Chirurgische Technik der Kochleaimplantation

ZusammenfassungDas Kochleaimplantat („cochlear implant“, CI) ist heute eine Standard-Versorgungsoption bei prälingual ertaubten Kleinkindern. Aber auch bei postlingual spätertaubten Erwachsenen wird sie zunehmend durchgeführt. Zusätzlich kommen die Hybridversorgungen mit CI und Hörgerät im selben Ohr in den Fokus, so dass eine apikale Kochlea schonende Elektrodeninsertion gefordert werden muss. Auch die Chorda tympani ist zu schonen, insbesondere bei der bilateralen Versorgung. Die bilaterale Implantation bekommt zunehmend Bedeutung, da das verbesserte Sprachverständnis in Situationen mit Störgeräuschen heute als nachgewiesen gilt. Die intraoperative Lagekontrolle der Stimulationselektrode mit einer intraoperativen Computertomographie kann mehr Sicherheit bedeuten. Mehr im kosmetisch-ästhetischen Bereich sind die Schnittführung und die Länge der Hautinzision anzusiedeln. Zukünftige Entwicklungen betreffen vollimplantierbare CIs und navigationsassistierte minimalinvasive Bohrungen von der Schädeloberfläche bis in die Kochlea. Auch bioaktive, neurotrophe Pharmaka freisetzende Elektroden zur verbesserten und nachhaltigen Reizankopplung könnten zukünftig Anwendung finden.AbstractThe cochlear implant (CI) has become a standard option for treating prelingually deaf children. But postlingual late deafness in adults is becoming increasingly common. In addition, hybrid implantation with a CI and a hearing aid in the same ear has come into focus, which demands a soft insertion technique that spares the apical parts of the cochlea. Also, the chorda tympani should be saved, especially in bilateral implantations, which are gaining importance because improved speech discrimination in noisy conditions is seen as proven today. Control of the electrode position intraoperatively with intraoperative computed tomography can further increase the safety and reliability of the position. The position and length of the skin incision is a more aesthetic issue. Future developments will include fully implantable CIs and navigation-assisted, minimally invasive drilling of a hole from the surface of the skull into the cochlea. Bioactive, neurotrophic-drug-releasing electrode designs for improved and sustainable connectivity to the neurons may become applicable.

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