晚期耳硬化症的人工耳蜗植入术:应对手术和决策的挑战

IF 0.1 Q4 OTORHINOLARYNGOLOGY
Shalabh Sharma, S. Singh, Anandita Gupta, A. K. Lahiri, Meenakshi Wadhera
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引用次数: 0

摘要

耳蜗植入术和镫骨切开术加助听器是晚期耳硬化症患者可接受的手术康复模式。CI的手术挑战包括电极插入和面神经刺激相关的困难。据报道,在许多患者中,镫骨切除术和助听器的使用在言语辨别评分和总体满意度方面的改善很差,但作为一种低成本的手术,它可能被用作一小部分患者的初始管理。病例报告:46岁弥漫性融合性耳膜后硬化患者行人工耳蜗植入术。使用行为阈值对患者进行定位,因为尽管耳蜗内电极放置,术中和术后均未记录到神经反应。使用磨牙周围电极和氟化钠治疗来克服FNS问题。CI后18个月,患者听力学结果良好(CAP 7),无任何FNS。结论:高分辨率计算机断层扫描、气骨间隙和言语识别评分对制定远晚期耳硬化患者的治疗方案具有重要意义。言语辨别评分差、耳蜗病变广泛的患者可考虑早期人工耳蜗植入术。充分的术前计划可以防止面神经刺激。孟加拉国[J] otorhinolyngol 2022;28 (1): 112 - 117
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cochlear Implantation in Advanced Otosclerosis: Rising to the Challenges of Surgery and Decision making
Introduction: Cochlear implantation as well as stapedotomy followed by use of hearing aid are acceptable modes of surgically rehabilitating patients with far advanced otosclerosis. Surgical challenges of CI include difficulties associated with electrode insertion and facial nerve stimulation. Improvement in speech discrimination scores and overall satisfaction with stapedotomy and hearing aid use are reportedly poor in many patients, yet being a low cost procedure it may be used as initial management in a subset of patients. Case Report: 46 year old patient with diffuse confluent retrofenestral otoscerosis underwent cochlear implantation. He was mapped using behavioral thresholds as despite intracochlear electrode position no neural response was recordable per-operatively as well as in the postoperative period. Perimodiolar electrodes and sodium flouride therapy were used to overcome problems of FNS. 18 months post CI the patient has good audiologic outcomes (CAP 7) without any FNS. Conclusion: High resolution computed tomography, air bone gap and speech discrimination scores are important in formulating treatment plan in patients with far advanced otosclerosis. Early cochlear implantation can be considered in patients with poor speech discrimination scores and extensive cochlear lesions. Facial nerve stimulation can be prevented by adequate pre-operative planning. Bangladesh J Otorhinolaryngol 2022; 28(1): 112-117
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