*AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Unité Otologie, Implants auditifs et Chirurgie de la base du crâne, Paris, France; †Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1159, "Réhabilitation chirurgicale mini-invasive et robotisée de l'audition," Paris, France; and ‡INSERM UMR-S 1159, "Réhabilitation chirurgicale mini-invasive et robotisée de l'audition," Paris, France.
Otol Neurotol. 2015 Apr;36(4):604-9. doi: 10.1097/MAO.0000000000000702.
To review indications, anatomical results, and complications of cochlear implant (CI) surgery in adults for which middle ear and mastoid obliterations were performed.
Thirty cases (26 patients, 4 bilaterally implanted) of 837 CI surgeries (3.5%) performed between January 2009 and December 2013 have been included in this retrospective study. The mean follow-up was 21 ± 18 months (mean ± SD, range 3-58). There were 11 males and 15 females. The mean age was 59 ± 19 years (range 35-82). All surgeries were performed with a single-stage technique including a canal wall down mastoidectomy with external auditory canal closure and mastoid obliteration with fat. A postoperative CT scan was performed in all cases.
Etiologies of hearing loss were mainly chronic otitis with or without cholesteatoma in 24 cases. Other etiologies were meningitis with cochlear ossification in one case, progressive hearing loss in two cases, enlarged vestibular aqueduct in one case, temporal bone fracture with CSF leak in one case, and congenital aural atresia in one case. Four of those 30 cases were revision CI surgery for electrode array misplacement (one case with cochlear ossification) or extrusion from an open cavity (one case) and recurrent cholesteatomas (two cases). All surgeries were uneventful and performed in a single stage. The electrode array was inserted in the basal turn (29 cases) or in the middle turn (one case) of the cochlea. No complications were observed. Two cases of postoperative abdominal hematoma were drained under local anesthesia. A major failure of the CI device occurred 5 months after surgery.
CI with mastoid and middle ear obliteration is a safe and effective technique for selected cases of cochlear implantation. Mastoid obliteration prevents from recurrent disease and lowering the facial ridge allows more space to manage extensive cochlear ossification or malformation.
回顾在 2009 年 1 月至 2013 年 12 月期间进行的 837 例人工耳蜗植入术（CI）中，对中耳和乳突进行闭塞的成年人的手术适应证、解剖学结果和并发症。
本回顾性研究纳入了 30 例（26 例患者，双侧植入 4 例）837 例 CI 手术（3.5%）的病例。平均随访时间为 21 ± 18 个月（平均 ± 标准差，范围 3-58）。其中 11 例为男性，15 例为女性。平均年龄为 59 ± 19 岁（范围 35-82）。所有手术均采用单阶段技术进行，包括经耳道关闭的耳道壁向下乳突切除术和脂肪乳突闭塞术。所有病例均行术后 CT 扫描。
听力损失的病因主要为慢性中耳炎伴或不伴胆脂瘤 24 例。其他病因包括脑膜炎伴耳蜗骨化 1 例，进行性听力损失 2 例，大前庭水管扩大 1 例，颞骨骨折伴脑脊液漏 1 例，先天性耳闭锁 1 例。在这 30 例中，有 4 例为电极阵列错位（1 例伴耳蜗骨化）或从开放腔中脱出（1 例）和复发性胆脂瘤（2 例）的人工耳蜗翻修手术。所有手术均顺利进行，且均为单阶段手术。电极阵列插入耳蜗的基底转（29 例）或中转（1 例）。未观察到并发症。2 例术后腹部血肿在局部麻醉下引流。术后 5 个月，人工耳蜗设备出现重大故障。
对于选择的耳蜗植入病例，乳突和中耳闭塞的 CI 是一种安全有效的技术。乳突闭塞可预防疾病复发，降低颧弓可提供更多空间来处理广泛的耳蜗骨化或畸形。
