Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine.
Stanford Ear Institute, Stanford, California.
Otol Neurotol. 2019 Sep;40(8):e782-e786. doi: 10.1097/MAO.0000000000002319.
To document the case of a patient with bilateral enlarged vestibular aqueducts who experienced sensorineural hearing loss in the nonimplanted ear following unilateral cochlear implantation complicated by perilymph gusher requiring lumbar drain insertion and to highlight the need to counsel regarding the risk of potential hearing loss to the contralateral ear when preparing for cochlear implants in the setting of inner ear malformations.
One patient with bilateral enlarged vestibular aqueducts in a tertiary referral center.
INTERVENTION(S): Cochlear implantation complicated by perilymph gusher requiring lumbar drain insertion.
MAIN OUTCOME MEASURE(S): Bone conduction hearing thresholds, word recognition scores.
The patient underwent unilateral cochlear implantation, which was complicated by a perilymphatic gusher and necessitated placement of an intraoperative lumbar drain. On postoperative day 1, the patient reported hearing loss in the opposite ear. The word recognition score in the contralateral ear dropped from 24% at preimplantation to 8% at 2-weeks postimplantation, and did not improve at 6 months postimplantation. Moreover, the bone conduction threshold at 1 kHz worsened from 20 dB preoperatively to no response at 75 dB (the limit of the testing equipment) at 2-weeks postoperatively and only partially improved to 40 dB at 6 months postimplantation.
As patients with inner ear malformations potentially have direct high-pressure anatomical connections between the perilymphatic spaces and the cerebrospinal fluid, they are at risk of hearing loss in the nonimplanted ear during cochlear implantation. This case highlights the need for potential additional patient counseling regarding this risk in the nonimplanted ear.
记录一例双侧扩大前庭水管患者的病例，该患者在单侧人工耳蜗植入术后出现对侧（未植入人工耳蜗的耳）感音神经性听力损失，其原因是人工耳蜗植入术中并发外淋巴漏，需要置入腰椎引流管。本研究旨在强调在存在内耳畸形的情况下，准备进行人工耳蜗植入时，有必要向患者说明对侧耳发生潜在听力损失的风险。
在一家三级转诊中心，一名双侧扩大前庭水管的患者。
人工耳蜗植入术并发外淋巴漏，需要置入腰椎引流管。
骨导听阈、言语识别率。
患者行单侧人工耳蜗植入术，术后并发外淋巴漏，术中需置入腰椎引流管。术后第 1 天，患者报告对侧耳听力下降。对侧耳的言语识别率从植入前的 24%下降至植入后 2 周的 8%，且在植入后 6 个月时并未改善。此外，1 kHz 骨导阈值从术前的 20 dB 变为术后 2 周时的无反应（测试设备的极限），75 dB，仅部分改善至植入后 6 个月时的 40 dB。
由于内耳畸形患者的外淋巴间隙和脑脊液之间可能存在直接的高压解剖连接，因此他们在进行人工耳蜗植入术时，存在对侧（未植入人工耳蜗的耳）听力损失的风险。本病例强调了需要向患者说明对侧耳潜在风险，以增加患者的潜在额外咨询。
