Boucek Jan, Vokral Jan, Cerny Libor, Chovanec Martin, Skrivan Jiří, Zverina Eduard, Betka Jan, Zabrodsky Michal
Department of Otorhinolaryngology Head and Neck Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, V Uvalu 84, 150 06, Prague 5, Czech Republic.
Department of Phoniatrics, The First Faculty of Medicine, Charles University, Zitna 24, 120 00, Prague 2, Czech Republic.
Eur Arch Otorhinolaryngol. 2017 Jun;274(6):2429-2436. doi: 10.1007/s00405-017-4505-z. Epub 2017 Mar 14.
Skull base tumors and, in particular, vestibular schwannoma (VS) are among the etiological reasons for single-sided deafness (SSD). Patients with SSD have problems in understanding speech in a noisy environment and cannot localize the direction of sounds. Baha is one of the most frequently used systems for SSD compensation. Out of 38 patients with SSD after retrosigmoid removal of VS who underwent testing with Baha softband, 16 were satisfied and were indicated for Baha implantation. Two surgical approaches have been used-the Nijmegen linear incision technique with subdermal thinning (Group I, implant BI300) and fast surgery technique without subdermal thinning (Group II, implant BIA400). The duration of the surgery, the implant stability measured by Ostell, and skin or soft tissue reactions in long range follow-up were evaluated and compared between Group I and II. There was a difference in duration of surgery, in Group II procedures averaged significantly faster (p > 0.001). In both groups, there was a similar trend of the gradual increase of implant stability. In the Group I and II, there was comparable rate of the skin or soft tissue reactions grade 0, I, II, or III. We have proved Baha to be a suitable possibility for SSD patients after the removal of VS, regardless of the approach. After the retrosigmoid approach to the VS, the key step of Baha implantation must be to reach intact healthy bone to avoid implantation into scar tissue.
颅底肿瘤，尤其是前庭神经鞘瘤（VS）是单侧耳聋（SSD）的病因之一。SSD患者在嘈杂环境中理解语音存在困难，且无法确定声音的方向。骨锚式助听器（Baha）是SSD补偿最常用的系统之一。在38例乙状窦后入路切除VS后出现SSD并接受Baha软带测试的患者中，16例满意并被建议植入Baha。采用了两种手术方法——带皮下减薄的奈梅亨直线切口技术（I组，植入物BI300）和无皮下减薄的快速手术技术（II组，植入物BIA400）。对I组和II组的手术时间、用Ostell测量的植入物稳定性以及长期随访中的皮肤或软组织反应进行了评估和比较。手术时间存在差异，II组手术平均明显更快（p > 0.001）。两组中，植入物稳定性均有逐渐增加的相似趋势。I组和II组中，皮肤或软组织0级、I级、II级或III级反应的发生率相当。我们已证明，无论采用何种方法，Baha对VS切除后的SSD患者都是一种合适的选择。在VS采用乙状窦后入路后，Baha植入的关键步骤必须是到达完整健康的骨组织，以避免植入瘢痕组织。
