Espahbodi Mana, Sweeney Alex D, Lennon Kristen J, Wanna George B
Vanderbilt University School of Medicine, Nashville, TN, USA.
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN USA.
Am J Otolaryngol. 2015 Jul-Aug;36(4):578-82. doi: 10.1016/j.amjoto.2015.04.003. Epub 2015 Apr 15.
To describe the incidence and management of patients with facial nerve stimulation (FNS) associated with cochlear implant (CI) use in the setting of a prior temporal bone fracture.
One adult CI recipient is reported who experienced implant associated FNS with a history of a temporal bone fracture. Additionally, a literature search was performed to identify similar patients from previous descriptions of CI related FNS.
Presence of FNS after implantation and ability to modify implant programming to avoid FNS.
The patient in the present report experienced FNS for middle and basal electrodes during intraoperative neural response telemetry (NRT) in the absence of any surgical exposure or manipulation of the facial nerve. FNS was absent during device activation, but it recurred during follow-up programming sessions. However, additional programming has prevented further FNS during regular implant use. Four other patients with FNS after temporal bone fracture were identified from the literature, and the present case represents the one of two cases in which reprogramming allowed for implant use without FNS.
CI associated FNS is uncommon in patients with a history of a temporal bone fracture, but it is likely that fracture lines provide a lower impedance pathway to the adjacent facial nerve and thus reduce the threshold for FNS. The present report suggests that, in the setting of a prior temporal bone fracture, NRT is not always a reliable predictor of FNS during implant use, and programming changes can help to mitigate FNS when it occurs.
描述在既往有颞骨骨折的情况下，使用人工耳蜗（CI）相关的面神经刺激（FNS）患者的发生率及处理方法。
报告1例成年CI接受者，其有颞骨骨折病史，经历了与植入相关的FNS。此外，进行文献检索以从先前关于CI相关FNS的描述中识别类似患者。
植入后FNS的存在情况以及修改植入程序以避免FNS的能力。
本报告中的患者在术中神经反应遥测（NRT）期间，在未对面神经进行任何手术暴露或操作的情况下，中耳和基底电极出现FNS。在设备激活期间未出现FNS，但在随访编程期间复发。然而，额外的编程在常规植入使用期间防止了进一步的FNS。从文献中识别出另外4例颞骨骨折后出现FNS的患者，本病例是两例通过重新编程允许在无FNS情况下使用植入物的病例之一。
有颞骨骨折病史的患者中，CI相关的FNS并不常见，但骨折线可能为相邻面神经提供了较低阻抗的通路，从而降低了FNS的阈值。本报告表明，在既往有颞骨骨折的情况下，NRT并不总是植入使用期间FNS的可靠预测指标，当FNS发生时，编程改变有助于减轻FNS。
