Wanna George B, Noble Jack H, Carlson Matthew L, Gifford René H, Dietrich Mary S, Haynes David S, Dawant Benoit M, Labadie Robert F
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A.
Laryngoscope. 2014 Nov;124 Suppl 6(0 6):S1-7. doi: 10.1002/lary.24728. Epub 2014 May 30.
OBJECTIVES/HYPOTHESIS: Three surgical approaches: cochleostomy (C), round window (RW), and extended round window (ERW); and two electrodes types: lateral wall (LW) and perimodiolar (PM), account for the vast majority of cochlear implantations. The goal of this study was to analyze the relationship between surgical approach and electrode type with final intracochlear position of the electrode array and subsequent hearing outcomes.
Comparative longitudinal study.
One hundred postlingually implanted adult patients were enrolled in the study. From the postoperative scan, intracochlear electrode location was determined and using rigid registration, transformed back to the preoperative computed tomography which had intracochlear anatomy (scala tympani and scala vestibuli) specified using a statistical shape model based on 10 microCT scans of human cadaveric cochleae. Likelihood ratio chi-square statistics were used to evaluate for differences in electrode placement with respect to surgical approach (C, RW, ERW) and type of electrode (LW, PM).
Electrode placement completely within the scala tympani (ST) was more common for LW than were PM designs (89% vs. 58%; P < 0.001). RW and ERW approaches were associated with lower rates of electrode placement outside the ST than was the cochleostomy approach (9%, 16%, and 63%, respectively; P < 0.001). This pattern held true regardless of whether the implant was LW or PM. When examining electrode placement and hearing outcome, those with electrode residing completely within the ST had better consonant-nucleus-consonant word scores than did patients with any number of electrodes located outside the ST (P = 0.045).
These data suggest that RW and ERW approaches and LW electrodes are associated with an increased likelihood of successful ST placement. Furthermore, electrode position entirely within the ST confers superior audiological outcomes.
2b.
目的/假设：三种手术入路：蜗窗造瘘术（C）、圆窗（RW）和扩大圆窗（ERW）；以及两种电极类型：侧壁（LW）和蜗轴周围（PM），占人工耳蜗植入的绝大部分。本研究的目的是分析手术入路和电极类型与电极阵列最终在耳蜗内的位置及随后听力结果之间的关系。
比较纵向研究。
100例语后聋成年植入患者纳入本研究。根据术后扫描确定耳蜗内电极位置，并使用刚性配准，将其转换回术前计算机断层扫描，该扫描使用基于10例人类尸体耳蜗显微CT扫描的统计形状模型确定了耳蜗内解剖结构（鼓阶和前庭阶）。使用似然比卡方统计量评估电极放置在手术入路（C、RW、ERW）和电极类型（LW、PM）方面的差异。
LW电极比PM设计更常见于电极完全置于鼓阶（ST）内（89%对58%；P＜0.001）。RW和ERW入路与电极置于ST外的发生率低于蜗窗造瘘术入路相关（分别为9%、16%和63%；P＜0.001）。无论植入物是LW还是PM，这种模式均成立。在检查电极放置和听力结果时，电极完全位于ST内的患者的辅音-元音-辅音单词得分优于有任何数量电极位于ST外的患者（P = 0.045）。
这些数据表明，RW和ERW入路以及LW电极与ST成功放置的可能性增加相关。此外，电极完全位于ST内可带来更好的听力学结果。
2b。
