Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Ear Nose Throat J. 2023 Jun;102(6):NP277-NP283. doi: 10.1177/01455613211009141. Epub 2021 Apr 13.
To investigate the anatomical status of the round window niche and hearing outcome of cochlear implantation (CI) after explorative tympanotomy (ExT) with sealing of the round window membrane in patients with sudden sensorineural hearing loss at a tertiary referral medical center.
Between January 1, 2007, and July 30, 2020, 1602 patients underwent CI at our department. Out of these, all patients previously treated by ExT with sealing of the round window membrane because of unilateral sudden hearing loss were included in the study. A retrospective chart review was conducted concerning method of round window membrane sealing, intraoperative findings during CI, postoperative imaging, and hearing results.
Twenty one patients (9 females; 8 right ears; 54.3 years [± 12.9 years]) underwent ExT with sealing of the round window membrane with subsequent CI after 26.6 months (± 32.9 mo) on average. During CI, in 76% of cases (n = 16), the round window niche was blocked by connective tissue due to the previous intervention but could be removed completely in all cases. The connective tissue itself and its removal had no detrimental effects on the round window membrane. Postoperative computed tomography scan showed no electrode dislocation. Mean postoperative word recognition score after 3 months was 57.4% (± 17.2%) and improved significantly to 73.1% (± 16.4%, = .005) after 2 years.
Performing CI after preceding ExT, connective tissue has to be expected blocking the round window niche. Remaining tissue can be removed safely and does not alter the round window membrane allowing for a proper electrode insertion. Short- and long-term hearing results are satisfactory. Consequently, ExT with sealing of the round window membrane in patients with sudden sensorineural hearing loss does not impede subsequent CI that can still be performed safely.
研究在一家三级转诊医疗中心，对因单侧突发性听力损失而行探查性鼓室切开术（ExT）并封闭圆窗膜的患者，圆窗龛的解剖状态和人工耳蜗植入（CI）的听力结果。
2007 年 1 月 1 日至 2020 年 7 月 30 日，我科共进行了 1602 例 CI。其中，所有因单侧突发性听力损失而行 ExT 并封闭圆窗膜治疗的患者均纳入研究。对行圆窗膜封闭的方法、CI 术中发现、术后影像学和听力结果进行回顾性图表审查。
21 例患者（9 例女性；8 例右侧耳；54.3 岁[±12.9 岁]）平均在初次手术 26.6 个月（±32.9 mo）后接受了 ExT 并封闭圆窗膜，随后进行了 CI。在 CI 过程中，76%（n=16）的患者因先前的干预而导致圆窗龛被结缔组织阻塞，但所有患者的结缔组织都可以完全清除。结缔组织本身及其清除对圆窗膜没有不良影响。术后 CT 扫描显示无电极脱位。术后 3 个月的平均单词识别评分（WRS）为 57.4%（±17.2%），2 年后显著提高至 73.1%（±16.4%，P=.005）。
对于先前接受过 ExT 的患者进行 CI，预计会有结缔组织阻塞圆窗龛。残留的组织可以安全清除，不会改变圆窗膜，从而可以正确插入电极。短期和长期听力结果均令人满意。因此，对于因突发性听力损失而行 ExT 并封闭圆窗膜的患者，并不妨碍随后仍可安全进行的 CI。
