Gray R F, Irving R M
East of England Cochlear Implant Centre, Addenbrooke's Hospital, Cambridge, United Kingdom.
Am J Otol. 1995 Sep;16(5):682-6.
Chronic suppurative otitis media (CSOM) in profoundly deaf patients is a contraindication for cochlear implantation. Eight (6%) of the 126 patients referred to cochlear implantation at this center between 1986 and 1992 became deafened as a result of bilateral CSOM but were otherwise suitable candidates. This study details the methods used in four patients to prepare the septic ear for a sterile device. Two patients had wet radical cavities with residual cholesteatoma, and two had discharging safe perforations resistant to surgical repair. Obliteration of the middle ear cleft with blind pit closure of the ear canal was attempted in all four patients, and cochlear implants were installed at a second operation 3 to 6 months later. The hearing results were as good as in implanted patients without CSOM, and the only complication has been the finding of a cholesteatoma pearl at the second operation in one patient. Fat obliteration of the mastoid and middle ear with blind pit closure of the ear canal can be adapted to make most chronic ears fit for implantation, if the patient is prepared to undergo two operations.
极重度聋患者的慢性化脓性中耳炎（CSOM）是人工耳蜗植入的禁忌证。1986年至1992年间，该中心转诊进行人工耳蜗植入的126例患者中有8例（6%）因双侧CSOM而致聋，但在其他方面是合适的候选人。本研究详细介绍了4例患者为将感染的耳朵准备好植入无菌装置所采用的方法。2例患者有伴有残余胆脂瘤的湿耳根治腔，2例患者有抵抗手术修复的流脓性安全穿孔。所有4例患者均尝试用耳道盲端封闭法闭塞中耳裂，并在3至6个月后的第二次手术中植入人工耳蜗。听力结果与未患CSOM的植入患者一样好，唯一的并发症是1例患者在第二次手术中发现了胆脂瘤珠。如果患者愿意接受两次手术，用耳道盲端封闭法行乳突和中耳脂肪填塞术可使大多数慢性耳适合植入。
