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

LIU Jun

doi:10.3969/j.issn.1672-4933.2023.02.003

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

Expert Forum | 更新时间：2023-05-22

- Point to Consider in Cochlear Implantation for Patients with Microtia and Atresia
- Chinese Scientific Journal of Hearing and Speech Rehabilitation Vol. 21, Issue 2, Pages: 121-124(2023)
- 作者机构：
  
  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
- 作者简介：
- 基金信息：
- DOI：10.3969/j.issn.1672-4933.2023.02.003
  CLC：
- Published：15 March 2023，
  
  Received：26 February 2023，
- 稿件说明：
移动端阅览
刘军.外中耳畸形患者人工耳蜗植入的注意事项[J].中国听力语言康复科学杂志,2023,21(02):121-124.

LIU Jun.Point to Consider in Cochlear Implantation for Patients with Microtia and Atresia[J].Chinese Scientific Journal of Hearing and Speech Rehabilitation,2023,21(02):121-124.
刘军.外中耳畸形患者人工耳蜗植入的注意事项[J].中国听力语言康复科学杂志,2023,21(02):121-124. DOI： 10.3969/j.issn.1672-4933.2023.02.003.

LIU Jun.Point to Consider in Cochlear Implantation for Patients with Microtia and Atresia[J].Chinese Scientific Journal of Hearing and Speech Rehabilitation,2023,21(02):121-124. DOI： 10.3969/j.issn.1672-4933.2023.02.003.

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。

Abstract

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

Keywords

MicrotiaExternal auditory meatus atresiaCochlear implantationFacial nerve malformationOutcomeEvaluation

references

中华耳鼻咽喉头颈外科杂志编辑委员会耳科组,中华医学会耳鼻咽喉头颈外科学分会耳科学组,中华医学会整形外科学分会耳再造学组.先天性外中耳畸形临床处理策略专家共识[J].中华耳鼻咽喉头颈外科杂志,2015,50(3):182-186.

中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会,中国残疾人康复协会听力语言康复专业委员会.人工耳蜗植入工作指南(2013). 中华耳鼻咽喉头颈外科杂志, 2014, 49(02): 89-95.

唐菲, 杨崇灵, 刘昭颖,等. 人工耳蜗植入术前筛查的注意事项[J]. 中国听力语言康复科学杂志, 2023, 21(1):4-7.

张山山,李万鑫,刘军,等.海南省人工耳蜗植入捐赠项目术前筛查结果分析[J].中国听力语言康复科学杂志,2016,15 (1):76-80

史文迪,陈佳慧,王永华,等.先天性外中耳畸形的早期听力诊断与干预策略[J].中国听力语言康复科学杂志,2021,19(4):265-269.

Hodgetts WE,Scollie SD.DSL prescriptive targets for bone conduction devices: adaptation and comparison to clinical fittings[J].International Journal of Audiology,2017,56(7):521-530.

张宇丽,刘军.大前庭水管综合征的临床表现、诊断及防治策略[J]. 听力学及言语疾病杂志,2014,22(4):436-436.

Zhang DJ,Yuan YY,Dai P,et al.Sequential bilateral cochlear implantation in a child with severe external,middle,and inner ear malformations:surgical considerations and practical aspects[J].ORL;journal for oto-rhino-laryngology and its related specialties,2021, 83(6):471-477.

Svrakic M.Rare case of bilateral aural atresia and cochlear dysplasia:when cochlear implantation is not the answer[J].Cochlear implants international,2018,19(4):234-238.

刘军,张宇丽,陈星睿,等.人工耳蜗植入术后发生面瘫的预防及处理[J].中国听力语言康复科学杂志,2012,10(5):337-339.

刘军,戴朴,洪梦迪,等.259例人工耳蜗植入的并发症分析和处理[J]. 中国听力语言康复科学杂志,2007,22(3):21-23.

刘军,戴朴,红梦迪,等.人工耳蜗植入手术知情同意书填写情况分析[J]. 中华耳科杂志,2008,6(4):420-423.

刘军,戴朴,冀飞,等.人工耳蜗植入脑脊液井喷原因及处理[J]. 中华耳科杂志,2008,6(2):176-179.

李万鑫,刘军,武文明,等. 人工耳蜗植入术中脑脊液井喷的原因分析及处理[J]. 中华耳科学杂志,2017,15(4):436-440.

Karen L,Michelle SM,William HS,et al.Combined microtia and aural atresia: issues in cochlear implantation[J].The Laryngoscope,2005,115(1):39-43.

刘军,杨仕明. 人工耳蜗及相关技术的进展[J]. 中国耳鼻咽喉颅底外科杂志, 2019, 25(5): 449-455.

刘军,于飞,戴朴,等. 人工耳蜗植入患者GJB2基因突变检测及耳蜗植入疗效分析.中华医学杂志 2009,89(7):433-437.

刘军,戴朴,韩东一.人工耳蜗植入的效果评估[J]. 中华耳科学杂志,2007,5(1):21-25.

于萍,迟美芬,刘军.语前聋青少年人工耳蜗植入发音清晰度与嗓音声学参数的分析[J]. 中国听力语言康复科学杂志,2007,23(4):35-37.

李佳楠,杨仕明,刘军,等.人工耳蜗不同电极植入术后听觉康复效果比较[J]. 中国听力语言康复科学杂志,2007,24(5):21-25.

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