ECAP检出与否的人工耳蜗植入患者的EABR表现

目的比较分析ECAP检出与否的耳蜗植入患者EABR特点,探讨EABR检测的意义。方法对26例人工耳蜗植入患者分别行神经反应遥测neural response telemetry,NRT）检测评估ECAP,并进行电诱发听洼脑干反应（electrically auditory evoked response,EABR）检测,将第20、10、3号电极均引出ECAP波形的14例患者纳入A组,未检出ECAP波形的12例患者纳入B组。对A、B两组患者的EABR阈值、V波潜伏期进行比较分析。结果A、B两组患者20、10、3号电极EABR阈值之间的差异有统计学意义（P〈0．001）,V波潜伏期之间的差异无统计学意义（P〉0．05）。结论ECAP波形引出与否人工耳蜗植入患者的EABR阈值有显著差异,v波潜伏期无明显差异。     

人工耳蜗植入后EABR动态变化的初步研究

目的观察人工耳蜗植入儿童电诱发听性脑干反应(electrically auditory evoked response EABR)的动态变化,了解慢性电刺激后听觉通路反映特性的变化,为听觉系统的可塑性变化研究提供实验依据。方法本研究采用前瞻性设计,对19例平均年龄为3.2±1.0岁的语前聋儿童在接受人工耳蜗植入术中电极植入后进行EABR检测,患者在人工耳蜗植入后5.4±3.2月后再次进行EABR检测,观察EABR阈值、波III、波V潜伏期以及EABR输入输出曲线指标的变化。结果EABR平均阈值从人工耳蜗植入术中的196.9±11.1CL下降到术后5.4±3.2个月的189.2±13.2CL CL,配对t检验显示显著性差异（p=0.006）。平均阈上20CL V波潜伏期从人工耳蜗植入术中的4.72±0.21ms缩短到术后5.4±3.2月的4.60±0.18ms,配对t检验显示显著性差异（p=0.032）。结论耳聋儿童在接受人工耳蜗电刺激后EABR的反应阈值和潜伏期变化在最初的5.4±3.2月已经出现,提示3岁左右年龄段儿童听觉系统具有较好的可塑性,人工耳蜗植入后早期的听觉、言语训练尤为重要。     

人工耳蜗植入术中EABR监测的应用

目的探讨人工耳蜗植入术中进行EABR监测的方法，以了解耳蜗电刺激下听觉传导通路的神经反应情况。方法20例人工耳蜗植入患者，男14例，女6例，平均年龄13．6岁，语前聋患者14例，语后聋患者6例。全麻后安置体表记录电极，将PPS与听觉诱发电位仪触发端口连接，并选定听觉诱发电位仪的外触发模式。人工耳蜗电极植入后，先行常规NRT监测，然后将NRT刺激参数改为EABR模式，采用Basic双极刺激，脉宽50μs，强度由200CL起以10CL为步长递减至反应阈值。结果20例患者均记录到EABR，阈上20CL时Ⅲ波．Ⅴ波的平均潜伏期分别为2．04±0．20ms．3．96±0．41ms。相同刺激条件下的EABR反应平均阈值为148．46±11．63CL，NRT反应平均阈值为160．72±13．56CL。一例脑白质轻度发育异常患儿，术中NRT波形引出良好，EABRⅠ～Ⅳ波分化良好，Ⅴ波波形低钝，Ⅴ波／Ⅲ波振幅比〈1／2，考虑可能存在耳蜗核上性神经发育不良，现正在语言康复训练随访中。结论人工耳蜗植入术中进行EABR监测比NRT能提供更完整的．更接近听觉中枢的神经反应信息，能更进一步了解听觉传导通路的功能状态，以期对患者听力康复的效果提供更准确的预测。     

语前聋听神经病多道人工耳蜗植入效果初步观察

目的 探讨听神经病患者人工耳蜗植入后的电生理结果 变化并分析其听力言语康复效果.方法 对行人工耳蜗植入术的2例听神经病患儿进行术前听力学评估,术中、术后听觉诱发电位反应监测及开机后1年的随访,获得其开机后6个月与12个月时的听力言语康复效果,并与人工耳蜗使用时间相近的非听神经病耳蜗植入患儿的康复效果进行对比.结果 例1术中神经反应遥测henral response telemetry,NRT)及电刺激听性脑干诱发反应(electric auditory brainstem response,EABR)可引出波形,但重复性不好,EABR V波潜伏期延长.开机12个月时复查,2项电生理检查均引出可重复波形,EABR V波潜伏期在正常范围;听力言语康复效果显著提高,开机1年后有意义听觉整合量表得分优于对照组儿童;例2术中NRT未引出有意义波形,EABR可引出波形,但重复性不好;开机12个月复查,2项电生理检查均引出可重复波形,EABR V波潜伏期在正常范围;术后听力言语康复效果亦有所提高.结论 2例听神经病患者人工耳蜗植入后,术前听觉通路电活动的去同步化均得到一定程度的恢复,听力言语能力也有不同程度提高,说明人工耳蜗植入可以作为听神经病患者实现听力重建,重返主流社会的治疗和康复手段.     

大前庭水管综合征患者ABR和人工耳蜗术后EABR反应特征分析北大核心CSCD

目的探讨大前庭水管综合征(LVAS)患者的听性脑干反应(ABR)及人工耳蜗植入术后电诱发听性脑干反应(EABR)的特点,为LVAS患者人工耳蜗植入围手术期的电生理监测反应特征提供参考。方法选择2013年1月至2016年3月在我院行人工耳蜗植入的14例大前庭水管综合征患者。记录人工耳蜗植入前ABR反应阈值及潜伏期,观察声诱发短潜伏期负反应(ASNR)的表现,并统计该波的出现概率。记录患者术后EABR波形、V波阈值及III、V波潜伏期,计算III、V波引出率及EABR分级。比较ABR的V波和EABR的V波的潜伏期差异。比较ABR出现与不出现ASNR组的EABR反应阈值和V波潜伏期差异。结果 14例患者中有5例术前ABR可引出ASNR,9例无ASNR,V波潜伏期6.6～8.15ms。人工耳蜗植入后有13例引出有意义的EABR波形,平均EABR阈值为190.8CL,平均III波潜伏期为1.80ms,平均V波潜伏期为3.59ms,有1例EABR未引出反应。根据Gibson EABR分级标准,ASNR组与无ASNR组EABR波形分化无明显差异。ASNR组EABR阈值177.5CL,无AS-NR组阈值196.7CL,二者有统计学差异。ASNR组V波潜伏期4.71ms,无ASNR组V波潜伏期4.68ms,二者无统计学差异。EABR的V波潜伏期比ABR的V波潜伏期短,二者有统计学差异。结论 LVAS患者的ABR反应中出现ASNR波是其听力学特征性表现之一,但EABR记录不到相应的短潜伏期负反应。EABR的V波潜伏期较ABR短。植入前存在ASNR的大前庭水管综合征患者具有较低的植入后EABR反应阈。     

电诱发听性脑干反应在人工耳蜗植入中的应用

目的分析人工耳蜗植入患者耳蜗植入前电诱发听性脑干反应（electrical auditory brainstem response,EABR）的测试结果并初步探讨其意义。方法对14例不同病因、不同年龄的人工耳蜗植入患者耳蜗植入前进行测试,采用EMG外置电刺激器连接面神经探针作为刺激电极,采用Neuro Soft公司生产的Neruo Audio听觉诱发电位仪及调试软件进行EABR测试,测量并分析EABR波形,各波潜伏期和波间期,Ⅴ波波幅、阈值。结果EABR的Ⅱ、Ⅲ、Ⅳ、Ⅴ波与声诱发ABR相似,Ⅲ、Ⅴ波的潜伏期较声诱发ABR缩短,但Ⅲ~Ⅴ波间期与声诱发ABR相同。14例耳聋患者均记录到EABR的Ⅲ波/Ⅴ波,引出率为100％。4例极重度感音神经性聋未合并其他异常患者术中2.5、2.0 mA刺激Ⅲ、Ⅴ波典型,潜伏期和波间期均正常,术中神经反应遥测技术（neural response telemetru,NRT）引出,提示其听神经脑干传导通路无异常,预后效果良好。其他部分患者存在潜伏期延长或波形分化不良或刺激阈值较高等表现,提示可能由于不同因素所导致听觉传导通路异常。结论EABR是通过电刺激耳蜗来了解听觉系统对电刺激的生理反应,最接近人工耳蜗的工作状态,可以对患者听力康复的效果提供更准确的预测;特别是对于一些特殊患者,具有评估人工耳蜗植入效果的优势。而对各种特殊类型耳聋的人工耳蜗植入术前检测、术后评估数据仍需深入探索。     

儿童人工耳蜗植入术后神经反应遥测阈值的变化

目的:通过对儿童患者术后神经反应遥测 (NRT) 阈值的分析,总结其变化规律,为儿童人工耳蜗植入术后调试提供帮助.方法:测试40例接受Nucleus CI24R 型多导人工耳蜗单侧植入术的患儿.测试使用澳大利亚Cochlear公司提供的便携式调试系统及NRT3.1版本软件.采用削减算法提取NRT反应波形,分别测试每位患者的第1、5、10、15、20号电极,NRT阈值使用NRT软件计算.分别在开机时、开机3、6和12个月时进行测试.结果:在术后同一测试时间,位于耳蜗不同部位电极的NRT阈值存在差异.耳蜗底部和顶部电极的NRT阈值较低,而位于耳蜗中部的电极NRT阈值较高.经单因素方差分析,不同部位NRT阈值均差异有统计学意义.同一测试电极,随术后开机时间的增长,NRT阈值呈逐渐增加的趋势.经单因素方差分析,术后不同测试时间NRT阈值均差异有统计学意义.结论:术后开机1年内,NRT阈值呈逐渐增加的趋势.若人工耳蜗植入术后调试需要NRT进行辅助,每次均应测试NRT阈值,以便更准确估算患者的行为反应T、C级,尤其对植入术后1年内的儿童患者更为重要.     

人工耳蜗植入者电听性脑干反应测试

目的　通过对人工耳蜗植入者的电听性脑干反应 (electricallyevokedauditorybrainstemresponses,EABR)检测 ,探讨术后患者的电听觉传导通路的功能状态和EABR阈值。方法　对 6例人工耳蜗植入患者术后进行EABR检测。分别选取近耳蜗底转、中部和近蜗顶部三个固定部位的蜗内电极作为刺激电极 ,进行EABR记录 ,将所测EABR阈值与主观阈值和NRT(neuralresponsetelemetry)阈值进行比较。结果　 6例患者 ,用 175电流级 (currentlevel)的刺激强度 ,每一部位都可记录到清晰易识别、重复性良好的EABR波形 ,在耳蜗底转 ,中部和蜗顶部电极测得EABR波Ⅲ平均潜伏期分别为 1.83± 0 .19、1.80± 0 .18、1.6 8± 0 .2 3ms ,波Ⅴ平均潜伏期分别为 3.90± 0 .16、3.74±0 .18、3.6 2± 0 .2 4ms;测得EABR平均阈值分别为 16 5 .33± 7.6 6、16 2 .6 7± 7.2 8、15 3.33± 8.0 2电流级。结论　EABR是了解人工耳蜗植入者听觉传导功能的存在及测定人工耳蜗植入术后听觉阈值的客观方法之一     

人工耳蜗植入者电诱发听性脑干反应阈值与行为测听阈值相关性研究

目的　通过对人工耳蜗植入者行为测听阈值和电诱发听性脑干反应（electrical evoked auditory brainstem response，EABR）阈值相关性比较，探讨用EABR波Ⅴ阈值 进行术后调试的可行性。方法　对19例（20耳）人工耳蜗植入者分别选取第1、6、11、16、22号刺激电极行EABR和行为测听测试，获得阈值。结果　刺激电极EABR波Ⅴ潜伏期为（3.73±0.37）ms；第1、6、11、16、22号电极EABR阈值分别为（145.50±9.85）、（144.75±7.69）、（148.25±11.04）、（146.50±9.20）和（142.25±10.45）CL；行为测听阈值分别为（138.95±7.87）、（138.20±9.04）、（136.50±9.32）、（137.90±10.23）和（134.40±13.43）CL。EABR阈值与行为测听阈值显著相关（r =0.533、0.671、0.580、0.749和0.811，P 均＜0.05）。结论　EABR阈值与行为测听阈值显著相关，EABR为低龄或无法配合行为测听的人工耳蜗植入者术后调机提供一种客观检测手段。     

人工耳蜗植入者EABR与ECAP分析

目的探讨听觉电诱发电位对人工耳蜗植入者的电听觉传导功能客观评价的意义。方法对14例人工耳蜗植入者行电诱发听性脑干反应（electrically evoked audiotory brainstem responses,EABR）和电诱发听神经复合动作电位（electrically evoked compound action potential,ECAP）检查,根据第1、10、22号电极ECAP波形的检出与否将其分成A（1、10、22号电极ECAP均检出）、B（1、10、22号三个电极中有一个及以上ECAP未检出）两组,检测A组和B组患者的EABR阈值、波Ⅲ、Ⅴ潜伏期、Ⅲ-Ⅴ波间期并对其结果进行比较。结果刺激脉宽分别为25、50、75、100、125μs时,22号电极的EABR阈值B组高于A组,差异有显著统计学意义（P〈0.001）;刺激脉宽为50μs时：1号和10号电极的EABR阈值B组高于A组,差异有显著统计学意义（P〈0.001）。A、B两组患者22、10、1号电极EABR波Ⅲ、Ⅴ潜伏期和Ⅲ-Ⅴ波间期之间的差异无统计学意义（P〉0.05）。结论 ECAP波形较好者的EABR阈值较ECAP波形较差者的EABR阈值低。EABR波Ⅲ、Ⅴ潜伏期、Ⅲ-Ⅴ波间期与ECAP波形引出与否无明显相关性,ECAP灵敏性高而EABR稳定性好。     

Electrophysiologic effects of placing cochlear implant electrodes in a perimodiolar position in young children

OBJECTIVE: The purpose of this study was to intraoperatively record the electrically evoked auditory brainstem response (EABR) before and after placement of the electrode positioning system (EPS) (CII Bionic Ear with HiFocus I cochlear implant electrode array) as well as before and after stylet removal (Nucleus Contour cochlear implant electrode array). It was hypothesized that physiologic changes would occur after perimodiolar positioning of the electrode array and these changes would be evident from the EABR recordings. STUDY DESIGN: Consecutive young (11-36 month old) pediatric cochlear implant recipients (n = 17) had intraoperative EABRs recorded from three intracochlear electrodes that represented apical, medial, and basal locations. Wave V amplitudes and thresholds were studied relative to electrode location and pre- versus postperimodiolar positioning. These evoked potential measures were analyzed for statistical significance. SETTING: Tertiary referral children's hospital/medical college. RESULTS: Wave V thresholds of the EABR were lower, and amplitudes were larger after perimodiolar positioning, although the changes were dependent on electrode location and implant design. Statistically significant decreases in EABR wave V threshold and increases in suprathreshold wave V amplitude were found for the basal electrode for the CII Bionic Ear HiFocus I and for the apical electrode for the Nucleus Contour. CONCLUSIONS: Placement of either the CII Bionic Ear HiFocus I or Nucleus Contour cochlear implant electrode array in the perimodiolar position in young children resulted in less electrical current necessary to stimulate the auditory system. Changes in electrophysiologic thresholds and amplitudes, measured with EABR, indicate that the electrode array is placed closer to the modiolus with both electrode designs.     

Electrically evoked auditory brain stem responses for lateral and medial placement of the Clarion HiFocus electrode

OBJECTIVE: The purpose of this study was to compare the electrically evoked auditory brain stem response (EABR) for lateral and medial placement of the Clarion HiFocus cochlear implant electrode array via the electrode positioning system (EPS). DESIGN: Twenty-five adult and pediatric cochlear implant recipients participated in the study. Intraoperatively recorded EABRs were evoked by stimuli via three intracochlear electrodes representing apical, medial, and basal locations, and responses were elicited before and after positioner insertion. Evoked potential measures of wave V amplitude and threshold were examined for statistical significance using ANOVA for repeated measures and Chi-Square methods. RESULTS: For a given supra-threshold stimulus level, the increase in EABR wave V amplitude was significantly larger after EPS placement compared to before EPS placement for electrodes 1 (apical) and 13 (basal). Likewise, when the stimulus was decreased to obtain a minimal amplitude, the wave V threshold was significantly lower after EPS placement for electrodes 7 (medial) and 13. The number of measurements that showed decreased wave V threshold after EPS insertion was significantly dependent on intracochlear electrode location. CONCLUSIONS: Placement of the Clarion Electrode Positioning System following HiFocus electrode insertion resulted in a reduction in the electrical current required to activate the auditory system. The effect of the EPS was greatest for the basal location, demonstrated by lower wave V thresholds and a larger percentage increase in wave V amplitude. The EABR reflected electrophysiologic changes relative to lateral-to-medial changes in intracochlear electrode position due to the EPS.     

人工耳蜗植入前电刺激听神经复合动作电位检测方法的建立和初步应用

目的 建立术中利用探测电极施行电刺激听神经复合动作电位(electrically evoked auditory nerve compound active potentials,ECAP)检测的方法,在植入人工耳蜗装置前评估患者耳蜗听神经功能状况.方法 选择20例人工耳蜗植入患者,其中耳蜗形态发育正常12例,5例双侧前庭导水管扩大,3例双侧耳蜗Mondini畸形.测试完成后全部使用Cochlear人工耳蜗.全麻后常规人工耳蜗手术进路,行标准耳蜗鼓阶开窗,将自制测试用多通道试验电极置入鼓阶,电极连接Cochlear公司体外言语处理器及自制电刺激发生器,连接电脑,采用Custom Sound EP 2.0软件,调整优化刺激参数进行神经反应遥测(neural responsetelemetry,NRT)初步了解听神经功能状态;刺激强度以5 CL为步长递减或递增至反应阈值给予电刺激脉冲,同时自动记录ECAP波形和阈值.植入人工耳蜗后常规进行NRT检测,记录ECAP波形和阈值;术后1个月患者开机后采集T、C值,将两种电极测试所得阈值和开机C值进行相关性研究,并进行数据统计分析.结果 试验电极ECAP引出率为90%,商业电极ECAP引出率为90%,平均阈值分别为(160.50±15.12)CL和(160.00±11.27)CL,两者经统计学检验没有显著性差异(P>0.05);和开机后C值(177.40±10.61)有明显相关性(R2=0.844,r=0.919).结论 成功建立了术中植入人工耳蜗装置前的ECAP检测方法,为内耳和/或听觉通路发育异常及无残余听力患者提供有效的听神经反应信息,对了解听觉系统发育程度及初步预测术后患者康复情况提供客观依据.     

人工耳蜗植入患者电诱发镫骨肌反射检测

目的 寻找可靠的客观测定方法,在术中即时评价由植入体至听觉中枢传导通路的情况,并在术后协助人工耳蜗编程调试.方法 植入奥地利Combi 40＋型人工耳蜗系统的36位患者,使用CI.STUDIO＋2.0软件在术中进行电诱发镫骨肌反射（electrically evoked stapedius reflex,ESR）检测,分别选取第1、6、12电极作为观察蜗顶、蜗中、蜗底3个不同部位的研究电极,观察ESR检出率以及镫骨肌反射阈（electrically evoked stapediua reflex threshold,ESRT）与主观阈值（threshold,THR）、最大舒适级（maximum comfortable level,MCL）之间的关系.结果 ESR检出率为69.44%;各电极ESRT远远大于心理物理测试得到的主观阈值,接近最大舒适级,在THR和MCL动态范围的80%～90%左右,均值t检验ESRT与MCL无统计学差异（P〉0.05）.结论 ESR既可以用于术中判断植入体是否完好和听觉传导通路是否正常,预测手术效果,又可以在术后协助人工耳蜗编程调试,是一种方便、快捷的客观检查方法.     

不同策略的声电双模式助听对事件相关电位的影响

目的 探讨听障儿童单侧耳植入人工耳蜗(cochlear implant,CI)后对侧耳联合使用助听器(hearing aid,HA)的双模式助听策略对事件相关电位P300的影响.方法 研究对象共52人,设实验组(人工耳蜗植入儿童)3组、听力正常对照组1组,每组13人,按实验设计步骤随机测试.按对侧耳配戴HA的不同将人工耳蜗植入儿童分为A(CI+模拟HA)、B(CI+数字HA,未优化)和C(CI+数字HA,优化)3组,评估实验对象术后左右耳的残余听力,分别设置和优化CI及HA的技术参数并在声场中评估其助听后的音频感知情况,测试并比较各组的P300潜伏期及振幅.结果 3组患者术后双耳均有残余听力,助听后组间比较无差别(P>0.05).P300潜伏期比较A组>B组>C组(P<0.05),A、B两组P300潜伏期比对照组延长(P<0.05),C组与对照组比较无差别(P>0.05);P300振幅A组和B组与对照组比较均无意义(P>0.05),C组P300振幅低于对照组(P<0.05).结论 大部分听障儿童一侧耳植入人工耳蜗后对侧耳仍有可利用的残余听力,可以联合配戴适合的全数字编程助听器,大脑听觉中枢可以整合声电双模式助听设备上传的听觉信息.     

Pre-perioperative, transtympanic electrically evoked auditory brainstem response in children

The purpose of this study was to characterize the transtympanically evoked, perioperative electrically evoked auditory brainstem response (EABR) and define its relationship with preoperative hearing, age and hearing loss etiology in 59 children (10-60 months of age) who had received cochlear implants. The results indicate that there was no difference between wave V latency obtained from the younger (10-36 months) and the older (37-60 months) children. There was a statistically significant difference in the preoperative pure-tone average between the higher-EABR threshold group (650 microA and above) and the lower-EABR threshold group (600 microA or less). Patients with post-meningitic deafness exhibited the longest EABR wave V latencies. Perioperative, transtympanic, promontory EABR is an effective clinical procedure which can decrease the likelihood of placing a cochlear implant in a non-stimulable ear, and may provide the clinician with a valuable tool for selecting the most appropriate ear for implantation.     

Toward a battery of behavioral and objective measures to achieve optimal cochlear implant stimulation levels in children

OBJECTIVES: Children require audible and comfortable stimulation from their cochlear implants immediately after device activation. To accomplish this, a battery of objective measures may be needed that could include the electrically evoked stapedius reflex (ESR), compound action potential from the auditory nerve (ECAP), and/or auditory brain stem response (EABR). In the present study, the following specific research questions were asked: In children using cochlear implants, 1) Can the ECAP, EABR, and ESR be recorded at the time of cochlear implantation? 2) What is the feasibility of measuring the ECAP, EABR, and the ESR repeatedly without the use of sedation over the first year of implant use? 3) Do ECAP, EABR, and ESR thresholds or behavioral measures change over time? 4) What is the relation between ECAP, EABR, and ESR thresholds and behavioral measures of threshold and comfortably loud levels? DESIGN: In 68 children, ECAP, EABR, and ESR responses as well as behavioral measures of stimulation threshold and maximum stimulation were recorded at regular intervals over the first year of implant use. In each child, responses were recorded to electrical pulses provided by three different electrodes along the implanted array. Visual inspections of the stapedius reflex (V-ESR) evoked by activation of the same three electrodes at the time of surgery were performed in an additional 20 children. RESULTS: ECAP and EABR measures were obtained in more than 84% of electrodes tested and 89% of children tested both in the operating room at the time of implant surgery (OR) and after surgery in nonsedated children. ESRs were recorded by using immittance measures in more than 65% of electrodes tested and 67% of children tested by 3 mo of implant use, but this technique was less successful in the OR and during early stages of device use. V-ESRs and ECAP thresholds were higher in the OR than ESRs and ECAPs at postoperative recording times. EABR and ECAP thresholds did not significantly change over the first 6 and 12 mo of implant use, respectively, whereas ESR thresholds increased. Behavioral measures of threshold decreased over time, whereas maximum stimulation levels rose over time. Behavioral measures of threshold and loudness were highly correlated at all test times. ECAP, EABR, and behavioral measures were lower when evoked by an electrode at the apical end of the implanted array than by more basal electrodes. Behavioral thresholds could be predicted mainly by ECAP thresholds, whereas maximum stimulation levels could best be predicted by ESR thresholds; both were significantly affected by the age at implantation. CONCLUSIONS: A combination of nonbehavioral measures can aid in the determination of useful cochlear implant stimulation levels, particularly in young children and infants with limited auditory experience. These measures can be made in the operating room and can be repeated after surgery when needed. Correction factors to predict threshold stimulation levels should be based on ECAP thresholds or EABR thresholds if necessary. Correction factors should be made for at least one apical and mid-array electrode, should take into account the age of the child, and may have to be revised during the first year of implant use. Maximum stimulation levels may be best determined by using the ESR.