Lu Zhaoyi, Pan Tao, Wang Yu, Xie Yufei
Department of Otolaryngology,Peking University Third Hospital,Beijing,100191,China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 Mar;37(3):218-221. doi: 10.13201/j.issn.2096-7993.2023.03.012.
To summarize the clinical characteristics of children undergoing surgery of cochlear reimplantation, focus on various problems and management in cochlear reimplantation, in order to avoid related problems in surgery of cochlear reimplantation and the initial implantation. A total of 32 children who underwent cochlear reimplantation in Peking University Third Hospital from July 2018 to July 2022 were retrospectively analyzed, and the duration from the initial implantation was from 1 year to 8 years. The cochlear implant mapping was performed 4 weeks after the operation, and the auditory performance was evaluated. Special intraoperative issues included 32 cases with bone and soft tissue hyperplasia at various sites(2 cases with obvious bone hyperplasia in cochlear window, 1 case with obvious bone hyperplasia in subperiosteal tunnel of wire), 5 cases with bone defects in important structures(including the posterior wall of the external auditory canal, the facial nerve canal, and the subperiosteal pocker of the receiver-stimulator), 1 case with cholesteatoma, 4 cases with other lesions or foreign bodies, 4 cases with abnormal position of the electrodes(migration or reversal). All operations were successfully completed without complications. Postoperative recoveries were smooth. In the initial cochlear implantation, attention should be paid to retain residual hearing as much as possible, fully consider the possibility of postoperative bone hyperplasia, avoid large amounts of non-absorbable adhesive materials, avoid bone defects in important structures(such as facial nerve canal or posterior wall of the external auditory canal), pay attention to the depth and orientation of electrode implantation. The possibility of "hidden injury" mentioned above should be fully considered in surgery of cochlear reimplantation to avoid new injury or complication.
总结人工耳蜗再次植入儿童的临床特点,关注人工耳蜗再次植入过程中的各类问题及处理方法,以避免人工耳蜗再次植入及初次植入手术中的相关问题。回顾性分析2018年7月至2022年7月在北京大学第三医院接受人工耳蜗再次植入的32例儿童,初次植入至再次植入的时间为1年至8年。术后4周进行人工耳蜗调机,并评估听觉效果。术中特殊情况包括各部位骨与软组织增生32例(耳蜗窗明显骨增生2例、导线骨膜下隧道明显骨增生1例),重要结构骨质缺损5例(包括外耳道后壁、面神经管、接收器刺激器骨膜下袋),胆脂瘤1例,其他病变或异物4例,电极位置异常(移位或反转)4例。所有手术均顺利完成,无并发症发生。术后恢复顺利。初次人工耳蜗植入时,应注意尽可能保留残余听力,充分考虑术后骨增生的可能性,避免使用大量不可吸收的黏附材料,避免重要结构骨质缺损(如面神经管或外耳道后壁),注意电极植入的深度和方向。人工耳蜗再次植入手术中应充分考虑上述“隐匿性损伤”的可能性,避免造成新的损伤或并发症。