Department of Otorhinolaryngology, Azienda Ospedaliera di Pescara, Pescara, Italy.
University of Parma, Department of Medicine and Surgery, Department of Otorhinolaryngology and Otoneurosurgery, Parma, Italy.
Acta Otorhinolaryngol Ital. 2023 Feb;43(1):65-73. doi: 10.14639/0392-100X-N2096.
To report the authors' experience in a series of patients treated with cochlear implant (CI) revision surgery due to medical problems.
Revision CI surgeries performed in a tertiary referral centre for medical reasons not related to skin conditions were reviewed; patients were included if device removal was required.
17 cochlear implant patients were reviewed. The main reasons requiring revision surgery with device removal were: retraction pocket/iatrogenic cholesteatoma (6/17), chronic otitis (3/17), extrusion in previous canal wall down procedures (2/17) or in previous subtotal petrosectomy (2/17), misplacement/partial array insertion (2/17) and residual petrous bone cholesteatoma (2/17). In all cases surgery was performed through a subtotal petrosectomy. Cochlear fibrosis/ossification of the basal turn was found in 5 cases and uncovered mastoid portion of the facial nerve in 3 patients. The only complication was an abdominal seroma. A positive difference was observed between the number of active electrodes and comfort levels before and after revision surgery.
In CI revision surgeries performed for medical reasons, subtotal petrosectomy offers invaluable advantages and should be considered as first choice during surgical planning.
报告作者在一系列因医学问题而接受人工耳蜗（CI）翻修手术的患者中的经验。
对因非皮肤状况相关的医学原因而在三级转诊中心进行的 CI 翻修手术进行回顾性研究；如果需要移除设备，则将患者纳入研究。
共回顾了 17 例人工耳蜗植入患者。需要进行翻修手术并移除设备的主要原因包括：（1） 回缩袋/医源性胆脂瘤（6/17）；（2） 慢性中耳炎（3/17）；（3） 先前经完壁式乳突切开术（2/17）或次全颞骨切除术（2/17）时出现的器械脱出；（4） 错位/部分电极插入（2/17）；（5） 残余岩骨胆脂瘤（2/17）。所有病例均通过次全颞骨切除术进行手术。在 5 例患者中发现了耳蜗纤维化/基底部骨化，在 3 例患者中发现了面神经未被覆盖的乳突部分。唯一的并发症是腹部血清肿。在翻修手术前后，观察到活跃电极数量和舒适度之间存在显著差异。
在因医学原因进行的 CI 翻修手术中，次全颞骨切除术提供了宝贵的优势，应在手术规划中作为首选考虑。
