成人人工耳蜗受者耳蜗-面神经裂的发生率及面神经刺激

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology Pub Date : 2025-06-18 DOI:10.1002/lio2.70181

Ezer H. Benaim, Michael W. Canfarotta, Margaret E. Richter, Margaret T. Dillon, Nicholas J. Thompson

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引用次数: 0

摘要

目的评估人工耳蜗（CI）受者耳蜗-面神经裂（CFD）的发生率，测量耳蜗-面神经隔宽（CFPW），并分析存在或不存在面神经刺激（FNS）时，CFD与CFPW的关系。方法对294例成人CI受术者314耳进行回顾性分析。两名盲法评估者测量了CFPW，并通过术前或术后高分辨率计算机断层扫描（CT）确定了CFD病例。分析包括CFPW和CFD与FNS的关联，FNS被定义为由CI刺激引起的面部运动。我们回顾了听力学和外科资料，以了解FNS的电极特征和处理方法。结果评价者对CFPW测量结果具有良好的等级间信度（类内相关系数= 0.974）。有FNS的耳CFPWs（中位数：0.40 mm）明显小于无FNS的耳(中位数：0.48 mm；p = 0.003)。CFD患病率为3.2% (n = 10)， 70%的CFD患者发生FNS（相对危险度[RR] = 14.2, 95% CI: 6.88-25.50, p < 0.001）。无论电极类型（侧壁电极还是预弯曲电极），CFD病例均显示更高的FNS发生率。结论CFD是CI受者发生FNS的危险因素。术前高分辨率CT可识别FNS高风险的CFD患者；然而，使用预弯曲电极阵列可能不会降低这一人群发生FNS的风险。需要研究降低CFD患者FNS风险的干预措施。证据级别3

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Prevalence of Cochlear-Facial Nerve Dehiscence and Facial Nerve Stimulation for Adult Cochlear Implant Recipients

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Prevalence of Cochlear-Facial Nerve Dehiscence and Facial Nerve Stimulation for Adult Cochlear Implant Recipients

Objectives

To estimate the prevalence of cochlear-facial nerve dehiscence (CFD) in cochlear implant (CI) recipients, measure cochlear-facial nerve partition width (CFPW), and analyze the relationship of CFD and CFPW for the presence or absence of facial nerve stimulation (FNS).

Methods

A retrospective review of 314 ears from 294 adult CI recipients was conducted. Two blinded reviewers measured CFPW and identified cases with CFD from the preoperative or postoperative high-resolution computed tomography (CT) scan. Analyses included the associations of CFPW and CFD with FNS, defined as facial movement elicited by CI stimulation. Audiologic and surgical data were reviewed for electrode characteristics and management of FNS.

Results

Reviewers had excellent inter-rater reliability for CFPW measurements (intraclass correlation coefficient = 0.974). CFPWs were significantly smaller in ears with FNS (median: 0.40 mm) compared to those without FNS (median: 0.48 mm; p = 0.003). The prevalence of CFD was 3.2% (n = 10) and 70% of cases with CFD experienced FNS (relative risk [RR] = 14.2, 95% CI: 6.88–25.50, p < 0.001). Cases with CFD demonstrated a higher rate of FNS regardless of electrode type (lateral wall versus precurved).

Conclusion

CFD is a risk factor of FNS in CI recipients. Preoperative high-resolution CT can identify patients with CFD that are at high risk for FNS; however, use of a precurved electrode array may not reduce the risk for FNS in this population. Investigation is needed of interventions to mitigate FNS risk in patients with CFD.