目的:本研究的目的是介绍一个机构的人工耳蜗再植入(CRI)的经验,评估手术挑战和术后结果,并提高CRI的成功率。
方法:回顾性单机构研究。
方法:三级医疗中心。
方法:我们回顾性评估了2001年至2022年在三级中心治疗的76例再植入病例的数据。临床特征包括听力损失的病因,失败的类型,手术问题,和听觉言语表现进行了分析。使用分类听觉表现(CAP)和语音清晰度等级(SIR)评分来评估CRI前后的结果。
结果:CRI人群包括来自我们研究所的7名患者,69名来自其他中心的转诊患者。设备故障是CRI最常见的原因(68/76,89.5%);此外,有7例医疗故障,1例同时出现软装置故障。医疗失败包括皮瓣破裂和设备挤压,磁铁迁移,听神经病,白质脑病,异物残留和脑膜炎.在21/76患者中,电极技术升级。平均失败时间为0.58-13年,平均4.97年。CRI前后的平均(±SD)CAP和SIR评分分别为5.2±1.2和5.5±1.1和3.4±1.1和3.5±1.1。6例严重耳蜗畸形患者表现不佳,听觉神经发育不良,白质脑病,和癫痫。
结论:CRI手术是一项具有挑战性但相对安全的手术,大多数再植入患者术后结局良好.内科并发症和耳蜗内损伤是术后效果不佳的主要原因。因此,为了获得最佳效果,应进行充分的术前准备和无创伤CRI.
OBJECTIVE: The aim of this study was to present an institution\'s experience with cochlear reimplantation (CRI), to assess surgical challenges and post-operative outcomes and to increase the success rate of CRI.
METHODS: Retrospective single-institution study.
METHODS: Tertiary medical center.
METHODS: We retrospectively evaluated data from 76 reimplantation cases treated in a tertiary center between 2001 and 2022. Clinical features including etiology of hearing loss, type of failure, surgical issues, and auditory speech performance were analyzed. Categorical Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scores were used to evaluate pre- and post-CRI outcomes.
RESULTS: The CRI population comprises of 7 patients from our institute,69 referred patients from other centers. Device failure was the most common reason (68/76, 89.5 %) for CRI; in addition, there were 7 medical failures and 1 had both soft device failure. Medical failures included flap rupture and device extrusion, magnet migration, auditory neuropathy, leukoencephalopathy, foreign-body residue and meningitis. In 21/76 patients, the electrode technology was upgraded. The mean time to failure was 0.58-13 years, with a mean of 4.97 years. The mean (± SD) CAP and SIR scores before and after CRI were 5.2 ± 1.2 versus 5.5 ± 1.1 and 3.4 ± 1.1 versus 3.5 ± 1.1, respectively. Performance was poor in six patients with severe cochlear malformation, auditory nerve dysplasia, leukoencephalopathy, and epilepsy.
CONCLUSIONS: CRI surgery is a challenging but relatively safe procedure, and most reimplanted patients experience favorable postoperative outcomes. Medical complications and intracochlear damage are the main causes of poor postoperative results. Therefore, adequate preoperative preparation and atraumatic CRI should be carried out for optimal results.