人工電子耳再植入術之評估探討：個案報告

Assessment and Investigation in Reimplantation of Cochlear Implant: Case Report

10.6143/JSLHAT.202006_(42).0004

涂茱婷(Chu-Ting Tu)；劉冠麟(Guan-Lin Liu)；劉如芳(Ju-Fang Liu)

人工電子耳 ； 再植入術 ； 術後成效 ； 聽能復健 ； Cochlear implant ； Reimplantation ； Postoperative recovery ； Aural rehabilitation

台灣聽力語言學會雜誌

42期（2020 / 06 / 01）

81 - 90

繁體中文

現今人工電子耳植入技術的發展進步，植入手術失敗率越來越低，人工電子耳的使用年限成為重要的關鍵，至今發現人工電子耳可能發生機械故障及電極異常等問題，因此，人工電子耳再植入術變得十分重要。本研究主要探討人工電子耳再植入個案治療成效，報告個案於3歲時進行首次人工電子耳植入術，術後能達到良好的聆聽能力，但個案於18歲時發現人工電子耳電極放電異常的問題，進行人工電子耳再植入手術，個案使用新的植入體及新的編碼策略，儘管在進行再植入手術前，個案有長達4個月的時間沒有聽覺刺激，術後只花了2個月的時間就能達到與再植入前一樣良好的聆聽表現，在聲場測驗與語音辨識度的檢查中，發現術後結果甚至有更好的聽能表現。此外，本研究還使用了新的編碼策略，利用較低的電流量除了可達到省電的效果外，也提高良好的聆聽表現。因此，本研究顯示個案的再植入手術及後續調頻追蹤的效益是良好的，可改善整體生活品質。

Cochlear implantation has been established as a reliable and effective means of hearing rehabilitation in patients with hearing loss and poor speech discrimination. Recently improved device design and refined surgical technique has decreased the implant failure rate, but the life span of cochlear implants is now a critical issue. Symptoms of device failure most frequently involve abrupt and complete loss of auditory signal. Among pediatric patients requiring reimplantation for device failure, more than 85% have an identifiable cause (loss of hermeticity, case fracture, circuit failure, etc.), and only a small percent have unexplained device malfunction. Therefore, the reimplantation of cochlear implant is extremely important. This study focuses on the treatment effect reimplantation of a cochlear implant in the case of 3-year-old male patient who underwent cochlear implantation. Surgery was uneventful, and speech perception was initially excellent, but 15 years postoperatively the patient developed symptoms such as intermittent loss of hearing. This required reimplantation for circuit failure of the device. Although the patient did not proceed with hearing stimulation for 4 months, he experienced a rapid restoration in speech perception with the novel implant device and sound encoding reprogramming strategy. His speech perception at 2-month post-reimplantation reached the levels of his best performance with the initial device. Postoperative audiometric testing and sound field audiometry showed that hearing performance was dramatically better than before the operation. Moreover, we utilized a novel sound encoding strategy which provide the lower electric current to extend battery life, patients with the new devices and the novel sound encoding strategy demonstrate better hearing perception performance. Overall, reimplantation surgery is feasible and safe when previously functioning devices no longer have adequate audiological performance. The results showed an individual case goes through the reimplantation and auditory threshold tracking that had a substantial impact and improved the patients' quality of life.

1. Cohen, N. L.,Waltzman, S. B.,Fisher, S. G.,Department of Veterans Affairs Cochlear Implant Study Group(1993).A prospective, randomized study of cochlear implants.The New England Journal of Medicine,328,233-237.
2. Gantz, B. J.,Lowder, M. W.,McCabe, B. F.(1989).Audiologic results following reimplantation of cochlear implants.Annals of Otology, Rhinology & Laryngology,98(8 Suppl.),12-16.
3. Haumann, S.,Imsiecke, M.,Bauernfeind, G.,Büchner, A.,Helmstaedter, V.,Lenarz, T.,Salcher, R. B.(2019).Monitoring of the inner ear function during and after cochlear implant insertion using electrocochleography.Trends in Hearing,23,2331216519833567.
4. Henson, A. M.,Slattery, W. H., III,Luxford, W. M.,Mills, D. M.(1999).Cochlear implant performance after reimplantation: A multicenter study.The American Journal of Otology,20,56-64.
5. Hochmair-Desoyer, I. J.,Burian, K.(1985).Reimplantation of a molded scala tympani electrode: Impact on psychophysical and speech discrimination abilities.Annals of Otology, Rhinology & Laryngology,94,65-70.
6. Kyriafinis, G.,Vital, V.,Psifidis, A.,Constantinidis, J.,Nikolaou, A.,Hitoglou-Antoniadou, M.,Kouloulas, A.(2007).Preoperative evaluation, surgical procedure, follow up and results of 150 cochlear implantations.Hippokratia,11,77-82.
7. Miyamoto, R. T.,Myres, W. A.,Robbins, W. A.,Pope, M. L.,Renshaw, J. J.,Kessler, K.(1988).The role of cochlear implants in deaf children.Scandinavian audiology. Supplementum,30,121-126.
8. Miyamoto, R. T.,Osberger, M. J.,Robbins, A. M.,Myres, W. A.,Kessler, K.,Pope, M. L.(1992).Longitudinal evaluation of communication skills of children with single- or multichannel cochlear implants.The American Journal of Otology,13,215-222.
9. Saeed, S. R.,Ramsden, R. T.,Hartley, C.,Woolford, T. J.,Boyd, P.(1995).Cochlear reimplantation.The Journal of Laryngology & Otology,109,980-985.
10. Staller, S. J.,Beiter, A. L.,Brimacombe, J. A.,Mecklenburg, D. J.,Arndt, P. L.(1991).Pediatric performance with the Nucleus 22-channel cochlear implant system.The American Journal of Otology,12(Suppl.),126-136.
11. Te, G. O.,Hamilton, M. J.,Rizer, F. M.,Schatz, K. A.,Arkis, P. N.,Rose, H. C.(1996).Early speech changes in children with multichannel cochlear implants.Otolaryngol Otolaryngology—Head and Neck Surgery,115,508-512.
12. Tobey, E. A.,Angelette, S.,Murchison, C.,Nicosia, J.,Sprague, S.,Staller, S. J.,Beiter, A. L.(1991).Speech production performance in children with multichannel cochlear implants.The American Journal of Otology,12(Suppl.),165-173.
13. Tyler, R. S.(1994).Advantages of disadvantages expected and reported by cochlear implant patients.The American Journal of Otology,15,523-531.
14. U. S. Food and Drug Administration. (2020). Premarket approval (PMA). Retrieved April 27, 2020, https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P970051S172
15. 衛生福利部中央健康保險署（n.d.）。全民健康保險醫療費用支付標準。取自http://www.nhi.gov.tw/resource/bulletin/4207_1010051715-01.pdf