耳蜗性耳硬化症人工耳蜗植入的应用研究

Application of cochlear implantation for cochlear otosclerosis

摘要:

分析耳蜗性耳硬化症患者的临床特点、人工耳蜗植入术中情况及人工耳蜗植入术后听觉言语康复效果，为该疾病的诊治提供参考。方法分析4例耳蜗性耳硬化症患者病史资料、听力学检查结果及影像学结果，观察人工耳蜗植入手术的术中所见，并定期对4例患者进行听力学及影像学随访。结果①所有患者人工耳蜗电极均经圆窗膜径路完全植入鼓阶。其中1例于术中发现镫骨完全固定，导致术中鼓阶开孔时外淋巴波动不明显；1例发现圆窗膜骨化，术中鼓阶开孔定位困难；其余2例患者镫骨活动好，圆窗结构清晰。所有患者术中电极阻抗检测均正常，且引出标准的神经反应遥测波形；②术后随访1~5年无术后并发症出现，声场测听示平均听阈为40.8 dBHL，平均言语识别率为77.3%，言语及交流能力较术前提高；颞骨高分辨率CT提示双侧内耳病变范围无明显进展。结论耳蜗性耳硬化症进展缓慢，严重时可导致重度/极重度感音神经性聋，当使用助听器无效时，人工耳蜗植入能帮助患者获得较满意的听觉康复效果。

Abstract:

ObjectiveTo analyze the clinical characteristics of cochlear otosclerosis and surgical findings during cochlear implantation as well as the auditory rehabilitation after cochlear implantation so as to provide reference for the diagnosis and treatment of this disease.MethodsClinical data including the past medical history, audiological outcome and imaging findings of 4 patients with cochlear otosclerosis were analyzed retrospectively. For all the 4 patients, intraoperative findings were obtained during cochlear implantation with regular postoperative followup by audiological examination and imaging examination.Results①The electrodes were completely inserted into the scala tympani through round window membrane in all the 4 patients. As for the intraoperative findings, complete fixation of the stape was found in one patient and caused unconspicuous perilymph fluctuations during scala tympani opening. Another patient was observed to have ossification of round window membrane resulting in difficult position determination of scala tympani. The other two had normal ossicular chain and round window. Intraoperative electrode impedance detection was normal in all patients with elicitation of standard nerve response telemetry waveforms. ② Postoperative followup for 1 year to 5 year showed no complications with 40.8dBHL of average hearing threshold of sound field audiometry and 77.3% of average speech recognition rate as well as improved communication skills in all the patients. The high resolution computed tomography of the temporal bone revealed no obvious progresses of bilateral inner ear lesions.ConclusionsCochlear otosclerosis usually progresses slowly. When the patient’s hearing level progresses to severeprofound sensorineural hearing loss and the hearing aid isn’t effective any longer, a satisfactory auditory rehabilitation effect can be obtained after cochlear implantation.