Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Curr Opin Otolaryngol Head Neck Surg. 2021 Oct 1;29(5):385-390. doi: 10.1097/MOO.0000000000000742.
Advancements in cochlear implant surgical approaches and electrode designs have enabled preservation of residual acoustic hearing. Preservation of low-frequency hearing allows cochlear implant users to benefit from electroacoustic stimulation, which improves performance in complex listening situations, such as music appreciation and speech understanding in noise. Despite the relative high rates of success of hearing preservation, postoperative acoustic hearing outcomes remain unpredictable.
Thin, flexible, lateral wall arrays are preferred for hearing preservation. Both shortened and thin, lateral wall arrays have shown success with hearing preservation and the optimal implant choice is an issue of ongoing investigation. Electrocochleography can monitor cochlear function during and after insertion of the electrode array. The pathophysiology of hearing loss acutely after cochlear implant may differ from that involved in delayed hearing loss following cochlear implant. Emerging innovations may reduce cochlear trauma and improve hearing preservation.
Hearing preservation is possible using soft surgical techniques and electrode arrays designed to minimize cochlear trauma; however, a subset of patients suffer from partial to total loss of acoustic hearing months to years following surgery despite evidence of residual apical hair cell function. Early investigations in robotic-assisted insertion and dexamethasone-eluting implants show promise.
耳蜗植入手术方法和电极设计的进步使残余听力得以保留成为可能。低频听力的保留使耳蜗植入患者能够受益于电声刺激，从而改善复杂聆听环境下的表现，如音乐欣赏和噪声中的言语理解。尽管听力保护的成功率相对较高，但术后听力结果仍然难以预测。
薄而灵活的侧壁电极阵列更有利于听力保护。缩短和变薄的侧壁电极阵列在听力保护方面都取得了成功，而最佳的植入物选择则是一个正在研究的问题。电描记术可在插入电极阵列过程中和之后监测耳蜗功能。耳蜗植入后听力急剧下降的病理生理学与耳蜗植入后延迟性听力下降的病理生理学不同。新兴创新技术可能减少耳蜗损伤并提高听力保护效果。
使用旨在最小化耳蜗损伤的软性手术技术和电极阵列可以实现听力保护；然而，尽管有证据表明残余顶区毛细胞功能存在，但一部分患者在手术后数月至数年内会出现部分或全部丧失听力。机器人辅助插入和地塞米松洗脱植入物的早期研究显示出了希望。
