Hoskison Emma, Mitchell Scott, Coulson Chris
a University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital , 58 Barcheston Road, Solihull, Knowle, Birmingham , UK.
Cochlear Implants Int. 2017 Jul;18(4):192-197. doi: 10.1080/14670100.2017.1330735. Epub 2017 May 23.
Cochlear implantation (CI) has developed from its origins in the 1980s. Initially, CI was for profound bilateral hearing impairment. However, candidacy for CI have become more widespread in recent years with unilateral implantation and an emphasis on hearing preservation. Evidence supports full electrode insertion in an atraumatic fashion into the scala tympani (ST) provides optimal hearing outcomes. The main aim of this systematic review was to elucidate the degree of trauma associated with CI insertion.
A systematic literature search was undertaken using PubMed Medline. A grading system described by Eshraghi was used to classify cochlear trauma. Both radiological and histological studies were included.
Twenty one papers were identified which were relevant to our search. In total, 653 implants were inserted and 115 (17.6%) showed evidence of trauma. The cochleas with trauma had basilar membrane elevation in 5.2%, ruptured in 5.2%, the electrode passed from the ST to the SV in 84.4% and there was grade 4 trauma in 5.2%. The studies used a variety of histological and radiological methods to assess for evidence of trauma in both cadaveric temporal bones and live recipients.
Minimizing cochlear trauma during implant insertion is important to preserve residual hearing and optimize audiological performance. An overall 17.6% trauma rate suggests that CI insertion could be improved with more accurate and consistent electrode insertion such as in the form of robotic guidance. The correlation of cochlea trauma with post-operative hearing has yet to be determined.
人工耳蜗植入（CI）自20世纪80年代起源以来不断发展。最初，CI用于双侧极重度听力损失。然而，近年来随着单侧植入以及对听力保留的重视，CI的适应证变得更加广泛。有证据表明，以无创伤方式将电极完全插入鼓阶（ST）可提供最佳听力结果。本系统评价的主要目的是阐明与CI植入相关的创伤程度。
使用PubMed Medline进行系统文献检索。采用Eshraghi描述的分级系统对耳蜗创伤进行分类。纳入放射学和组织学研究。
共识别出21篇与我们的检索相关的论文。总共植入了653个耳蜗，其中115个（17.6%）显示有创伤证据。有创伤的耳蜗中，基底膜抬高占5.2%，破裂占5.2%，电极从鼓阶进入前庭阶占84.4%，4级创伤占5.2%。这些研究使用了多种组织学和放射学方法来评估尸体颞骨和活体接受者中的创伤证据。
在植入过程中尽量减少耳蜗创伤对于保留残余听力和优化听力学表现很重要。总体17.6%的创伤率表明，通过更精确和一致的电极插入方式，如机器人引导形式，CI植入可以得到改善。耳蜗创伤与术后听力的相关性尚未确定。
