山东大学耳鼻喉眼学报 ›› 2013, Vol. 27 ›› Issue (4): 43-46.doi: 10.6040/j.issn.1673-3770.0.2012.325

• 论著 • 上一篇    下一篇

显微镜下骨锚式助听器植入术和适宜植入部位的初步研究

蔡勋华1,陈文文1,杨钰2,张裕华1,童军1,邓亚新1   

  1. 上海交通大学附属上海市第一人民医院分院 1.耳鼻喉科; 2.放射科, 上海 200081
  • 收稿日期:2012-11-02 发布日期:2013-08-16
  • 通讯作者: 陈文文,主任医师。Email:chenww50@hotmail.com
  • 作者简介:蔡勋华,主治医师。Email:wanghecai@yahoo.com.cn

Position and operation skill of boneanchored hearing aids implantation under microscopy

CAI Xun-hua1, CHEN Wen-wen1, YANG Yu2, ZHANG Yu-hua1, TONG Jun1, DENG Ya-xin1   

  1. 1. Department of Otolaryngology; 2. Department of Radiology, Branch Hospital of Shanghai Jiao Tong University Affiliated First People′s Hospital, Shanghai 200081, China
  • Received:2012-11-02 Published:2013-08-16

摘要:

目的    探讨局麻下通过显微镜进行骨锚式助听器(BAHA)植入手术的优点,总结植入的适宜部位。方法    选择2例男性患者,①62岁患者为左耳混合性聋, 右耳极重度感音神经性聋(近全聋),气导左耳为92.5dB,右耳>100dB (取0.5、1、2、4kHz均数,当听阈>100dB时仍作100dB,下同),声场检查双耳均大于100dB,声场软带BAHA试验45~100dB下降斜坡型,4kHz以上消失。BAHA植入部位选择在耳后沟后3cm,外耳道口上缘水平上方2.5~3.0cm处,距外耳道口约5.0~5.5cm植入基座;②16岁患者为双耳传导性耳聋,曾先后行鼓室成形听骨链重建术,均因3听骨畸形固定,术后听力提高不明显。声场检查50~70dB水平型(左耳为67.5dB,右耳为52.5dB),声场软带BAHA试验40~50dB,水平型。BAHA植入部位选择外耳道口上缘平面、耳后沟后2cm距外耳道口约4.5~5.0cm处。结果    带机后声场检查结果,病例1术耳平均57.5dB,对侧耳平均72.5dB;曲线呈水平型,且双侧4kHz亦测出,术侧较术前平均提高35dB,对侧耳平均提高27.5dB,较术前试戴结果术侧也平均提高26.25dB;病例2术耳32.5dB,曲线呈水平型,较术前声场检查术侧平均提高35dB,比术前软带试验结果也平均提高13.75dB。2例术后3个月复查CT均显示骨融合良好。三维重建显示,病例1钛钉虽未穿入颅骨中,但局部向颅内突起。病例2见钛钉远端离颅内面至少有2cm的距离。结论    BAHA对改善传导性耳聋及独耳患者听力效果确切,局麻下显微镜手术一般可以适用。耳道正后方乳突骨质较厚,比传统耳道后上方植入基座产生颅内损伤机率更少。

关键词: 骨锚式助听器, 听力提高, 并发症, 基座

Abstract:

Objective    To explore bone-anchored hearing aids(BAHA) implant position and operation skill under local anaesthesia microscopy. Methods    Both 2 male patients were operated under microscopy and local anaesthesia. One was 62 years old. He had the mixed hearing loss at the left and sensorineural deafness at the right. The result of sound field examine was over 100dB in two ears, and the BAHA soft belt test was 45-100dB sharp decline type, over 4kHz was lost. In case 1, the BAHA pedestal was implanted in the conventional position on the skull, which was behind the ear groove 3cm and above the ear canal 3cm. The two was 16 years old. He had double three-auditory-ossicle malformed fixation and hearing loss, but the hearing was only a little improved after operation of two times. The result of sound field audiometry was 67.5dB, and the BAHA soft belt test was 40-50dB flat type. In case 2, the BAHA pedestal was implanted on the different position on the skull, which was in the level of the ear canal and behind the ear groove about 2cm. Results    Case 1 obtained the hearing improved about 35dB in the sound field examine post-operation. Case 2 hearing improved above 35dB. The post-operative CT revealed Case 1 pedestal had a little projecting skull bone into meninges. Case 2 pedestal was away from meninges about 2cm. Conclusion     BAHA can evidently improve hearing, and the pedestal can be implanted under local anaesthesia and microscopy in most cases. Bone is thicker at the position behind the ear canal than at the conventional position, so pedestal implantation at this position  has less probability of damage mininges than the conventional position.

Key words: Pedestal, Complication, Hearing improve, Bone-anchored hearing aids

中图分类号: 

  • R764.5
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