Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.
J Med Ethics. 2018 Mar;44(3):174-179. doi: 10.1136/medethics-2016-103655. Epub 2017 Sep 25.
Cochlear explantation for purely elective (e.g. psychological and emotional) reasons is not well studied. Herein, we aim to provide data and expert commentary about elective cochlear implant (CI) removal that may help to guide clinical decision-making and formulate guidelines related to CI explantation.
We address these objectives via three approaches: case report of a patient who desired elective CI removal; review of literature and expert discussion by surgeon, audiologist, bioethicist, CI user and member of Deaf community.
A systematic review using three scientific online databases was performed. Included articles addressed the benefits and/or complications of cochlear implantation in young children, CI explantation with or without revision surgery and the ethical debate between the medical and Deaf communities on cochlear implantation and explantation.
The medical and audiological perspectives identify a host of risks related to implant removal without reimplantation, including risk from surgery, general anaesthesia, cochlear ossification and poor audiometric outcomes. The member of the deaf community and bioethicist argue that physicians need to guide the principles of beneficence, non-maleficence and patient autonomy. Taken together, patient desires should be seen as paramount, if the patient is otherwise fit for surgery and well informed.
Similar to the case of device implantation, device explantation should be a multidisciplinary and collaborative decision with the patient and the family's desires at the centre. While every case is different, we offer a CI explantation discussion to assist in clinical decision-making, patient counselling and education.
因纯粹的选择性（如心理和情绪）原因而进行耳蜗摘出的研究并不充分。在此，我们旨在提供有关选择性人工耳蜗植入（CI）取出的数据和专家意见，以帮助指导临床决策并制定与 CI 取出相关的指南。
我们通过三种方法来实现这些目标：一名患者因期望选择性 CI 取出而行案例报告；对文献进行回顾和由外科医生、听力学家、生物伦理学家、CI 用户和聋人社区成员进行的专家讨论。
使用三个在线科学数据库进行了系统综述。纳入的文章涉及小儿人工耳蜗植入的益处和/或并发症、有或无修正手术的 CI 取出以及医学和聋人社区在人工耳蜗植入和取出方面的伦理辩论。
医疗和听力学观点确定了与不重新植入相关的一系列植入物移除风险，包括手术、全身麻醉、耳蜗骨化和听力结果不佳的风险。聋人社区成员和生物伦理学家认为，医生需要指导有益于患者、避免伤害和患者自主的原则。总之，如果患者适合手术且知情同意，患者的愿望应被视为首要考虑因素。
与装置植入的情况类似，装置取出也应是一个多学科和协作的决策过程，以患者及其家庭的愿望为中心。虽然每个病例都不同，但我们提供 CI 取出讨论，以协助临床决策、患者咨询和教育。
