Ardışık 216 koklear implantasyon serisinde cerrahi komplikasyonların retrospektif analizi

Amaç: Bu çalışmanın amacı, bir Üniversite Hastanesinde koklear implantasyon uygulanan çocuk ve yetişkin yaş grubundaki hastalarda, intraoperatif ve postoperatif erken ve geç dönem komplikasyonları belirlemek ve bunların nedenlerini ve tedavilerini tartışmaktır. Materyal ve metod: Çalışma, üçüncü basamak Üniversite Hastanesi Kulak Burun Boğaz Hastalıkları Bölümünde 2014 ile 2018 tarihleri arasında bilateral ileri ve çok ileri sensörinöral işitme kaybı (SNHL) tanısı konan ve koklear implant uygulanan, 192 çocuk ve 24 yetişkin olmak üzere toplam 216 ardışık olgunun dahil edildiği retrospektif bir araştırmadır. Olguların intraoperatif ve postoperatif erken ve geç dönem komplikasyonları ve tedavileri değerlendirilmiştir. Bulgular: Toplam komplikasyon oranları % 19.4 (n: 42) olarak saptandı. Bu oranın % 17.1’i (n:37) minör komplikasyonlar ve % 2.3 (n:5) majör komplikasyonlardı. Yara bölgesinin seromaya bağlı ödemi en sık saptanan komplikasyondu (n=12, %5.5). Genel olarak enfeksiyonlar da sık görülen komplikasyonlar olarak saptandı (n=9, %4.1). İntraoperatif olarak 4 olguda perilenf gusher; 1 olguda kanama; 1 olguda iatrojenik timpanik membran perforasyonu; 2 olguda dış kulak yolu travması saptandı. 6 olguda vertigo; 1 olguda tinnitus saptandı. Ameliyat sonrası 2 olguda geçici fasiyal parezi; 1 olguda anormal facial sinir uyarımı; 1 olguda geçici korda timpani sendromu saptandı. 2 olguda şiddetli flep ve mastoid enfeksiyonu nedeniyle cihaz çıkartıldı. Kokleaya yerleşemeyen elektrot pozisyonu nedeniyle 1 hastada implante edilen iç parça çıkartıldı. Sonuç: Koklear implantasyon cerrahisi, sunulan popülasyonda nispeten, ciddi komplikasyon oranının düşük olduğu, minör cerrahi komplikasyonların çoğunluğunun konservatif önlemlerle veya minimal müdahaleler ile yönetilebildiği güvenli bir tekniktir. Öğrenme eğrisi zamanı ilerledikçe komplikasyonlarda azalmaktadır. Farklı merkezlerde ortaya çıkan komplikasyon oranlarının incelenmesi, cerrahinin daha dikkatli yapılmasını ve cerrahın öğrenme eğrisini geliştirir.

Anahtar Kelimeler:

Sensörinöral, İşitme kaybı, Cerrahi tedavi, Koklear implantasyon

Ardışık 216 koklear implantasyon serisinde cerrahi komplikasyonların retrospektif analizi

Background: The aim of this study is to determine the intraoperative and postoperative early and late period complications in children and adults age group patients, who underwent cochlear implantation in a University Hospital, and to discuss their causes and treatment.Methods: The study is a retrospective study consisting of 216 consecutive cases, including 192 children and 24 adults, who were diagnosed with bilateral severe and profound sensorineural hearing loss (SNHL) and who underwent cochlear implantation between 2014 and 2018, in the Department of Otolaryngology at the tertiary University Hospital. Intraoperative and postoperative early and late period complications and treatments of the cases are evaluated.Results: Total complication rate was found to be 19.4% (n: 42). 17.1% (n: 37) of this rate was minor complications and 2.3% (n: 5) was major complications. Seroma-induced edema of the wound area was the most common complication (n = 12, 5.5%). In general, infections were also found to be common complications (n = 9, 4.1%). Intraoperatively, perilymphatic gusher was found in 4 cases; bleeding in 1 case; iatrogenic tympanic membrane perforation in 1 case and meatus posterior wall injury in 2 cases. 6 cases had vertigo and one case had tinnitus. After surgery; temporary facial paralysis was detected in 2 cases, abnormal facial nerve stimulation was detected in 1 case and transient chorda tympani syndrome was detected in 1 case. In 2 cases, the device was removed due to severe flap and mastoid infection. The implanted internal part was removed in 1 patient due to electrode position which could not be placed in the cochlea.Conclusion: Cochlear implantation surgery is a safe technique in which the majority of minor surgical complications can be managed with conservative measures or minimal interventions, with relatively low rates of serious complications in the presented population. As the learning curve progresses, complications decrease. The examination of the complication rates occurring in different centers improves learning curve of surgeon and the attention to be given to surgery.

Keywords:

Sensorineural Hearing loss, Surgical treatment, Cochlear implantation, Complication,

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