Barbara Maurizio, Volpini Luigi, Covelli Edoardo, Filippi Chiara, Monini Simonetta
Otolaryngology Clinic, NESMOS Department, Medicine and Psychology, Sapienza University, Rome, Italy.
Otol Neurotol. 2016 Jun;37(5):520-3. doi: 10.1097/MAO.0000000000001020.
To verify the efficacy of a powerful active hearing device in a patient different from far-advanced otosclerosis, specifically when the stapes footplate is mobile.
A patient with severe-to-profound mixed hearing loss, who was not benefiting from the use of a conventional hearing aid, was selected for an inner ear active implant. This was justified by a bone conductive threshold above 60 dB, which had discouraged any other rehabilitative solutions such as a bone conductive implant, or an active middle ear implant (AMEI).
The hearing device was surgically applied using a combined transmastoid/transcanal approach. During surgery, a mobile stapes were found and was perforated for the insertion of a piston prosthesis, crimped on the new-incus of the device.
The bone conduction threshold was assessed postoperatively to identify any possible surgery-related hearing deterioration. Pure tone audiometry was conducted in a sound field, and a speech reception threshold test was performed with the contralateral ear masked. The hearing outcome was assessed soon after the implant activation (6 weeks after surgery), and 6 months after surgery.
Upon activation of the device, a PTA of 45 dB was obtained (at 0.5, 1, 2 and 4 kHz). At 6 months after surgery, the speech discrimination score reached 90% at 80 dB SPL.
The application of the Codacs device has shown to be compatible with a mobile stapes footplate, as demonstrated in this report. The footplate perforation did not cause any further hearing deterioration, and has allowed to achieve a favorable auditory outcome.
验证一种强大的有源听力设备在一名不同于晚期耳硬化症患者中的疗效，特别是当镫骨足板活动时。
一名患有重度至极重度混合性听力损失且使用传统助听器无效的患者被选作内耳有源植入。骨导阈值高于60dB，这使得诸如骨导植入物或有源中耳植入物（AMEI）等其他康复解决方案都不可行，从而证明了选择有源植入的合理性。
采用经乳突/经耳道联合入路通过手术植入听力设备。手术过程中，发现镫骨活动，在其上穿孔以插入活塞式假体，并固定在设备的新砧骨上。
术后评估骨导阈值，以确定任何可能与手术相关的听力下降情况。在声场中进行纯音听力测定，并在对侧耳掩蔽的情况下进行言语接受阈值测试。在植入物激活后不久（手术后6周）和手术后6个月评估听力结果。
设备激活后，获得了45dB的纯音平均听阈（在0.5、1、2和4kHz处）。手术后6个月，在80dB声压级时言语辨别得分达到90%。
如本报告所示，Codacs设备的应用已证明与活动的镫骨足板兼容。足板穿孔未导致任何进一步的听力下降，并取得了良好的听觉效果。
