Ulanovski David, Attias Joseph, Sokolov Meirav, Greenstein Tali, Raveh Eyal
Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Institute for Audiology & Clinical Neurophysiology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Department of Communication Sciences & Disorders, University of Haifa, Haifa, Israel.
Am J Otolaryngol. 2018 Mar-Apr;39(2):107-110. doi: 10.1016/j.amjoto.2017.12.014. Epub 2017 Dec 19.
Hard cochlear implant failures are diagnosed by objective tests whereas soft failures are suspected on the basis of clinical signs and symptoms. This study reviews our experience with children in tertiary pediatric medical center who underwent revision cochlear implantation, with emphasis on soft failures.
Children (age<18years) who underwent revision cochlear implantation from 2000 to 2012 were identified by database search. Pre- and post-explantation data were collected.
Twenty-six revision surgeries were performed, accounting for 7.4% of all cochlear implant surgeries at our center during the study period. The pre-explantation diagnosis was hard failure in 7 cases (27%), soft failure in 12 (46%), and medical failure in 7 (27%). On post-explantation analysis, 7/12 devices from the soft-failure group with a normal integrity test had abnormal findings, yielding a 63% false-negative rate (12/19) for the integrity test. All children regained their initial performance. Compared to hard failures, soft failures were associated with a shorter median time from first implantation to symptom onset (8 vs 25months) but a significantly longer time from symptom onset to revision surgery (17.5 vs 3months; P=0.004).
Soft cochlear implant failure in young patients poses a diagnostic challenge. A high index of suspicion is important because a delayed diagnosis may have severe consequences for language development. A normal integrity test does not unequivocally exclude device failure and is unrelated to functional outcome after revision surgery. Better education of parents and rehabilitation teams is needed in addition to more accurate diagnostic tests.
硬式人工耳蜗故障通过客观测试进行诊断，而软故障则根据临床体征和症状怀疑。本研究回顾了我们在三级儿科医疗中心对接受人工耳蜗翻修手术儿童的经验，重点关注软故障。
通过数据库搜索确定2000年至2012年期间接受人工耳蜗翻修手术的儿童（年龄<18岁）。收集植入前和植入后的数据。
共进行了26例翻修手术，占研究期间我们中心所有人工耳蜗手术的7.4%。植入前诊断为硬故障7例（27%），软故障12例（46%），医疗故障7例（27%）。植入后分析显示，软故障组中完整性测试正常的12个设备中有7个出现异常结果，完整性测试的假阴性率为63%（12/19）。所有儿童均恢复了初始表现。与硬故障相比，软故障与首次植入至症状出现的中位时间较短（8个月对25个月）相关，但从症状出现至翻修手术的时间明显更长（17.5个月对3个月；P=0.004）。
年轻患者的软式人工耳蜗故障带来了诊断挑战。高度怀疑很重要，因为延迟诊断可能对语言发育产生严重后果。正常的完整性测试不能明确排除设备故障，且与翻修手术后的功能结果无关。除了更准确的诊断测试外，还需要对家长和康复团队进行更好的教育。
