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。     

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。     

人工耳蜗植入者EABR、NRT与ESR检测

目的探讨应用客观检测方法评价人工耳蜗植入患者术后听觉传导功能并指导术后调试的可行性。方法对39名人工耳蜗植入者分别选取第3、10、20电极,进行电诱发听性脑干反应(electric allyevok edaudito rybrainstem responses,EABR)、神经反应遥测(neuralresponset elemetry,NRT)、电刺激镫骨肌反射(electricall yevokedstap ediusresponses,ESR)检测及主观心理物理测试,测定EABR、电诱发听神经复合动作电位(electricallyevokedcompoundactionpotentials,ECAP)、ESR阈值、主观阈值(T-levels)和主观最大舒适强度(C-levels),分别对EABR、ECAP阈值与主观阈值,ESR阈值与主观最大舒适强度进行相关性研究。结果EABR平均阈值分别为158.63±10.86、159.71±11.17、152.92±10.82电流级(currentlevel,CL);ECAP平均阈值分别为188.71±15.19、194.61±10.21、185.07±11.52CL;ESR平均阈值分别为210.10±16.16、209.81±14.24、204.55±12.90CL。EABR阈值与主观阈值间、ESR阈值与最大舒适强度间显著相关(P<0.01);ECAP阈值与主观阈值间无显著相关性(P>0.05)。结论EABR是判断人工耳蜗植入者听觉传导功能的有效客观方法;EABR和ESR阈值的测定可协助判断人工耳蜗植入者的主观阈值和最大舒适强度。     

人工耳蜗植入术后NRT与EABR动态变化研究

目的观察人工耳蜗植入后短期神经反应遥测（neural response telemetry,NRT）、电诱发听性脑干反应（electrically auditory brainstem response EABR）的动态变化,探讨人工耳蜗植入术后神经传导通路的动态变化。方法：对12例极重度感音神经性聋患者分别于人工耳蜗植入术后1月（开机）及术后2月（开机1月）行NRT、EABR检测,观察NRT、EABR阈值及EABR波v潜伏期变化。结果：术后1月及术后2月NRT阈值无显著性差异（P〉0．05）;术后2月与术后1月相比,20号电极EABR阈值显著降低（P〈0．05）、EABR波V潜伏期显著缩短（P〈0．05）。10号、3号电极在两个不同时间点EABR阈值、EABR波V潜伏期均无显著性差异（P〈0．05）.结论：人工耳蜗植入术后短期内,NRT阈值变化不明显,而EABR阈值、波V潜伏期在发生变化,提示人工耳蜗术后患者的听觉神经传导通路具有动态变化趋势。     

电诱发听性脑干反应在人工耳蜗植入中的应用

人工耳蜗植入是治疗重度、极重度耳聋的重要手段,其效果依赖于听神经通路的完整性。在对无残余听力耳聋患者的术前评估中,电诱发听性脑干反应（EABR）能直接刺激听神经末梢,较常规的听力学测试更具有优势。本文针对该技术在特殊病例人工耳蜗植入及术后调机中的应用进行综述。     

听神经病人工耳蜗植入术中EABR监测及其疗效评估

目的:探讨听神经病的病变部位并观察听神经病人工耳蜗植入术后的疗效。方法:选择在我院行人工耳蜗植入术的8例听神经病患者,同时筛选背景接近的8例非听神经病极重度聋人工耳蜗植入患者作为对照组进行配对。回顾性分析2组患者术前听力学资料;术中耳蜗植入前采用自制电极行电刺激听性脑干诱发反应(EABR)评估听觉通路;植入后检测神经反应遥测(NRT)、EABR;并随访术后调机T、C值,采用听觉行为分级标准(CAP)、言语可懂度分级标准、言语识别率评估术前和开机后1年时听力言语情况。结果:8例听神经病患者术中植入前均可引出EABR波形,但是波形较正常有变异,需要刺激量加大或者调整参数,Ⅴ波潜伏期长短不一;植入耳蜗后NRT反应好,EABR和术中测试波形接近。术后开机均有听性反应,随访开机T、C值与对照组差异无统计学意义;听神经病组患者术前及开机1年CAP分别为6.50±0.94和6.90±0.77,言语识别率(双字词)分别为(85.00±11.66)%和(89.50±9.02)%,与对照组比较差异无统计学意义。结论:术前EABR可以做为评估听神经病(听同步不良患者)听觉通路的有效工具,筛选合适植入者;人工耳蜗可以帮助听神经病患者提高听力及言语能力。     

大鼠多通道人工耳蜗植入模型的建立

目的:建立多通道人工耳蜗植入的大鼠动物模型.方法:5只正常听力的Hooded Wister大鼠经药物致聋后,采用在前期研究中所创立的新手术步骤,在鼓阶内植入多通道电极.对双极电刺激诱发的听性脑干反应(EABRs)进行分析,对耳蜗组织学切片进行评价.结果:在电极植入后,顺利描记到正常EABRs波形,从而确认了有效的人工耳蜗功能状态.组织学观察表明,电极植入后的大鼠耳蜗内未见组织结构的严重损伤.结论:本文介绍的大鼠多通道人工耳蜗植入法有效,安全,所建立的大鼠动物模型为进行多通道人工耳蜗植入研究提供了一个新的途径;也为其他小啮齿动物(如沙鼠和小鼠)的实验性耳显微外科研究提供了思路.     

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     

不同脉宽条件下人工耳蜗植入者术中 电诱发听性脑干反应检测的特点分析

摘要：目的比较不同脉宽条件下人工耳蜗植入者术中电诱发听性脑干反应（electrically evoked auditory brainstem response,EABR）的特点,分析脉宽与EABR波V引出率和阈值之间的关系,总结不同脉宽条件对EABR波V引出率和阈值的影响,选择更优化的EABR脉宽测试参数。方法无残余听力的人工耳蜗植入患者24例作为实验组,其中耳蜗形态正常12例、大前庭导水管综合征（large vestibular aqueduct syndrome,LVAS）4例、Mondini畸形4例、共同腔畸形（common cavity deformation,CCD）2例、内听道狭窄2例;筛选条件相近的24例有残余听力的人工耳蜗植入者配对作为对照组。应用改装的Cochlear Freedom人工耳蜗及自制的铂铱合金球电极对拟行人工耳蜗植入的两组者术中分别给予50、100、200 μs不同脉宽的电刺激,Bio logic Navigator Pro听觉诱发电位仪记录不同脉宽条件下EABR波V引出率和阈值。结果脉宽50、100、200 μs时,EABR波V引出率实验组（均为91.7%）低于对照组（分别为100%、100%、95.8%）,差异无统计学意义（P均>0.05）;而EABR阈值实验组［分别为(183.73±8.96)CL、(151.28±10.05)CL、(120.56±12.82)CL］高于对照组［分别为(175.50±9.14)CL、(142.71±11.45)CL、(110.63±10.24)CL］,差异均具有统计学意义(t值分别为18.87、16.82、17.64,P均<0.05)。结论蜗内单极刺激能诱发出良好的EABR波形,无残余听力的患者EABR阈值要明显高于有残余听力的患者。相对于脉宽200 μs,50、100 μs时EABR波形波V引出率高;脉宽50 μs波形分化更好、动态范围广,内耳畸形严重可能需要适当加大刺激量（如将脉宽改为100 μs）。     

儿童人工耳蜗植入术后电诱发复合动作电位分析

目的 应用神经反应遥测(NRT)技术,观察人工耳蜗植入后不同时间段的电诱发复合动作电位(ECAP)阈值变化,探讨其对人工耳蜗术后调机的指导意义。方法 对33例使用Nucleus CI24R(CA)型人工耳蜗植入的患儿,于术中及术后1、1.5、2、4、6个月进行ECAP 阈值测试,统计分析其变化规律。结果 33例165个电极的波形检出率为93.3%。电极1、7、11、17、22的术中ECAP阈值与术后30d开机时的ECAP阈值的差异有统计学意义。同一测试电极,随术后开机时间的增长,ECAP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ECAP阈值差异有统计学意义。结论 ECAP检出率高,术中可用于检测神经反应;术后可协助估算患者的行为反应T、C级,指导调机,尤其对儿童患者更为重要。     

Residual hearing in cochlear implant patients

Preservation of residual hearing should be a desirable outcome of implant surgery. Prevention of neural degeneration due to loss of residual hair cells, together with the continuous progress in cochlear implant technology should be able to preserve cochlear integrity as well as possible. The degree of hearing preservation may vary depending on surgical approach, maximum insertion depth and other factors not uniformly considered to date. The aim of this retrospective case controlled study is to evaluate residual hearing after cochlear implant surgery. In particular, we analyzed data obtained with use of two different kinds of electrode arrays, with and without rigid introductor (stylet). We report the results on 37 patients with measurable preoperative hearing thresholds, mean age of 28 years (5–70 years), having the following implants: seven Advanced Bionics^®, four Med-El^®, 24 Cochlear^®, two MXM^®; 19 of them were performed using the stylet and the other 18 without it. A minimally invasive surgical approach was performed with a short retroauricular incision and a 1.2 mm cochleostomy. A complete electrode array insertion was obtained in all patients. Responses to pure-tone stimuli were measured for each ear in pre-implantation conditions and 3–12 months after surgery. After implantation 14 patients (38%) showed no hearing threshold variation, 29 (78%) maintained an appreciable hearing threshold level in the implanted ear, 8 (22%) had a total loss of residual hearing. Median increases of threshold levels were, in all 37 studied patients, 5, 10, 10 and 5 dB HL, respectively, for 125, 250, 500 and 1 kHz. For the 18 patients having implants without the stylet median increases of threshold levels were 0, 10, 5 and 7 dB HL; in the stylet group, they were 10, 5, 5 and 10 dB HL. On a comparison between the stylet and the non-stylet group, no significant differences in mean hearing threshold worsening were found. Data seem to suggest that cochlear function is less sensitive to mechanical trauma during implant surgery than was thought. Besides, electrode array stiffness seems not to influence preservation of cochlear residual functional integrity. Finally, the authors hypothesize a direct spiral ganglion activation under strong mechanical stimulation.     

Establishing the standard method of cochlear implant in Rongchang pig

Conclusions: In this investigation, a large mammal, Rongchang pigs were used to successfully establish a research platform for cochlear implant study on the routine use of it in clinic.

Objective: The aim of this study was to establish a standard method of cochlear implant in a large mammal—pig.

Methods: Rongchang pigs were selected, then divided into two groups: normal-hearing group (Mitf?+/+) and mutation group with hearing loss (Mitf ?/?). Cochlear implants were used and ABR and EABR were recorded. The implanted electrodes were observed by X-ray and HE stains.

Results: The success with cochlear implant and the best electrode position could be defined in all animals, the coiling of the cochlea reached 1.5–1.75 turns. Immediately after the operation of cochlear implants, the ABR threshold of the operated ear (right) could not be derived for each frequency at 120?dB SPL. Moreover, 7 days after surgery, the low-frequency ABR threshold of the operated ear (right) could be derived partly at 100?dB SPL, but the high-frequency ABR threshold could not be derived at 120?dB SPL. Immediately or 1 week after cochlear implants, the EABR threshold was 90?CL in the Mitf?+/+?group. This was obviously lower than the 190?CL in the Mitf ?/? group.     

Electrically evoked compound action potential (ECAP) in cochlear implant children: Changes in auditory nerve response in first year of cochlear implant use

AimRecording of the electrically evoked compound action potential (ECAP) of the auditory nerve in cochlear implant (CI) patients represents an option to assess changes in auditory nerve responses and the interaction between the electrode bundle and the neural tissue over time. The aim of the present work is to assess ECAP changes during the first year of cochlear implant for the purpose of predicting thresholds and adjustment of the patients’ programs over time.MethodData were collected from 25 children using Cochlear Nucleus 24 implants. ECAP thresholds were examined at the time of surgery, at initial stimulation, and 3, 6 and 12 months post-stimulation. Five electrodes located at basal, middle, and apical positions in the cochlea were tested at each time interval and ECAP thresholds were analyzed and compared.ResultsThere was a significant decrease in ECAP thresholds between the intraoperative measure and fitting time at all electrode sites. Mean ECAP thresholds measured at 3, 6 and 12 months post-stimulation remained similar to initial stimulation levels. Although there was no significant difference in ECAP thresholds recorded at fitting time and 12 months follow up session, there was significant increase in behavioral T and C levels from initial stimulation to the 12 months’ time point.ConclusionMost electrodes undergo non-significant change in ECAP thresholds over time, and therefore thresholds obtained on the day of initial stimulation can be used to estimate the patients’ map levels at any time. On the other hand, intraoperative thresholds demonstrated significant change relative to postoperative recording times, limiting the ability to use intraoperatively recorded ECAP thresholds to predict postoperative measurements.     

神经反应遥测技术在人工耳蜗术后调试中的应用

目的通过对小儿人工耳蜗植入者术后言语处理器调试中运用NRT（神经反应遥侧）技术效果的分析．探讨NRT在人工耳蜗术后调试中的应用价值。方法选取10例术后主观调试配合欠佳的儿童．用Cochlear公司NRT3．0编程软件进行ECAP波形检测并测定ECAP阈值，利用测试结果判断主观阈值（T-值）和最大舒适阈（C-值），并得出言语处理器映射图（Map）。术后6个月行声场听阈测听。结果86．2％的电极引出ECAP波形，开机调试时反应阈值较小，以后逐渐升高，3～4个月左右闽值逐渐趋于稳定，而且靠近蜗底的阈值比蜗尖高。声场平均听阈为30～40dBSPL。经过言语康复训练，获得良好的效果。结论NRT技术可为术后快速准确地调试言语处理器提供客观依据．     

人工耳蜗适应证评估标准的应用及分析

目的了解低龄听障儿童人工耳蜗（以下简称CI）适应证评估项目的临床应用及意义。方法应用“听力重建启聪行动”项目组制定的CI适应证评估标准,对211例CI候选者逐个进行术前检查和综合评估,汇总筛查结果递交CI技术小组讨论评议,并推荐上报符合CI植入标准的人选。结果211例CI候选者共筛出151例符合标准,15例听力评估不达标,14例智力或精神发育迟滞,9例耳蜗畸形,8例慢性中耳疾病,5例不符合年龄政策。3例多动症,3例有自闭症倾向,2例生长发育低下,1例有心脏病史。结论本项目组制定的CI适应证评估标准内容覆盖面广,操作流程统一规范,评估目的明确,能体现捐赠活动“优中选优”的宗旨,有较强的临床应用价值。     

内耳畸形与耳蜗骨化患者的耳蜗植入

目的探讨先天性内耳畸形与耳蜗骨化患者耳蜗植入术的有关问题.方法对我院2002年10月～2004年2月间行耳蜗植入术的8例内耳畸形和2例耳蜗骨化的患者进行回顾性分析.结果4例大前庭水管综合征患者术中有外淋巴液搏动;3例Mondini畸形和1例共同腔畸形患者术中出现井喷;1例耳蜗部分骨化患者术中误将电极插入内听道后纠正;另一例耳蜗部分骨化患者植人短电极.1例Mondini畸形患者术后发生少量脑脊液耳鼻漏,保守治疗3月后痊愈,其余患者无并发症.所有患者均成功开机.结论对于内耳畸形或耳蜗骨化的患者,耳蜗植入术前详细的影像学评估,对术中困难的充分估计和正确、规范处理是手术成功的基本条件.     

Acute mastoiditis in children with a cochlear implant

ObjectivesCochlear implantation is performed at a young age, when children are prone to acute otitis media. Acute mastoiditis is the most common complication of otitis media, but data on its management in the presence of a cochlear implant are sparse. The objective of this study was to assess the characteristics, treatment, and outcome of acute mastoiditis in children with a cochlear implant.MethodsThe medical files of all children who underwent cochlear implantation at a pediatric tertiary medical center in 2000–2014 were retrospectively reviewed. Those diagnosed with acute mastoiditis after implantation were identified, and data were collected on demographics, history, presentation, method of treatment, complications, association with untreated otitis media with effusion, and long-term middle-ear sequelae.ResultsOf the 370 children (490 ears) who underwent cochlear implantation, 13 (3.5%) were treated for acute mastoiditis (median age at acute mastoiditis, 32 months). Nine had a pre-implantation history of chronic secretory or acute recurrent otitis media, and 5 had been previously treated with ventilation tubes. In all 9 children who had unilateral cochlear implant, the acute mastoiditis episode occurred in the implanted ear. The time from implantation to mastoiditis was 5–61 months. The same treatment protocol as for normal-hearing children was followed, with special attention to the risk of central nervous system complications. Primary treatment consisted of myringotomy with intravenous administration of wide-spectrum antibiotics. Surgical drainage was performed in 8 out of 13 patients, with (n = 7) or without (n = 1) ventilation-tube insertion, to treat subperiosteal abscess or because of lack of symptomatic improvement. There were no cases of intracranial complications or implant involvement or need for a wider surgical approach. No middle-ear pathology was documented during the average 3.8-year follow-up.ConclusionsThe relatively high rate of acute mastoiditis and subperiosteal abscess in children with a cochlear implant, predominantly involving the implanted ear, supports the suggestion that recent mastoidectomy may be a risk factor for these complications. Despite the frequent need for drainage, more extensive surgery is usually unnecessary, and recovery is complete and rapid. As infections can occur even years after cochlear implantation, children with otitis media should be closely followed, with possible re-introduction of ventilation tubes.     

语前聋儿人工耳蜗植入术后心理物理测试的探讨

目的探讨符合语前聋儿心理特点的人工耳蜗植入术后心理物理测试手段.方法采用行为观察法和游戏测听法,对86名接受了人工耳蜗植入手术的语前聋儿进行术后心理物理测试.结果84例(96.51%)测试出听性反应,其间1例第13、14号电极引起非听性反应,2例(2.33%)电极植入失败.41例(47.67%)一月内、39例(45.34%)三月内、4例(4.65%)六个月建立起听性条件反应.各患儿的T、C值均不相同,无正常值范围,在测试的三个月内有T值渐减小、C值渐增大的趋势,声场啭音测试显示患儿听阈都在长时间平均会话声谱(言语香蕉图)上限,对言语的强声和音响器具的强声无不适感觉.结论采用符合语前聋小儿心理特点的人工耳蜗植入术后心理物理测试方法,患儿很快建立听性条件反应,声场评估显示参数设置适宜.