E-方式人工中耳の植込み手術方法とその成績

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The partially implantable hearing aid (PIHA) utilizing the piezoelectric bimorph ossicular vibrator reported here consists of two units, external and internal unit. The electlet microphone in the external unit converts sound signals into electrical signals which are fed into the external link coil after amplification. The outer link coil then excites transcutaneously the internal link coil by means of electromagnetic induction. The ossicular vibrator of piezoelectric bimorph is then activated by receiving electroacoustic signals from the internal link coil. Direct coupling of the vibrator to the stapes allows highly efficient transmission of acoustic signals to the inner ear. As a result the patients can hear the natural quality of sound without feed back, troubles due to occlusion of the external ear canal and fatigue.<BR>The Ehime type internal component (E-type) was primarily designed to implant it using the intact canal wall technique preserving the posterior ear canal and the ear drum. This original technique is termed the type 1 implant operation. During the last four years we developed a surgical method which enables the device implantable in the ear missing the bony external auditory canal, the ear was previously operated on by a radical mastoidectomy. This new method of operation has been named the type 2 implant operation. Since the first time we applied the device to a patient in 1984, we have implanted the device into 34 patients. The types 1 and 2 operations were performed in 25 and 7 patients, respectively. In the remaining 2 patients, the device was implanted in the radical mastoid cavity under the tympanomeatal skin flap. In the first chapter, the methods of operation together with the indication and the preoperative cautions were described in detail. In the second chapter, the surgical results were described with respect to clinical advantages and audiological benefits. The overall success rate was 88%. The surgical failures included retroauricular skin atrophy in 4 patients, insufficient sensitivity in 2, disconnection between the vibrator and stapes in 2 and recurrence of cholesteatoma in 1. Among them, reimplantation was attempted in 4 patients with satisfactory result. Each problematic patient was reported. Prevention and countermeasures of the problems are described.
耳鼻咽喉科臨床学会の論文

E-方式人工中耳の植込み手術方法とその成績

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