发现分级不能满足这些植入物的要求。有些项目是可有可无的，而其他重要的成像因素则缺失。我们旨在创建一个新的分级系统，可以描述畸形的程度，并预测植入 aMEI 的可行性和挑战。
对 103 例畸形耳进行颞骨高分辨率 CT 评估。定性项目包括中耳和乳突气腔化、卵圆窗、镫骨、圆窗、鼓室盖移位和面神经移位。包括了新的前、后圆窗通道、卵圆窗和镫骨通道的定量评估，并描述了手术区域的大小和通往窗口的视线。
耳朵按 16 分制分级（16-13 分容易，12-9 分中等，8-5 分困难，4-0 分高风险）。计算得分与实际植入之间的一致性很强。新的 16 分制与 Jahrsdoerfer 评分的比较表明，两者都能明确地检测到高风险组；然而，新的 16 分制能够进一步确定哪些畸形耳适合 aMEI，而 Jahrsdoerfer 评分则不能。
用于耳畸形的主动中耳植入物评分（aMEI 评分）允许更精确的风险分层和植入决策。手术通道的使用似乎比 Jahrsdoerfer 评分具有更好的预后准确性。
