Poutoglidis Alexandros, Fyrmpas Georgios, Vlachtsis Konstantinos, Paraskevas George K, Lazaridis Nikolaos, Keramari Stergiani, Garefis Konstantinos, Dimakis Christodoulos, Tsetsos Nikolaos
Department of Otorhinolaryngology-Head and Neck Surgery, 'G. Papanikolaou' General Hospital, Thessaloniki, Greece.
Department of Otorhinolaryngology-Head and Neck Surgery, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
Clin Otolaryngol. 2022 Nov;47(6):708-716. doi: 10.1111/coa.13909. Epub 2022 Jan 11.
To review the role of the endoscope in cochlear implantation (CI).
MEDLINE, ScienceDirect, Google Scholar and the Cochrane Library databases, as well as other sources, were searched by two independent reviewers. Studies including patients undergoing either exclusively endoscopic or endoscopically assisted CI were eligible for inclusion. Endoscopic CI approaches and postoperative complications were the primary outcomes. Secondary endpoints included the degree of round window (RW) microscopic visualisation according to St Thomas' Hospital classification and type of cochleostomy for electrode insertion in the scala tympani (ST).
Fourteen studies met the inclusion criteria comprising 191 endoscopic or endoscopically assisted CI cases. The endoscope was used for better visualisation of the RW across all included studies, facilitated the insertion of the electrode in the ST and spared a mastoidectomy in a number of cases. No facial nerve palsy was reported in any of the studies. The most common complication was external auditory canal/tympanic membrane tear followed by chorda tympani injury.
The microscopic CI approach is still the gold standard. The endoscope facilitates the recognition of the RW area and leads to successful and safe implantation, particularly in difficult anatomical scenarios, ear malformations and advanced otosclerosis. Endoscopically assisted CI procedures offer the opportunity to avoid a posterior tympanotomy and reduce the risk of facial nerve injury. To date, the lack of long-term data does not permit the widespread adoption of completely endoscopic CI procedures without a mastoidectomy.
回顾内窥镜在人工耳蜗植入（CI）中的作用。
由两名独立审稿人检索MEDLINE、ScienceDirect、谷歌学术和考克兰图书馆数据库以及其他来源。纳入的研究包括仅接受内窥镜或内窥镜辅助人工耳蜗植入的患者。内窥镜人工耳蜗植入方法和术后并发症是主要结局。次要终点包括根据圣托马斯医院分类法的圆窗（RW）显微镜可视化程度以及鼓阶（ST）中电极插入的蜗窗造瘘类型。
14项研究符合纳入标准，共191例内窥镜或内窥镜辅助人工耳蜗植入病例。在所有纳入研究中，内窥镜用于更好地观察圆窗，便于电极插入鼓阶，并且在一些病例中避免了乳突切除术。所有研究均未报告面神经麻痹。最常见的并发症是外耳道/鼓膜撕裂，其次是鼓索神经损伤。
显微镜下人工耳蜗植入方法仍是金标准。内窥镜有助于识别圆窗区域，实现成功且安全的植入，特别是在解剖结构复杂、耳部畸形和晚期耳硬化症的情况下。内窥镜辅助人工耳蜗植入手术提供了避免后鼓室切开术并降低面神经损伤风险的机会。迄今为止，由于缺乏长期数据，不进行乳突切除术的完全内窥镜人工耳蜗植入手术无法广泛应用。
