Wickert Eva, Kurz Anja, Voelker Johannes, Hagen Rudolf, Kaulitz Stefan, Rak Kristen
Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Direktor: Prof. Dr. med. Dr. h. c. R. Hagen, Univ.-Klinik Würzburg, Würzburg, Germany.
Laryngorhinootologie. 2021 Nov;100(11):882-888. doi: 10.1055/a-1369-9530. Epub 2021 Feb 11.
Surgical treatment with bone conduction hearing implants and epitheses for ear malformations offer the right combination of hearing rehabilitation and cosmetic reconstruction. The surgical procedure is often performed in two-stage surgical steps. This project aimed to gain experience with a procedure in which the hearing implant and the epithesis anchors are inserted simultaneously.
Four ears of three patients (n = 1, n = 2) with severe ear malformations (type III, according to Weerda) received a Bonebridge and an epithesis anchor with three base posts in one operation each. Previously, the indication for the use of a bone conduction implant using the active middle ear implant (aMEI) score, according to Frenzel (2013), had been established.
All patients scored 4 points each in the aMEI-score, indicating an unfavorable prognosis for successful implantation of an active middle ear implant. The treatment with a Bonebridge and an epithesis anchor was performed without complications. Postoperatively, the initial audiological fitting and the application of the magnetic abutment were performed after 4 weeks. Audiometry showed a functional gain of up to 30 dB and an improved speech comprehension. The epithesis was shaped like the contralateral ear. After treatment, patients were satisfied with the audiological and cosmetic results.
The simultaneous surgical procedure with a bone conduction hearing implant and epithesis anchor is a good option for the treatment of ear malformations. The aMEI-score was a helpful instrument for the indication. The procedure reduced the surgical risk and the time and effort required for treatment.
采用骨传导听力植入物和耳畸形修复体进行手术治疗，能为听力康复和美容重建提供恰当的组合。该手术通常分两个阶段进行。本项目旨在积累关于同时植入听力植入物和修复体锚定物的手术经验。
3例患者（1例1耳、2例各2耳）共4耳患有严重耳畸形（根据韦尔达分类为III型），每耳在一次手术中同时植入了骨桥和带有三个基柱的修复体锚定物。此前，已根据弗伦泽尔（2013年）的主动中耳植入物（aMEI）评分确定了使用骨传导植入物的指征。
所有患者的aMEI评分均为4分，表明主动中耳植入物成功植入的预后不佳。采用骨桥和修复体锚定物进行治疗未出现并发症。术后4周进行了初始听力适配和磁性基台的应用。听力测试显示功能增益高达30dB，言语理解能力有所提高。修复体的形状与对侧耳朵相似。治疗后，患者对听力和美容效果感到满意。
同时进行骨传导听力植入物和修复体锚定物的手术是治疗耳畸形的一个良好选择。aMEI评分是确定手术指征的有用工具。该手术降低了手术风险以及治疗所需的时间和精力。
