内耳发育畸形患者人工耳蜗植入术后的疗效分析  

Efficacy of cochlear implantation in patients with inner ear malformations

作　　者：刘兰 费静 陶美慧 李雷激 LIU Lan;FEI Jing;TAO Mei-hui;LI Lei-ji(Department Of Otolaryngology-Head and Neck Surgery, the Affiliated Hospital of Sout hwest Medical University , Luzhou646000, China)

机构地区：[1]西南医科大学附属医院耳鼻咽喉头颈外科

出　　处：《中国耳鼻咽喉颅底外科杂志》2019年第2期152-156,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的分析内耳发育畸形患者行人工耳蜗植入术后的疗效。方法回顾性分析2011年1月~2017年7月在西南医科大学附属医院行人工耳蜗植入术的30例内耳发育畸形患者的临床资料,其中大前庭水管综合征(large vestibular aqueduct syndrome,LVAS) 8例,Mondini畸形(不完全分隔Ⅱ型)7例,同时伴有LVAS和Mondini畸形10例,内听道狭窄5例。随机选取同时期临床资料相匹配的30例耳蜗结构正常的人工耳蜗植入患者作为对照组。采用听觉行为分级标准和言语可懂度分级标准进行评估。比较两组患者的术前听力、术中情况以及术后听觉言语康复情况。结果 3例LVAS患者在术中耳蜗钻孔后出现外淋巴液不同程度的外涌,1例Mondini畸形患者术中出现脑脊液井喷现象。两组患者术后均获得有意义的听觉反应,术后的听觉言语能力相比较,差异无统计学意义(P>0.05)。同组患者,术后3,6,9,12个月的听觉言语能力均较各自术前均有明显提高(P<0.05)。结论内耳发育畸形患者不是人工耳蜗植入术的绝对禁忌证,其术后言语康复效果与内耳结构正常者无明显差异,但手术难度比内耳结构正常者要大,术前应根据不同的畸形类型制定个性化的手术方案,以减少并发症的发生。Objective To analyze the surgical efficacy of cochlear implantation in patients with inner ear malformations.Methods Clinical data of 30 patients with inner ear malformations underwent cochlear implantation in our department from Jan. 2011 to July 2017 were analyzed retrospectively. The involved inner ear malformations included large vestibular aqueduct syndrome(LVAS, n=8), Mondini deformity(incompletely separated typeⅡ,n=7), LVAS combined with Mondini deformity(n=10), and internal auditory canal stenosis(n=5). 30 implantees with a normal inner ear structure were randomly selected as control. The evaluation was performed using the categories of auditory performance(CAP) and speech intelligibility rating(SIR). The preoperative hearing, intraoperative condition and postoperative hearing and speech rehabilitation outcomes of the two groups were compared. Results All the patients in both groups obtained meaningful auditory reaction after cochlear implantation. Intraoperative perilymph fluid gushing occurred at different levels in 3 cases with LVAS, and cerebrospinal fluid gusher in one with Mondini deformity. The indifference of postoperative hearing and speech rehabilitation outcomes between the two groups were statistically insignificant(P>0.05). In both groups, hearing and speech rehabilitation outcomes at 3, 6, 9 and 12 months after operation were obviously improved compared with the preoperative ones(all P<0.05). Conclusions The inner ear malformations are not absolute contraindications for cochlear implantation. There are no significant differences in hearing and speech rehabilitation outcomes between the patients with normal and abnormal inner ear structures. However, the inner ear malformations increase the difficulty of operation. Selection of a proper surgical procedure according to the type of the inner ear malformation can reduce the incidence of complications.

关 键 词：人工耳蜗植入 内耳发育畸形 康复疗效 

分 类 号：R764.93[医药卫生—耳鼻咽喉科]