RESUMO
Objective:To investigate the predictive value of temporal bone high-resolution CTï¼HRCTï¼ multiplanar reconstructionï¼MPRï¼ for cerebrospinal fluidï¼CSFï¼ gusher during cochlear implantation in patients with inner ear malformation. Methods:The clinical data of 33 patientsï¼36 earsï¼ with inner ear malformation who underwent cochlear implantation were retrospectively analyzed. The predictive value of HRCT for cerebrospinal fluid gusher during cochlear implantation was evaluated. Results:The width of the cochlear foramenï¼P=0.024, OR=1.735ï¼ and the diameter of the inner auditory meatusï¼P=0.022, OR=6.119ï¼ were independent risk factors for CSF gusher during cochlear implantation. The area under the curveï¼AUCï¼ of cochlear foramen width in predicting intraoperative gusher was 0.851, the sensitivity was 93.33%, and the specificity was 61.90%. The AUC of the upper and lower diameter of the internal auditory canal for predicting intraoperative gusher was 0.848, the sensitivity was 80.00%, and the specificity was 80.95%. The AUC of cochlear foramen width combined with the upper and lower diameters of the internal auditory meatus for predicting intraoperative gusher was 0.930, the sensitivity was 80.00%, and the specificity was 95.24%. Conclusion:Based on temporal bone HRCT, the prediction model of cochlear foramen width combined with the upper and lower diameter of the internal auditory canal has crucial predictive value for the "gusher" during cochlear implantation in patients with inner ear malformation.
Assuntos
Vazamento de Líquido Cefalorraquidiano , Implante Coclear , Orelha Interna , Osso Temporal , Implante Coclear/efeitos adversos , Osso Temporal/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Humanos , Orelha Interna/anormalidades , Orelha Interna/cirurgiaRESUMO
OBJECTIVES: To evaluate the safety and feasibility of cochlear implantation (CI) in irradiated ears of nasopharyngeal carcinoma (NPC) patients. STUDY DESIGN: A retrospective study. METHODS: From 2008 to 2017, 10 adults with binaural severe or profound sensorineural hearing loss subsequent to radiotherapy for NPC underwent CI in our center. The mean follow-up was 63.2 months. Hearing and speech performance were evaluated pre- and postoperatively with audiometric and speech discrimination testing, Category of Auditory Performance, Speech Intelligibility Rating, and Chinese version of Nijmegen Cochlear Implant Questionnaire. RESULTS: According to the severity of radioactive osteomyelitis of temporal bone, patients were classified into three categories: mild, moderate, and severe. Patients in mild category underwent routine CI. Patients in moderate category underwent extended radical mastoidectomy and CI simultaneously. Patients in severe category underwent subtotal temporal bone resection, external auditory canal elimination, and CI simultaneously or by stage. There was no massive hemorrhage, facial paralysis, or nonunion of incision after operation. One suffered from radiation encephalopathy 13 months postoperatively; since then, the cochlear implant has been idle. The other nine patients demonstrated encouraging results of hearing and speech performance. CONCLUSION: CI for postirradiated ears of NPC is safe and feasible. Strict control of operative indications and extra care during surgery are required. Individual surgical plan should be made according to the severity of radioactive osteomyelitis. Choose one-stage surgery as much as possible in severe cases to avoid the risk of difficulty in locating round window in second-stage surgery. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:649-655, 2021.
Assuntos
Implante Coclear , Perda Auditiva Neurossensorial/cirurgia , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/radioterapia , Lesões por Radiação/complicações , Idoso , Audiometria , Estudos de Viabilidade , Feminino , Perda Auditiva Neurossensorial/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Testes de Discriminação da Fala , Inteligibilidade da Fala , Resultado do TratamentoRESUMO
Objective:To analysis the long-term outcomes of ossicular chain reconstruction using the malleostapedotomyï¼MTï¼. Method:A total of 11 patientsï¼12 earsï¼ underwent MT and their hearing levels were measured prior to surgery, 1 week and more than 1 year after surgery. The indications of MT were discussed and its safety and efficacy were evaluated in terms of the intra-operative findings, post-operative hearing and complications. Result:Among 11 patientsï¼12 earsï¼, there were 1 patientï¼1 earï¼ with tympanosclerosis, 3 patientsï¼4 earsï¼ with ossicular chain deformity, 5 patientsï¼5 earsï¼ with otosclerosis and 2 patientsï¼2 earsï¼ with localized cholesteatoma of the middle ear. No cases of bone conduction hearing lossï¼more than 10 dBï¼ were observed within 2 weeks after surgery while four patients suffered from short-term vertigo with an average remission duration of 3 days. And no recurrence was found in the two patients with cholesteatoma. After a follow-up of 1-6 years, we found a remarkable improvement of air conduction without bone conduction loss in all patients and there was a significant difference between preoperative and post-operative air-bone gapï¼P<0.05ï¼. Conclusion:With a strict selection according to the indications, MT showes safe and effective long-term outcomes and is proved to be applicable in ossicular chain reconstruction in the cases of fixation of the stapes footplate accompanied with malleus/incus mobility disorder by various causes.