Cochlear implant failures and revision
Cochlear implant failures and revision
复制标题
DOI：
10.1097/01.mao.0000178123.35988.96
复制
发表时间：
2005-07-01
影响因子：
2.1
通讯作者：
Telian, SA
中科院分区：
文献类型：
--
作者：
Lassig, AAD;Zwolan, TA;Telian, SA
目的：回顾一个大型人工耳蜗植入项目中涉及植入失败和翻修手术的病例。研究设计：回顾性病例系列。设置：一个学术医疗中心的人工耳蜗植入项目。患者：接受人工耳蜗植入翻修术的成人和儿童（n = 58）。干预：人工耳蜗植入失败的诊断和修复，随后重新植入。评估植入功能和语音perception.Main Outcome Measures：器械类型，从植入到翻修的时间，失败原因，原始植入物与翻修的性能，放置的电极数量，以及与reimplantation.Results相关的手术挑战：45例最初在该程序中植入的患者和13例在其他地方植入的患者接受了翻修手术。机构器械失效率为3.7%，总体翻修率为5.1%。植入物翻修的原因包括记录的内部器械故障（46%）、头皮瓣并发症（17%）、电极放置优化（13%）、无法解释的性能恶化（12%）、技术升级（10%）和颞内病理（3%）。翻修手术通常仅涉及较小的解剖挑战，但5名患者需要进行环蜗轴钻孔手术以改善电极位置。58例中有53例的电极插入相等或更深。言语感知能力下降，只有三个patients.Conclusions：植入失败的管理和翻修手术的性能在人工耳蜗植入程序变得越来越重要。结果一般都很好。翻修植入术是一种安全和适当的手术，当患者出现人工耳蜗植入失败时，应及时进行。
Objective: To review cases involving implant failure and revision surgery in a large cochlear implant program.Study Design: Retrospective case series.Setting: Cochlear implant program in an academic medical center. Patients: Adults and children who underwent revision cochlear implantation (n = 58).Intervention: Diagnosis and explantation of failed cochlear implants, with subsequent reimplantation. Assessment of implant function and speech perception.Main Outcome Measures: Device type, time from implantation to revision, cause of failure, performance with original implant versus revision, number of electrodes placed, and surgical challenges related to reimplantation.Results: Forty-five patients initially implanted at this program and 13 patients implanted elsewhere underwent revision surgery. The institutional device failure rate was 3.7% and the overall revision rate was 5.1%. Reasons for implant revision included documented internal device failure (46%), scalp flap complications (17%), optimization of electrode placement (13%), unexplained deterioration of performance (12%), technology upgrade (10%), and intratemporal pathology (3%). Revision surgery typically involved only minor anatomic challenges, but five patients required circumodiolar drillout procedures to improve electrode position. Electrode insertion was equal or deeper in 53 of 58 cases. Speech perception ability decreased in only three patients.Conclusions: Management of implant failures and performance of revision surgery are becoming increasingly important in cochlear implant programs. Outcomes are generally excellent. Revision implantation is a safe and appropriate procedure that should be pursued in a timely fashion when patients experience cochlear implant failure.