Die minimal-invasive Cochlea-Implantation – Chirurgische Machbarkeit und erste klinische Erfahrungen

Zusammenfassung

Hintergrund: In den vergangenen Jahren wurden die Indikationen zur Cochleaimplantation ausgeweitet und gleichzeitig schonendere operative Vorgehensweisen entwickelt.

Methoden und Patienten: Das hier vorgestellte und von uns entwickelte Verfahren kombiniert eine verkürzte retroauriculäre Hautinzision von 25 mm Länge mit einer Reduzierung der Mastoidbohrung, der konsequenten Nutzung des Rundfensterzugangs und der Bohrung einer temporalen Implantatmulde (sog. Bremer Zugang). In der vorliegenden Arbeit werden erste Erfahrungen und Ergebnisse mit einem minimal-invasiven Vorgehen (MiCI) bei n = 31Patienten im Alter zwischen 9–79 Jahren berichtet.

Ergebnisse: Es gelang die Länge des retroauriculären Hautschnitts auf im Mittel 29,7 mm, die Fläche der Mastoidbohrung auf 20mm² und die Verweildauer um 0,55 Tage zu reduzieren. Es zeigte sich eine signifikante Lernkurve bei der Verkürzung der OP-Zeiten (p < 0.03). Die Frequenz und Art der Komplikationen entsprach der eines konventionellen Vorgehens.

Schlußfolgerung: Die minimal-invasive Cochleaimplantation ist eine zuverlässige und sichere Methode zur Implantatversorgung.

Abstract

Objective: Cochlear implantation is a standard procedure for rehabilitation of profound hearing loss and single sided deafness. Audiologic criteria for implantation have been extended with the growing experience. Less traumatic access has been developed at the same time.

Methods and Patients: This study reports first experiences with a minimaltraumatic cochlear implantation (MiCI) approach in a series of 31 consecutive patients (9–79 yrs.) in our department. The approach combines a short retroauricular incision of 25mm with a minimized mastoidectomy, a round window approach and a temporal well for the implant.

Results: Retroauricular incision could be reduced to 29, 7 mm, the size of the mastoid cavity to 20 mm² and the stay in hospital for 0,55 days in average. Main postoperative complaint was dizziness. Overall complication rate was comparable to conventional surgery.

Conclusion: Minimal-invasive cochlear implantation is a safe and reliable procedure in experienced hands for children and adults.

Schlüsselwörter

Cochleaimplantat - minimal-invasiv - Chirurgie - Rundfensterinsertion - Mastoidektomie - Bremer Zugang

Key words

Cochlear Implant - minimal-invasive - mastoidectomy - Bremen approach

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