243例人工耳蜗植入围手术期处理与术后效果

目的总结243例多导人工耳蜗植入术围手术期的处理经验和听觉语言康复效果。方法介绍我们在多导人工耳蜗植入术围手术期的处理方法。术前评估：主要包括听力学评估、影像学评估和智力心理评估。手术方法介绍了不同型号人工耳蜗插入电极的要领，特别强调了24R（Contuor Advance）型植入电极时，不要主动向外拔金属丝。结果243例患者术后6个月用声场测听啭音语言频率平均听阈达到25-35dB（nHL），平均27．4±4．8dB。开机后1年的开放词表言语分辨率平均达到87．7％。其中成人语后聋患者术后Mapping后全部能听到家人叫他名字。经2个月3～5次调试，声场测听阈在28．1±5．4dB，非限定词表（Openset）言语测听，识别率达82％～93％，平均91．6％。学龄前的语前聋儿童，开机后1～2个月，声场测听都能达到30dB（nHL）或更佳。经过1年以上语训，测定63名可合作儿童的限定词表（Closeset）言语测听，言语识别率平均达N88．6％，非限定词表（Openset）言语测听，识别率平均达83．7％。7岁以上语前聋的儿童，开机后12个月测定26例合作语前聋儿童的Closeset言语识别率平均达Nsl．6％，Openset言语识别率平均达78．2％。结论人工耳蜗植入是治疗全聋患者的最佳选择。对语前聋患者而言，植入年龄最好在7岁前。人工耳蜗植入后，听觉语言康复工作将是一项长期的工作，需要家庭、社会、医生和聋康老师的共同努力。     

人工耳蜗不同电极植入术后听觉康复效果比较

目的通过对澳大利亚Nucleus（直电极和弯电极）、奥地利Medel和美国Advanced Bionics人工耳蜗不同电极植入者开机后的调试情况，以及听觉和言语康复效果进行观察比较，探讨不同植入电极患者术后效果是否存在差异。方法我科自1997年3月至2007年6月共植入人工耳蜗313例，选择其中植入年龄、植入时间、术前残余听力、术后康复条件等各方面条件相近的语前聋人工耳蜗植入者70例，将其按植入产品的不同分为4组，包括澳大利亚Nucleus直电极组22人，澳大利亚Nucleus弯电极组25人，奥地利Medel C40＋组12人和美国AB公司90K组11人。比较4组人工耳蜗植入患者开机半年后的阈值（T-levels）．最大舒适强度（C-levels／M-levels）和动态范围（dynamic range）有无差异，并根据听觉行为分级标准（categories of auditory performance，CAP）和言语可懂度分级标准（speech intelligibility rating，SIR）对4组人工耳蜗植入者进行评估，用统计学方法分析不同电极人工耳蜗植入者听觉水平和言语可懂度康复效果是否存在统计学差异。结果经单因素方差分析，4组耳蜗植入者CAP分级和SIR分级得分的差异无统计学意义（P〉0．05）。调试时澳大利亚弯电极组和直电极组的T-levels、C-levels和动态范围大小无统计学差异（P〉0．05）；奥地利C40＋组与其它三组相比，最大舒适强度和动态范围更大；美国90K组阈值最低，所需刺激量最小。结论人工耳蜗不同电极植入术后均能产生良好效果，其阈值，最大舒适强度和动态范围有差别，但不同植入电极术后的听觉水平和言语可懂度等康复效果无明显差异。     

不同内耳畸形人工耳蜗植入效果分析

目的 就不同内耳畸形人工耳蜗植入特点及效果进行分析,积累经验。方法 1996年1月～2004年5月北京同仁医院共开展多道人工耳蜗植入术410例(410耳),对其中双侧内耳畸形患者82例(82耳)进行回顾性分析,就不同原因内耳畸形的人工耳蜗植入手术特点及术后开机调试特点与耳蜗形态正常的人工耳蜗植入者进行了比较。结果 ①所有内耳畸形患者人工耳蜗植入术后都有听觉;②内耳畸形人工耳蜗术中容易出现井喷;③82例中除2例患者各遗留2对蜗外电极外,其余电极均完全植入蜗内;④术后无面瘫、脑脊液漏等并发症;⑤术后开机调试数值与结构正常植入者接近,无统计学差异(P>0.05);⑥术后经过语训,1年后听力及言语能力均有不同程度的提高。结论 伴有内耳发育畸形的深度感音性聋患者可以行人工耳蜗植入手术,植入效果与耳蜗发育正常患者的人工耳蜗植入效果基本一致,人工耳蜗植入术可以作为伴有内耳畸形的深度感音性聋患者的治疗和康复手段。     

学龄前不同年龄段语前聋人工耳蜗植入患儿康复效果比较

目的：分析学龄前不同年龄段语前聋患儿人工耳蜗植入后听觉言语康复效果,探讨影响其康复效果的可能因素。方法将55例植入Freedom人工耳蜗的学龄前语前聋患儿按植入年龄分为1～3岁组32例,＞3～5岁组23例,于术后开机1、3、6、12、18、24个月时分别采用听障儿童听觉言语评估词表及标准评估程序、听觉行为分级（categories of auditory performance ,CAP）和言语可懂度分级（speech intelligibility rating ,SIR）评估并比较两组患儿听觉能力、言语能力及学习能力。结果在术后两年内,随着康复时间的延长,两组对象的平均言语识别率、平均语言年龄、CAP分级及SIR分级均逐渐提高,且在术后各时间段1～3岁组的平均言语识别率、平均语言年龄康复效果优于＞3～5岁组（P＜0．05）;在术后开机1、3、12个月时1～3岁组的CAP评级高于＞3～5岁组（P值分别为0．001、0．002和0．002）;在术后开机1、3、12、24个月时1～3岁组的SIR评分高于＞3～5岁组（P值分别为0．00、0．00、0．024和0．024）;两组间各时间段学习能力比较差异无统计学意义（ P＞0．05）。结论对于语前聋患儿,人工耳蜗植入的年龄越小,术后两年内康复训练时间越长,效果越好;人工耳蜗植入时的年龄和术后康复时间是影响语前聋人工耳蜗植入患儿术后康复效果的关键因素。     

伴中枢神经系统病变的聋儿的人工耳蜗植入

目的 探讨伴中枢神经系统病变的语前聋儿人工耳蜗植入手术可行性及疗效问题.方法 回顾性分析我科自2005年以来7例伴有脑性瘫痪(简称脑瘫)、脑白质病的极重度感音神经性聋患者人工耳蜗植入,总结术前情况及术后康复效果.结果 7例患者均在术前的磁共振检查发现合并有中枢神经系统病变,手术后均成功重建了听力.听力及言语能力均有不同程度的提高.结论 术前磁共振检查是发现大脑疾病的重要手段,对于伴有脑瘫、脑白质病的语前聋儿在经过术前全面评估和定期随访观察后可以实施人工耳蜗植入手术,脑瘫聋儿术后康复效果与脑瘫病情轻重有关.术后制定特殊的康复计划是让患者从人工耳蜗植入术中受益的保障.     

伴脑瘫语前聋儿童的人工耳蜗植入

目的探讨伴脑瘫语前聋儿童人工耳蜗植入的疗效。方法回顾性分析1例5年前行人工耳蜗植入术的脑瘫患儿的临床资料及术后5年来的肢体运动状况,并以听觉行为分级标准(categories of auditory performance,CAP)和言语可懂度分级标准(speech intelligibility rating,SIR)评估并比较其手术前后听力言语能力。结果术后该患儿成功重建了听力,经过肢体康复训练,躯体运动障碍完全康复。术后5年声场测听为轻度听力下降,语言能力较听觉能力提高缓慢。CAP为5级,SIR为2级。普通话声调识别率约为43%,声母、韵母识别率分别约为50%、55%。结论对于伴有脑瘫的语前聋儿童经过术前全面评估和审慎观察后可以实施人工耳蜗植入手术,术后需要制定特殊的康复计划方能让患者从人工耳蜗植入术中受益,人工耳蜗植入可以作为脑瘫聋儿的康复手段之一。     

突发性聋致双耳重度聋的人工耳蜗植入术

目的 探讨突聋致全聋患者植入人工耳蜗的效果.方法 回顾性分析解放军总医院1998年6月～2006年8月6例不明原因的突发性聋所致双耳语后重度感音神经性聋接受人工耳蜗植入术的患者的临床资料,并对患者及其家属进行了电话问卷调查,包括术后开机听力、耳鸣、语言情况等,综合比较术前、术后各项指标.结果 6例患者术中均成功植入人工耳蜗,术后均无感染、面瘫、电极脱出.术后全部患者进行了开机调试,5例患者进行了语言康复训练.术后言语分辨率和听力情况:除1例恢复较差外,其余5例都达到了满意的效果;5例患者术后耳鸣减轻或消失;言语交流及社会满意度都达到了术前预期的程度.综合各项效果评价,患者及患者家属表示满意的4例,表示基本满意的1例,表示不满意的1例.结论 突聋致双侧重度或极重度聋未恢复者应尽早行人工耳蜗植入手术,可获得良好的言语康复效果,并且对耳鸣也有较好的疗效.     

脑白质异常聋儿人工耳蜗植入后效果初步分析

目的探讨对脑白质异常的重度感音神经性聋患儿,人工耳蜗植入手术的可行性及听力言语康复效果分析。方法自2012年1月至2014年12月行人工耳蜗植入术的120例(120耳)重度感音神经性聋患儿中,有脑白质异常的患儿15例。随机抽取15例脑白质无异常的聋儿作为对照组,比较两组患儿植入人工耳蜗后手术效果、开机调试结果及听力言语康复效果。结果 130例(30耳)电极全部植入耳蜗内;2所有患者术后无脑膜炎、面瘫、脑脊液漏等并发症;3所有脑白质异常患儿在人工耳蜗植入术后都有听觉;4脑白质异常儿童术后平均听阈与对照组无明显区别;5随访6至24月后,脑白质异常患儿的听觉行为分级标准(categories of auditory performance,CAP)和言语可懂度分级标准(speech intelligibility rating,SIR)与对照组比较,差异均无显著性意义(P>0.05)。结论经过严格术前评估后,人工耳蜗植入可应用于脑白质异常伴重度感音神经性聋的患儿,其术后效果与脑白质无异常的聋儿植入效果基本一致,术后的听力言语康复效果无明显差异。     

语前聋儿童人工耳蜗植入术后听觉言语识别能力发展水平评估

目的 通过对语前聋儿童人工耳蜗植入术后不同康复时段的听觉言语识别能力评估,探索人工耳蜗植入儿童术后听觉言语识别能力的获得规律,为评价及预测聋儿康复效果提供参考.方法 采用标准化的儿童言语听觉测试环境及测试词库,对863例不同年龄、不同康复时段的语前聋人工耳蜗植入儿童进行听觉言语识别能力评估,包括自然环境声响、声母、韵母...     

人工耳蜗植入术后听觉言语效果的影响因素

目的〓〖HTK〗探讨影响人工耳蜗植入术后听觉言语恢复效果的相关因素。〖HTW〗方法〓〖HTK〗对24例双耳重度或极重度感音神经性耳聋患者,术前进行智力、听力学、影像学检查,配带助听器评估,并严格掌握手术适应证,经乳突－面隐窝进路行人工耳蜗植入术,记载术中情况,术终测电极电阻,术后1个月开机调试,语前聋者进行听觉语言培训,术后追踪随访疗效满意度和言语可懂度,对所得临床资料进行分析。〖HTW〗结果〓〖HTK〗23例耳蜗植入手术一次成功,1例电极移位二次手术成功,术后暂时性面瘫2例、眩晕1例,两周X线颞骨拍片证实耳蜗电极位于耳蜗内,1个月开机调试,全部病例获取听力。3例语后聋患者听觉言语恢复,其他语前聋患者均行半年以上的听觉语言培训,随访4～6年,半开放式言语识别率＞80％,全部患者及家属达到术前的期望值。〖HTW〗结论〓〖HTK〗人工耳蜗是治疗重度极重度感音神经性耳聋及全聋的有效方法,术后效果主要与人工耳蜗植入时的年龄、术前听力与言语基础、听神经及其传导功能、智力、植入电极在规定的部位、术后调机与康复的有效性等关系密切。     

Kochleaimplantation bei Kindern im 1. Lebensjahr

BACKGROUND: The success of cochlear implants in children was followed by a stepwise reduction in age at time of surgery. As a result of newborn hearing-screening (NHS) and the reliable audiologic diagnostic procedure, the question is raised as to whether an implantation before the age of 1 year is effective and safe in terms of surgery and rehabilitation. METHOD AND PATIENTS: This retrospective study included 27 children implanted before the age of 1 year (Gr. 1) and 89 children implanted between the age of 1 and 2 years (Gr. 2). Patient related data were analysed for individual history, surgery, rehabilitation and speech understanding. RESULTS: The incidence of complications was not increased in Gr. 1. The fitting of a speech processor was effective and uneventful in all children. The development of hearing and speech understanding showed better results after 2 years in Gr. 1. This development is more obvious for absolute age and not to rehabilitation time. CONCLUSION: In order to achieve an optimal timing for the development of speech understanding, cochlear implantation should be performed before the age of 2 years. This study revealed no additional risks for children in Gr. 1, but the development of speech understanding was better. As a consequence, cochlear implantation should be considered for very young children with an identified bilateral profound hearing loss.     

感音神经性聋患儿伴分泌性中耳炎同期人工耳蜗植入效果分析

目的探讨伴分泌性中耳炎的感音神经性聋患儿同期植入人工耳蜗术后的听觉言语康复效果。方法回顾性分析安徽医科大学第一附属医院2015年1月到2017年12月期间伴分泌性中耳炎同期植入人工耳蜗的感音神经性聋患儿30例(A组)的临床资料,并与同期不伴分泌性中耳炎的感音神经性聋患儿30例(B组)比较。所有患儿均采用面隐窝入路植入人工耳蜗,术后随访24个月,采用听觉行为分级(categories of auditory performauce-Ⅱ,CAP-Ⅱ)和言语可懂度分级(speech intelligibility rating,SIR)评估并比较两组患儿的听觉言语康复效果。结果 A组患儿同期植入人工耳蜗后均未出现术后并发症,术前A组CAP-II评分为0.87±1.07分,SIR评分为1.07±0.37分,术后分别为5.07±0.91和3.73±0.87分,术后较术前明显提高(P<0.01)。B组术前CAP-II评分为0.93±1.17分,SIR评分为1.10±0.40分,术后分别为5.23±0.77和3.77±0.73分,术后较术前明显提高(P<0.01)。A组与B组之间术前、术后CAP-II和SIR评分差异均无统计学意义(P>0.05)。结论感音神经聋患儿伴分泌性中耳炎患儿同期人工耳蜗植入安全可行,且分泌性中耳炎对术后听觉言语康复效果无明显影响。     

GJB2基因突变致聋患儿人工耳蜗植入效果分析

目的 比较GJB2基因突变致聋患儿与非GJB2基因突变且内耳结构正常聋儿人工耳蜗植入术后的听觉言语康复效果.方法 对37例经C下及MRI检查排除内耳畸形的聋儿术前行GJB2基因检查,根据结果 分成A组(GJB2基因突变10例)和B组(非GJB2基因突变27例),术后随访0.5～2年,进行术后的听阈、言语识别率及言语能力评估.结果 37例聋儿人工耳蜗植入手术全部成功,均建立了主观听性反应.A组的声场听阈水平平均为34.41±6.12 dB HL.言语识别率平均为76%; B组的声场听阈水平平均为36.23±4.16 dB HL.言语识别率平均为79%,两组均达到平均言语康复级别二级;两组听觉及言语能力测试结果 均无统计学意义(P>0.05).结论 人工耳蜗患者中GJB2基因突变率高,可能是内耳结构正常的人工耳蜗植入人群耳聋的主要致聋原因;GJB2基因突变致聋患儿与非GJB2基因突变且内耳结构正常聋儿人工耳蜗植入术后效果基本一致.人工耳蜗植入可作为GJB2基因突变致聋患儿的有效治疗手段.     

Poznań's program of cochlear and brainstem implantation: a general review

The cochlear implantation program in Poznań started in January 1994. Within 8 years, 151 patients were implanted (149 cochlear and 2 auditory brain-stem implants). The implanted group comprised 111 children and 40 adults. We have extended the lower age limit for cochlear implant candidates, and the youngest implanted patient was 18-months-old at the time of surgery. We have also implanted six multi-handicapped subjects. All patients were implanted with different nucleus devices (22, 24 M, 24 K, 24 Contour, 24 Double Array and 24 ABI). Insertion of the Nucleus 24 Contour electrode carrier requires a little larger cochleostomy in comparison with conventional straight array. After insertion, the intraoperative measurements are taken (impedance telemetry, electrically evoked stapedius reflex and NRT). The day after surgery, each patient undergoes an X-ray examination (the cochleogram or cochlear view). The calculated length of the electrode array insertion was 12.75-24.0 mm (mean: 22.05 mm) and the degree of electrode rotation was 180-540 degrees (mean: 292.82 degrees). After speech processor switch-on, we performed NRT measurements. Our results indicated that the NRT threshold was in 51.4% of the dynamic range within the group of examined patients. The adults' progress of rehabilitation was checked during individual sessions. The rehabilitation of children included two rehabilitation schedules: continuous ones and weekly rehabilitation camps. The progress of the recovery process of implanted children enabled them to change their school profile from hearing impaired to mainstream. Voice rehabilitation is often monitored by acoustic analysis using the Multi Dimensional Voice Program (MDVP).     

不同训练方法对人工耳蜗植入儿童术后康复效果影响的比较研究

目的：考察3种训练方法对人工耳蜗植入儿童术后康复效果的影响。方法随机选取2～7岁人工耳蜗植入儿童106人,其中34人接受综合感官训练法、36人接受音素辨听训练法、36人接受听觉口语训练法。采用《听障儿童听觉语言能力评估标准及方法》对所有听障儿童进行评估。结果不同训练方法对听障儿童的听觉、语言能力具有显著影响（P〈0.05）。结论综合感官训练法能在一定程度上帮助听障儿童提高语言能力,但听觉能力发展效果不佳;音素辨听训练法可促进听障儿童的细致辨听能力,但语言能力发展有限;听觉口语训练法能使听障儿童的听觉和言语能力得到均衡发展。     

Cochlear implants: indications in groups of patients with borderline indications. A review

Cochlear implants (CI) represent the current treatment for patients affected by profound sensorineural hearing loss (SNHL). Initially only deaf adult patients were considered to be candidates for a CI; however, the development of technology and matured experience have expanded the indications for cochlear implantation. Today, CIs are implanted in adults and children and broader indications are followed. There are, however, a number of patients who do not completely fulfill the current indications and who are potential candidates for CI. The duration of deafness and residual hearing represent prognostic indicators for CI performance; however, the candidacy of children with residual hearing and prelingually deafened adults are still under debate. Anatomical variants such as cochlear ossification, cochlear malformation and chronic otitis media represented and still represent for some surgeons a contraindication to CI. The otological experience of CI surgeons and the advent of auditory brainstem implants have changed the approach to these patients, who may still benefit from hearing rehabilitation. This paper briefly analyses and reviews the results obtained in these groups of patients, who were not, at least initially, considered to be candidates for cochlear implantation.     

Hearing-impaired children in the United Kingdom, I: Auditory performance, communication skills, educational achievements, quality of life, and cochlear implantation

OBJECTIVES: The objectives of this study were to identify variables that are associated with differences in outcome among hearing-impaired children and to control those variables while assessing the impact of cochlear implantation. STUDY DESIGN: In a cross-sectional study, the parents and teachers of a representative sample of hearing-impaired children were invited to complete questionnaires about children's auditory performance, spoken communication skills, educational achievements, and quality of life. Multiple regression was used to measure the strength of association between these outcomes and variables related to the child (average hearing level, age at onset of hearing impairment, age, gender, number of additional disabilities), the family (parental occupational skill level, ethnicity, and parental hearing status), and cochlear implantation. RESULTS: Questionnaires were returned by the parents of 2858 children, 468 of whom had received a cochlear implant, and by the teachers of 2241 children, 383 of whom had received an implant. Across all domains, reported outcomes were better for children with fewer disabilities in addition to impaired hearing. Across most domains, reported outcomes were better for children who were older, female, with a more favorable average hearing level, with a higher parental occupational skill level, and with an onset of hearing-impairment after 3 years. When these variables were controlled, cochlear implantation was consistently associated with advantages in auditory performance and spoken communication skills, but less consistently associated with advantages in educational achievements and quality of life. Significant associations were found most commonly for children who were younger than 5 years when implanted, and had used implants for more than 4 years. These children, whose mean (preoperative, unaided) average hearing level was 118 dB, were reported to perform at the same level as nonimplanted children with average hearing levels in the range from 80 dB to 104 dB, depending on the outcome measure. CONCLUSIONS: When rigorous statistical control is exercised in comparing implanted and nonimplanted children, pediatric cochlear implantation is associated with reported improvements both in spoken communication skills and in some aspects of educational achievements and quality of life, provided that children receive implants before 5 years of age.     

不同内耳畸形人工耳蜗植入效果分析

OBJECTIVE: To describe clinical experiences with multi-channel cochlear implantation in patients with bilateral inner ear malformations. METHODS: Among 410 patients who received multi-channel cochlear implantations from 1996 to 2004 in Beijing Tongren Hospital, 82 patients were diagnosed with inner ear malformations and implanted. A retrospective analysis was performed about the surgical characteristics and mapping characteristics after implantation. RESULTS: (1) All patients had auditory sensations. (2) Gusher was more common than the normal cochlear implantation. (3) The electrodes were inserted in the "cochleostomy" in full length of 80 Patients, but 2 pairs of electrodes remained outside of "cochleostomy" in 2 patients. (4) No serious complications occurred after implantation. (5) The impedance of the electrodes, the T level and C level were similar with the normal cochlear implantation. The results had no significant difference in compare with normal cochlear group (P > 0. 05). (6) The abilities of speech discrimination and spoken language were improved through rehabilitation. CONCLUSIONS: The cochlear implantation can be performed safely in inner ear malformations. The outcome of hearing rehabilitation for patients with inner ear malformations are similar to those children with normal cochlear structure followed the multi-channel cochlear implantation.     

Cochlear implantation in posttraumatic bilateral temporal bone fracture

Temporal bone (TB) fractures can cause loss of audiovestibular function. Four cases of profound hearing impairment following bilateral TB fracture are presented in this report. All patients received a cochlear implant. All 4 patients became regular users of their implants. None of the patients experienced facial nerve stimulation. Implant-aided audiometry demonstrated a hearing threshold of 28 dB HL. The performance in speech understanding was comparable to standard postlingual adult patients implanted. We believe that cochlear implantation in patients suffering from profound sensorineural hearing losses secondary to TB fractures can be an effective tool for rehabilitation.