Woolley A L, Jenison V, Stroer B S, Lusk R P, Bahadori R S, Wippold F J
Department of Surgery, University of Alabama at Birmingham and The Children's Hospital of Alabama, 35233, USA.
Ann Otol Rhinol Laryngol. 1998 Jun;107(6):492-500. doi: 10.1177/000348949810700607.
We performed a case study and intervention study, with follow-up of 1 to 5 years, in 4 children with inner ear malformations who underwent implantation of a multichannel cochlear implant (Nucleus, Cochlear Corporation) at ages 3 to 12 years. Malformations included a common cavity deformity, 2 incomplete partitions, and 1 case of isolated bilateral vestibular aqueduct enlargement. One child had a single-channel implant placed at 3 years of age, and this was exchanged for a 22-channel implant at age 9. One child had her implant placed at age 4.5 years, but due to complications from a cerebrospinal fluid (CSF) leak had the initial implant removed and replaced at age 5 years during repair of the CSF leak. Intraoperative findings included a CSF leak at the time of surgery in 3 patients. One patient contracted bacterial meningitis 7 months postimplantation that was thought to be secondary to acute otitis media in the unoperated ear. Bilateral CSF leaks were noted in the middle ear by a lumbar puncture radionuclide and fluorescein dye study. Successful repair of the CSF leaks and reimplantation of the cochlear implant was carried out in this patient. Mapping and programming of the implant was found to be challenging in each of these patients. All patients demonstrated improved performance after implantation. Two patients demonstrated some open-set speech perception. One patient demonstrates improved use of temporal cues in a structured closed set. One patient has achieved no significant speech recognition at this time, but does have improved sound detection and awareness. Cochlear implantation in children with congenital inner ear abnormalities can be a successful method of rehabilitation. It should be recognized that the postoperative speech perception results may be highly variable among patients, and that intraoperative complications may occur.
我们对4名患有内耳畸形的儿童进行了一项病例研究和干预研究，并进行了1至5年的随访。这些儿童在3至12岁时接受了多通道人工耳蜗植入（Nucleus，科利耳公司）。畸形包括共同腔畸形、2例不完全分隔以及1例孤立性双侧前庭导水管扩大。一名儿童在3岁时植入了单通道人工耳蜗，并于9岁时更换为22通道人工耳蜗。一名儿童在4.5岁时植入人工耳蜗，但由于脑脊液漏的并发症，在5岁时修复脑脊液漏的过程中取出并更换了初始植入物。术中发现3例患者在手术时有脑脊液漏。一名患者在植入后7个月患细菌性脑膜炎，被认为继发于未手术耳的急性中耳炎。通过腰椎穿刺放射性核素和荧光素染料研究发现中耳存在双侧脑脊液漏。对该患者成功修复了脑脊液漏并重新植入了人工耳蜗。发现对这些患者中的每一位进行人工耳蜗的图谱绘制和编程都具有挑战性。所有患者在植入后表现出功能改善。两名患者表现出一定程度的开放式言语感知。一名患者在结构化的封闭式测试中表现出对时间线索的使用有所改善。一名患者目前尚未获得显著的言语识别能力，但声音检测和意识有所提高。对患有先天性内耳异常的儿童进行人工耳蜗植入可以是一种成功的康复方法。应该认识到，患者术后的言语感知结果可能差异很大，并且可能会发生术中并发症。
