外中耳畸形患者人工耳蜗植入的注意事项  

Point to Consider in Cochlear Implantation for Patients with Microtia and Atresia

作　　者：刘军[1,2] LIU Jun

机构地区：[1]解放军总医院第六医学中心耳鼻咽喉头颈外科医学部/国家耳鼻咽喉疾病临床医学研究中心,北京100037 [2]解放军总医院第七医学中心耳鼻咽喉头颈外科,北京100700

出　　处：《中国听力语言康复科学杂志》2023年第2期121-124,共4页Chinese Scientific Journal of Hearing and Speech Rehabilitation

基　　金：北京市科技计划首都市民健康项目培育基金(Z131100004013019);解放军总医院临床科研扶持基金课题(2012FCTSYS-4017);解放军总医院科技创新基金项目(06ZY13)。

摘　　要：重度-极重度感音性聋且助听器验配效果不佳是人工耳蜗植入的适应证。当人工耳蜗植入患者合并外中耳畸形时,术前评估、手术和术后康复有其特点。外中耳畸形患者需完成听力学和助听器效果评估,外耳道闭锁可对纯音测听、声导抗、耳声发射和气导ABR阈值的检查产生影响,需结合骨导ABR阈值检测。影像学评估包括CT和磁共振成像,以明确解剖结构,有助于确定手术计划。外中耳畸形患者行人工耳蜗植入手术时需关注手术入路的解剖是否异常,尤其是面神经畸形、内耳畸形,备面神经监测和术中CT,避免损伤面神经,确保电极植入位置准确;整形和听功能重建均十分重要,需设计切口,尽量减少对后期矫正耳廓畸形手术的影响。因患者无正常的耳廓悬挂,所以术后需要使用特殊设计的言语处理器。术后疗效评估包括听阈、言语识别率、有意义听觉整合量表(meaningful auditor integration scale,MAIS)/听觉行为分级问卷(CAP)等问卷可了解患者的听说能力,与外中耳形态正常人群相似。当外中耳畸形患者需要进行人工耳蜗植入时要考虑其解剖、手术的特殊性,减少并发症的发生。Severe-profound hearing loss with poor hearing aids was an indication for cochlear implantation(CI). Preoperative evaluation, surgery and postoperative rehabilitation had their own characteristics in CI patients with microtia and atresia(MA).Audiological and hearing aid evaluation should be completed in patients with MA. Pure tone audiometry, acoustic immittance,otoacoustic emission and ABR thresholds of air conduction could be affected by the external auditory meatus atresia. So the ABR bone conduction threshold should be taken into consideration. Imaging evaluations includes the temporal bones high-resolution computed tomography(HRCT) and the cerebral magnetic resonance imaging(MRI) should be performed to provide anatomy information, which were important to the surgical plans. When CI was performed in patients with MA, it was necessary to pay attention to the ones who were with abnormal anatomy, especially the facial nerve and inner ear malformations. The facial nerve monitoring and intraoperative CT should be used to avoid injury of facial nerve and make sure that the electrode location was accurate. It was necessary to minimize the incision to the second stage operation of auricle deformity. A specially designed speech processor was needed after the operation, because there was no normal auricle suspension. Similar to the CI patients with normal anatomy, the hearing threshold, speech recognition rate and MAIS/CAP could be used to assess the hearing and speaking ability. So, to the CI patients with MA, we should consider the characteristics of anatomy and operation to reduce the occurrence of complications.

关 键 词：小耳畸形 外耳道闭锁 人工耳蜗植入 面神经畸形 疗效 评估 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]