Vashishth Ashish, Fulcheri Andrea, Prasad Sampath Chandra, Bassi Margherita, Rossi Gianluca, Caruso Antonio, Sanna Mario
Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy.
Otol Neurotol. 2018 Jan;39(1):17-28. doi: 10.1097/MAO.0000000000001613.
Retrospective study.
Otology and skull base surgery center.
Charts of 40 patients (42 ears) with cochlear ossification undergoing cochlear implantation were reviewed. Demographic features, operative findings, auditory outcomes, and complications were analyzed. Operative findings included extent of cochlear ossification, extent of drilling required to obtain patent cochlear lumen, approach (posterior tympanotomy/subtotal petrosectomy), electrode insertion (partial/complete, scala tympani/vestibuli), and complications. Auditory outcomes were assessed over a 4-year follow-up period using vowel, word, sentence, and comprehension scores. Patients were divided into groups (otosclerotic/non-otosclerotic and round window/basal turn ossification) for comparison of auditory outcomes. Outcomes were compared with 60 randomly identified controls (adults with postlingual deafness) who underwent implantation with no cochlear ossification.
The median age and duration of deafness of patients was 54.39 and 27.15 years, respectively. Etiology of cochlear ossification was otosclerosis in 23 of 42 ears and mixed in 19 of 42 ears (chronic otitis media, temporal bone fractures, idiopathic, meningitis, Cogan's syndrome) with exclusive round window involvement in 54.7% of cases and the rest having partial or complete basal turn ossification. 59.5% ears underwent subtotal petrosectomy for implantation. Three patients underwent scala vestibuli insertion and five had incomplete electrode insertion. Auditory outcomes were comparable in otosclerotic and non-otosclerotic cases and in round window and basal turn ossification cases. No significant differences were observed in auditory scores when compared with controls with no ossification.
Cochlear implantation in cochlear ossification is feasible despite surgical challenges and modifications. Auditory outcomes in basal turn ossification appear to be comparable to cases with no ossification with extent of ossification having no significant association with outcomes.
1）回顾人工耳蜗植入术治疗耳蜗骨化病例的手术及听觉效果和并发症。2）评估骨化程度和病因与治疗效果之间的关联。
回顾性研究。
耳科学与颅底外科中心。
回顾40例（42耳）接受人工耳蜗植入术的耳蜗骨化患者的病历。分析患者的人口统计学特征、手术结果、听觉效果及并发症。手术结果包括耳蜗骨化程度、打通耳蜗腔所需的钻孔范围、手术入路（后鼓室切开术/部分岩骨切除术）、电极植入情况（部分/完全植入、鼓阶/前庭阶）及并发症。在4年随访期内，使用元音、单词、句子及理解得分评估听觉效果。将患者分为几组（耳硬化症/非耳硬化症组、圆窗/鼓室底转骨化组）以比较听觉效果。将治疗效果与60例随机选取的未发生耳蜗骨化的人工耳蜗植入术对照患者（语后聋成人）进行比较。
患者的中位年龄和耳聋持续时间分别为54.39岁和27.15年。42耳中，23耳耳蜗骨化病因是耳硬化症，19耳为混合型（慢性中耳炎、颞骨骨折、特发性、脑膜炎、科根综合征），54.7%的病例仅圆窗受累，其余病例存在部分或完全鼓室底转骨化。59.5%的耳接受部分岩骨切除术以植入人工耳蜗。3例患者电极植入前庭阶，5例电极植入不完全。耳硬化症和非耳硬化症病例以及圆窗和鼓室底转骨化病例的听觉效果相当。与未发生骨化的对照患者相比，听觉得分无显著差异。
尽管存在手术挑战及需进行手术调整，但人工耳蜗植入术治疗耳蜗骨化是可行的。鼓室底转骨化患者的听觉效果似乎与未发生骨化的病例相当，骨化程度与治疗效果无显著关联。
