Yehudai Noam, Duek Marine, Barzilai Roni, Brodsky Alexander, Khniefes Riad, Shihada Rabia, Peleg Caroline, Shpak Talma, Luntz Michal
The Ear and Hearing Program, Department of Otolaryngology Head and Neck Surgery, Bnai-Zion Medical Center, Haifa.
The Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa.
Harefuah. 2020 Feb;159(1):93-97.
After cochlear implantation (CI) there is concern regarding the potential risks of spread of middle ear infection along the electrode array into the cochlea and central nervous system and regarding late sequela of otitis media (OM): eardrum perforation, atelectasis and cholesteatoma. The age for implantation in children overlaps the peak age incidence of acute OM (AOM) and secretory OM (SOM) and delay of implantation reduces the potential benefit from the intervention. Therefore, control of OM by inserting ventilating tubes (VT) is widely performed in pediatric CI candidates who also suffer from otitis media.
To refine indications for VT insertion in candidates for cochlear implantation who also suffer from OM.
Of 200 children referred for CI and implanted one after another, 126 were classified as OM-prone, 98 due to AOM and 28 due to SOM. The rate of development of late sequela of middle ear disease was compared between the two subgroups of OM-proneness.
A total of 15 children (7.5%) developed late sequela of middle ear disease; all belonged to the SOM group; 3.5% developed eardrum perforation; 3.5% atelectasis and 0.5% cholesteatoma.
Pre-CI VT insertion in children with SOM who underwent CI did not prevent development of late sequela of middle ear disease; VT insertion with the object of preventing late sequela of middle ear disease in CI candidates who suffer from SOM only is not required; in otitis-prone children a long term oto-microscopic follow-up is needed in order to identify late sequela of middle ear disease.
人工耳蜗植入（CI）后，人们担心中耳感染沿着电极阵列扩散至耳蜗和中枢神经系统的潜在风险，以及中耳炎（OM）的晚期后遗症：鼓膜穿孔、肺不张和胆脂瘤。儿童植入人工耳蜗的年龄与急性中耳炎（AOM）和分泌性中耳炎（SOM）的高发年龄重叠，而延迟植入会降低干预的潜在益处。因此，对于同时患有中耳炎的小儿人工耳蜗植入候选者，通过插入通气管（VT）来控制中耳炎的做法被广泛采用。
完善针对同时患有中耳炎的人工耳蜗植入候选者插入通气管的指征。
在200名依次接受人工耳蜗植入的儿童中，126名被归类为易患中耳炎，其中98名因AOM，28名因SOM。比较了两个易患中耳炎亚组中耳疾病晚期后遗症的发生率。
共有15名儿童（7.5%）出现了中耳疾病的晚期后遗症；均属于SOM组；3.5%出现鼓膜穿孔；3.5%出现肺不张，0.5%出现胆脂瘤。
接受人工耳蜗植入的SOM患儿在人工耳蜗植入前插入通气管并不能预防中耳疾病晚期后遗症的发生；仅为预防患有SOM的人工耳蜗植入候选者中耳疾病晚期后遗症而插入通气管并无必要；对于易患中耳炎的儿童，需要进行长期耳镜随访，以便发现中耳疾病的晚期后遗症。
