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目的:探讨中耳乳突炎性改变对人工耳蜗置入术的影响。方法:9例行人工耳蜗置入术患者均伴有中耳乳突炎性改变。1例乳突根治术后Ⅱ期行人工耳蜗置入及应用耳廓软骨软骨膜复合物重建并加强后鼓室外侧壁及外耳道后壁;1例慢性中耳炎伴鼓膜穿孔Ⅰ期行人工耳蜗置入及应用耳廓软骨软骨膜复合物重建鼓膜;3例隐性中耳乳突炎,Ⅰ期行改良乳突开放术并人工耳蜗置入术;3例硬化型乳突伴鼓室粘连,Ⅰ期行鼓室探查并人工耳蜗置入术;1例慢性中耳乳突炎伴松弛部内陷袋形成,Ⅰ期行上鼓室开放及软骨软骨膜复合物重建上鼓室外侧壁并人工耳蜗置入术。结果:术中所有的电极均顺利置入,并经术中检测电极完好,电阻测试效果满意。术后伤口均甲级愈合,1个月后均开机成功。随访无并发症。结论:对于慢性中耳乳突炎的患者,若欲行Ⅱ期人工耳蜗置入术,Ⅰ期中耳乳突手术应尽可能保留相关解剖结构。对于隐性中耳乳突炎的患者在确保鼓窦乳突、上鼓室、咽鼓管口三处引流均通畅的前提下可行Ⅰ期人工耳蜗置入。对于病变局限的上鼓室胆脂瘤,有经验的术者可以选择Ⅰ期手术,但一定要慎重。感染因素很可能在乳突汽化不良及不明原因先天性感音神经性聋的发病中起着重要的作用。对于乳突硬化、乙状窦前移严重的患者可选择经外耳道鼓岬开窗。对于人工耳蜗置入术时的鼓膜修补术,上鼓室外侧壁或外耳道后壁重建选择软骨软骨膜复合物可以提高成功率,加固鼓膜避免内陷及电极脱出。
Objective: To investigate the effect of otitis media on the cochlear implant after inflammatory changes. Methods: Nine patients underwent cochlear implantation were accompanied by otitis media with inflammatory changes. One case of radical mastectomy performed cochlear implantation and application of auricular cartilage perichondrium composite to reconstruct and strengthen the posterior wall of the posterior tympanic cavity and the posterior wall of the external auditory canal. One case of chronic otitis media with perforation of the tympanic membrane underwent cochlear implantation Auricular cartilage and perichondrium composite was used to reconstruct the tympanic membrane. Three cases of occult otitis media were treated with modified mastoid open surgery and cochlear implantation. Three cases with scleroderma with tympanic adhesions, Exploration and cochlear implantation; 1 case of chronic otitis media with flaccid invagination bag formation, stage Ⅰ on the tympanic opening and cartilaginous cartilage complex reconstruction on the outer wall of the tympanic cavity and cochlear implantation. Results: All the electrodes were successfully placed in the operation, and the electrodes in operation were in good condition and the resistance test results were satisfactory. Postoperative wounds were grade A healing, 1 month after the boot are successful. No complications were followed up. CONCLUSIONS: For patients with chronic otitis media who have stage II cochlear implants, stage I otitis media should retain the relevant anatomical structure as much as possible. For patients with latent otitis media Otitis mediais mastoidectomy, upper tympanic cavity, eustachian tube drainage are smooth under the premise of three feasible cochlear implants. For the limitations of the tympanosclerosis cholecystolithiasis, experienced surgeons can choose Ⅰ surgery, but we must be careful. Infectious factors are likely to play an important role in the pathogenesis of mastoidal vaporization and idiopathic sensorineural deafness of unknown origin. For mastoid sclerosis, sigmoid sinus advanced patients may choose to have the ear canal Drum Cape window. For the repair of tympanic membrane during cochlear implantation, the selection of cartilaginous perichondrium composite on the lateral wall of the tympanic cavity or the posterior wall of the external auditory meatus can improve the success rate and strengthen the tympanic membrane to avoid invagination and electrode prolapse.