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背景:人工电子耳蜗是用来代替病变耳蜗的一种高科技治疗手段,影像学检查可以帮助了解人工耳蜗电极的植入情况。目的:探讨CT及X射线检查对人工电子耳蜗植入术前患者筛选及术后效果评估的价值。设计:自身前后对照观察。单位:南方医科大学附属珠江医院耳鼻咽喉科听力重建病房。对象:选择1999-01/2003-06拟进行人工耳蜗植入术的重度或极重度感音性耳聋患者44例。语前耳聋32例,年龄2.5～12岁;语后耳聋12例,年龄10～42岁。方法:对44例患者均采用颞骨轴位高分辨率CT螺旋扫描及内耳三维重建。患者取仰卧位,两侧对称分别做靶扫描,视野9.6cm,基线与听眶上线平行,轴位容积扫描颞骨。扫描参数:层厚1mm,螺距1.0,间距0.5mm,扫描结束后再行层厚1mm,间距0.1mm内插重建。术后采用常规耳蜗轴位改良的斯氏位X射线摄影,对于怀疑有术后并发症的3例患者,行螺旋CT颞骨容积扫描。主要观察指标:①术前患者内耳结构检查结果。②术后患者内耳和植入电极排列及深度检查结果。结果:按意向处理分析,44例患者均进入结果分析。①术前患者内耳结构检查结果:32例语前聋患者中检出1例2耳Mondini畸形Ⅰ型,2例4耳Mondini畸形Ⅱ型;12例语后聋患者中检出2例4耳慢性化脓性中耳炎,1例2耳内耳骨化,1例2耳耳硬化症,3例6耳大前庭水管综合征。②术后患者内耳和植入电极排列及深度检查结果:X射线片显示,植入的耳蜗电极位于耳蜗之中,呈二维的螺旋状,位于内耳道底。3例术后行CT检查,电极自圆窗植入耳蜗底周。其中1例术后植入电极扭结并感染。结论:①人工耳蜗植入患者术前应用颞骨轴位高分辨率CT螺旋扫描及内耳三维重建可以检出急慢性中耳炎、内耳骨迷路结构的严重畸形。②术后耳蜗位X射摄影片可提供电极的位置、植入的深度以及电极有无扭结或滑脱。CT及耳蜗位摄片检查相互补充,可进行术前病例选择和术后效果评估,有助于最大限度地发挥人工耳蜗改善听力的作用。
BACKGROUND: Artificial cochlear implants are a high-tech treatment used to replace cochlear implants. Imaging studies can help understand the implantation of cochlear implants. Objective: To investigate the value of CT and X-ray examination in the screening of preoperative cochlear implant and the evaluation of the postoperative effect. Design: control before and after their own observation. SETTING: Department of Otorhinolaryngology, Zhujiang Hospital Affiliated to Southern Medical University, Department of Hearing Reconstruction. PARTICIPANTS: A total of 44 patients with severe or very severe sensorineural hearing loss who were enrolled in cochlear implants from January 1999 to June 2003 were enrolled. 32 cases of deafness before the language, age 2.5 to 12 years; 12 cases of deafness after language, aged 10 to 42 years old. Methods: Forty-four patients underwent temporal bone axial high resolution CT spiral scan and three-dimensional reconstruction of the inner ear. Patients supine position, respectively, on both sides of the target to do the symmetry scan, field of vision 9.6cm, baseline and auditory orbital upper parallel to the axial volume scan the temporal bone. Scanning parameters: layer thickness 1mm, pitch 1.0, pitch 0.5mm, after the scan layer thickness 1mm, spacing 0.1mm interpolation reconstruction. Postoperatively, a modified Cochrane X-ray was performed using conventional cochlear axial changes. Spiral CT temporal bone volume scanning was performed on 3 patients suspected of having postoperative complications. MAIN OUTCOME MEASURES: ① Preoperative examination of the inner ear structure. ② postoperative patients with the inner ear and the arrangement of electrodes and depth examination results. Results: According to intention-to-treat analysis, 44 patients entered the result analysis. ① Results of examination of inner ear structure in preoperative patients: One case of Mondini deformity of 2 ears and 2 cases of Mondini deformity of 2 cases were detected in 32 cases of prelingual deafness. Two cases of 4 cases chronic dementia Suppurative otitis media, 1 case 2 ears ear ossification, 1 case of 2 ear sclerosis, 3 cases of 6 ears large vestibular aqueduct syndrome. ② The arrangement and depth of the inner ear and the implant electrode in the postoperative patients: The X-ray films show that the implanted cochlear electrode is located in the cochlea and is in a two-dimensional spiral shape and located at the bottom of the ear canal. 3 cases underwent CT examination, the electrode from the window implantation of the bottom of the cochlea. One case of postoperative implantation of electrodes kinked and infected. Conclusions: ①Cervical and chronic otitis media, severe malformation of the internal ear bleb labyrinth structure can be detected by high resolution CT spiral scan of the temporal bone and three-dimensional reconstruction of the inner ear before cochlear implantation. ② postoperative cochlear X-ray film can provide the location of the electrode, the depth of implantation and the electrode has no kink or slippage. CT and cochlear radiography complement each other, can be preoperative case selection and postoperative evaluation, help to maximize cochlear auditory function.