Minimizing Intracochlear Trauma during Cochlear Implantation
Minimizing Intracochlear Trauma during Cochlear Implantation
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DOI：
10.1159/000262601
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发表时间：
2010-01-01
期刊：
影响因子：
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通讯作者：
Buchman, Craig A.
中科院分区：
文献类型：
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作者：
Adunka, Oliver F.;Pillsbury, Harold C.;Buchman, Craig A.
一些临床试验已经证明了同侧双峰电和声刺激听觉系统对不同程度听力损失患者的可行性和益处。作为这些研究的一部分，所采用的手术技术是相似的，并侧重于实施无创伤手术原则。每一个手术步骤都旨在最大限度地减少脑内损伤。位于圆窗膜下方和稍前方的耳蜗造口部位形成了用于创建通向鼓阶的开口的基础，该开口避开了内耳的关键结构。电极阵列也已经被开发和改进，以允许相对有限的插入相关的损伤。使用这些专门的方法，听力保护率接近90%。虽然令人印象深刻，但这个数字反映了只有一定程度的剩余听力的保护。完全保留听力而没有纯音阈值和/或辨别能力的任何损失仍然是不寻常的，特别是在接受了全转插入的受试者中。因此，显然需要进一步的工作来优化手术方案，以在所有情况下实现完全的听力保护。各种生物和技术领域的调查有望实现这些目标。本报告将回顾听力保留人工耳蜗植入术的现状，因为它涉及到同侧双峰或电声联合刺激。版权所有（C）2010 S. Karger AG，巴塞尔
Several clinical trials have now demonstrated the feasibility and benefit of ipsilateral bimodal electric and acoustic stimulation of the auditory system for patients with varying degrees of hearing loss. Surgical techniques employed as a part of these investigations have been similar and focus on the implementation of atraumatic surgical principles. Each procedural step aims at minimizing intracochlear damage. A cochleostomy site inferior and slightly anterior to the round window membrane forms the basis for creating an opening into the scala tympani that avoids the critical structures of the inner ear. Electrode arrays have also been developed and refined to allow for relatively limited insertion-related damage. Using these specialized approaches, hearing preservation rates approaching 90% have been achieved. While impressive, this number reflects the conservation of only some degree of residual hearing. Complete preservation of hearing without any loss in pure tone thresholds and/or discrimination abilities remains unusual, especially in subjects that have received a full-turn insertion. Thus, further work is clearly needed to optimize surgical protocols in an attempt to achieve total hearing preservation in all cases. A variety of biological and technological areas of investigation hold promise for fulfilling these goals. This report will review the current state of hearing preservation cochlear implantation as it relates to combined ipsilateral bimodal or electric acoustic stimulation. Copyright (C) 2010 S. Karger AG, Basel