Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University Faculty of Medicine, Kanagawa, Japan.
Department of Rehabilitation, Kitasato University Faculty of Allied Health Sciences, Kanagawa, Japan.
J Int Adv Otol. 2022 Sep;18(5):451-454. doi: 10.5152/iao.2022.21357.
Cochlear implantation is anatomically more difficult in postoperative ears than in normal ears due to chronic otitis media. In cochlear implantation after canal wall down mastoidectomy, the electrodes must be protected. We report a case of cochlear implantation with partial mastoid obliteration using a retrofacial approach in an 81-year-old woman. Bilateral tympanoplasty was performed for bilateral chronic otitis media, but no improvement in hearing was observed. Hearing aids were used, but their effect was insufficient and cochlear implantation was needed. Since the patient was an older adult with diabetes, it was necessary to avoid the risk of wound infection associated with fat harvesting from the abdomen, which is necessary for overclosure of the external ear. Therefore, we chose to perform partial mastoid obliteration using a retrofacial approach to ensure the prevention of electrode exposure. One year after surgery, the electrode had not been exposed or infected. The ear canal was preserved, and the eardrum could be observed. Although long-term follow-up is required, this approach may be useful for cochlear implantation in patients with chronic otitis media after canal wall down mastoidectomy.
由于慢性中耳炎，与正常耳朵相比，术后耳朵的耳蜗植入在解剖学上更具难度。在完壁式乳突切除术（canal wall down mastoidectomy）后的耳蜗植入中，必须保护电极。我们报告了一例 81 岁女性采用经面神经隐窝入路行部分乳突切除术的耳蜗植入病例。该患者双侧慢性中耳炎行双侧鼓室成形术，但听力未见改善。使用了助听器，但效果不佳，需要进行耳蜗植入。由于患者为老年糖尿病患者，需要避免与从腹部获取脂肪（用于外耳全包）相关的伤口感染风险。因此，我们选择经面神经隐窝入路行部分乳突切除术，以确保预防电极暴露。术后 1 年，电极未暴露或感染。耳道得以保留，可观察鼓膜。虽然需要长期随访，但对于完壁式乳突切除术（canal wall down mastoidectomy）后的慢性中耳炎患者的耳蜗植入，这种方法可能是有用的。
