現行人工耳蝸植入方法：對耳科專家的問卷調查

Current Practices in Cochlear Implant: A Questionnaire Survey to Otologists

周尚瑋(Shang-Wei Chou) ； 楊昭輝(Chao-Hui Yang) ； 吳靖農(Ching-Nung Wu) ； 黃仲鋒(Chung-Feng Hwang)

《台灣耳鼻喉頭頸外科雜誌》 54卷2期 (2019/06) Pp. 86-91

https://doi.org/10.6286/jtohns.201906_54(2).086

摘要

背景：針對重度聽障者，人工耳蝸植入為一種有效的手術治療，隨著醫療的進步，其手術方式也持續演進，以期減少手術併發症。本篇研究藉由問卷調查，統計近年來耳科專家在人工耳蝸手術方法的異同。方法：作者回溯近幾年參加國内外人工耳蝸相關會議中，請執行人工耳蝸手術的耳科醫師匿名填寫的問卷調查。結果：共有41名接受並完成問卷調查，75.6％（31/41）耳科專家以耳後微創手術的方式，傷口長度明顯小於其他切口（3.3 ± 0.6 vs. 5.0 ± 12 cm，p=0.001），所有回應者都以典型乳突鑿開術找到面神經隱窩和圓窗，進入耳蝸的方式，最常使用為圓窗進入占49.0％；總是在頭骨磨出造井的比例成人和兒童分别為78.0％和82.9％，而從不在頭骨造井的醫師也有14.6％；針對是否將接受器綁在頭骨不管是對成人或是孩童完全不綁者比較多，也就是說總是綁和從不綁在成人比例是30.0％及35.0％，孩童則是32.5％及40.0％。對成人植入總是和經常暴露腦膜已經很少5.4％（2/37），然在孩童中，則約55.3％（21/38）會總是和經常暴露腦膜；術後93.9％的回應者有會針對傷口進行乳突加壓包紮。結論：本研究發現，多數醫師以耳後微創的切口手術法進行，為了配合微創小切口，傾向執行淺的造井和不縫合固定接受器。此調查仍無法判斷特定手術方式的優劣，但顯示微創的進行人工耳蝸手術已經被多數耳科醫師所接受。

關鍵字

cochlear implantation ； cochlea ； surgery ； dura ； suture（人工耳蝸植入 ； 耳蝸 ； 手術 ； 硬腦膜 ； 縫合）

並列摘要

BACKGROUND: Cochlear implantation is an effective method for the rehabilitation of bilateral profound hearing loss. Over time, recent techniques have focused on smaller incisions and hearing-preservation methods that minimize complications. However, many gray areas and controversies still exist and the management of these patients is an issue that increasingly confronts clinicians. The aim of our survey was to determine the current common practices regarding these issues of cochlear implantation. METHOD: We performed a retrospective, anonymized, cross-sectional survey. A questionnaire consisting of 15 questions regarding their management and surgical practices was distributed to otologists at the cochlear implant associated conferences that authors has attended worldwide. The results of the questionnaire were then analyzed. RESULTS: A total of 41 otologists responded and completed our questionnaire. 75.6% (31/41) of the respondents used minimal invasive surgery with average 3.3 cm incision wound as access route. The length of incision wound was significantly smaller than other wounds (3.3 ± 0.6 vs. 5.0 ± 1.2 cm, p = 0.001). All respondents chose traditional mastoidectomy approach to access the promontorium or round window. 49.0% of the respondents indicated that they round window approach for cochlear implantation. Regarding the drilled wells for the internal receiver, 78.0% and 82.9% of respondents always performed this procedure in adult and children respectively. There was 14.6% surgeons never drilling well in both adults and pediatric population. About the securing of the internal receiver, the surgeons who is always tied is lower than the one who is never tied for adult (30% vs. 35%) and pediatric (32.5% vs. 40%) group. In adult patients, most respondents seldom exposed the dura while drilling for the well (5.4%). However, there was more than half of respondents (55.3%) always or usually exposing the dura in the pediatric patients. The majority of respondents (93.9%) used mastoid pressure dressing post operation. CONCLUSION: We demonstrate that most respondents used minimal invasive surgery as access route via traditional mastoidectomy and round window approach for cochlear implantation. More and more surgeons tended to do drill the shallow wells and without fixation for internal receivers, even never drill the well to match minimal incision. There is no evidence in the study to support which specific surgical practice is better. The result of this survey emphasizes that minimal invasive surgery is more acceptable in recent years.

並列關鍵字

cochlear implantation ； cochlea ； surgery ； dura ； suture