脑膜炎后耳蜗骨化患者人工耳蜗植入的临床分析

Cochlear implantation in patients with cochlear ossification after meningitis

摘要:

目的总结因脑膜炎而致严重感音神经性听力损失的人工耳蜗植入经验，探讨其诊疗策略。方法回顾性分析2010年9月—2020年9月于首都医科大学附属北京同仁医院耳鼻咽喉头颈外科因脑膜炎致重度及极重度感音神经性听力损失进行人工耳蜗植入的22例患者资料，其中成人13例，儿童9例。对其术前影像学、手术所见进行分析。结果颞骨HRCT检查中16例(72.7%)诊断耳蜗骨化；6例(27.3%)未诊断，但经手术探查证实存在耳蜗骨化。18例内耳MRI检查中，3例(16.7%)未发现耳蜗信号改变，而经手术探查存在耳蜗骨化。两者结合后检出率为90.9%(20/22)，20例(90.9%)可见合并半规管等其他迷路病变。术中未见耳蜗骨化者1例(4.5%)，圆窗骨化7例(31.8%)，耳蜗底转骨化14例(63.6%)。电极完全植入者18例(81.8%)，部分植入者4例（18.2%）。结论脑膜炎后耳蜗骨化可致严重感音神经性听力损失，人工耳蜗是理想的治疗策略，建议尽早植入。术前颞骨HRCT和MRI对确定是否适合耳蜗植入和术前计划至关重要，诊断存在假阴性，但联合检查可大大提高耳蜗骨化的术前诊断阳性率。

Abstract:

ObjectiveTo explore the strategy of cochlear implantation in patients with cochlear ossification after meningitis.MethodsA retrospective study was conducted. Medical records of patients diagnosed as severeprofound sensorineural hearing loss due to cochlear ossification after meningitis and undergone cochlear implantation in our department from Sept. 2010 to Sept. 2020 were collected and reviewed. Twentytwo patients (9 children and 13 adults) with unilateral cochlear implantation were included. Preoperative imagings and intraoperative findings were analyzed.ResultsCochlear ossification was confirmed by preoperative temporal highresolution computed tomography (HRCT) in 16 cases (63.7%), and 6 cases (27.3%) without preoperative HRCT findings were confirmed as having cochlear ossification during cochlear implantation. Of the 18 cases with preoperative inner ear magnetic resonance imaging (MRI), 3 cases (16.7%) without any cochlear MRI signal changes were confirmed as having cochlear ossification during surgery. Combination of CT and MRI could achieve a detection rate of 90.9%, and ossified labyrinths such as ossification of semicircular canal were found in 20 cases (90.9%). There was no cochlea ossification in 1 case (4.5%), ossification of round window in 7 (31.8%), and ossification of cochlear basal turn in 14 (63.6%). Eighteen cases (81.8%) had complete electrode implantation and 4 (18.2%) had partial electrode implantation.ConclusionsCochlear ossification after meningitis can cause profound sensorineural hearing loss. Cochlear implantation is an ideal treatment strategy and should be performed as soon as possible. Preoperative temporal bone HRCT and inner ear MRI are essential for determining whether it is suitable for cochlear implantation and preoperative planning. Diagnosis of imaging can be false negative, but the combination of CT and MRI can greatly improve the positive rate of preoperative diagnosis of cochlear ossification.