小儿专科医院开展人工耳蜗植人手术的优势

目的通过本组6家小儿专科医院开展人工耳蜗植入手术的临床工作,讨论小儿专科医院开展人工耳蜗植入手术的优势。方法从1998年5月-2009年3月11年间,本组6家小儿专科医院耳鼻咽喉科共开展了103例人工耳蜗植入手术。术前信息：全部为双耳重度和极重度感音神经性聋,年龄8．5个月-10．2岁,平均年龄为3．8岁,全部为语前聋患儿。术前进行听力学评估、发育和智力评估、影像学评估、人工耳蜗植入适应证的评估。术前进行全麻风险的评估。进行与综合性医院开展人工耳蜗植入手术的优势比较,包括：①术前评估水平,②术中麻醉风险,③人工耳蜗植入手术结果,④围手术期护理和并发症处理水平。结果①术前评估：术前视觉强化行为测听检查：103例查出有残留听力49例,平均听力98dB,余54例无残留听力。畸变产物耳声发射检查：103例均未引出耳声发射。听觉脑干诱发电位、40Hz、多频稳态诱发电位检查：引出波形41例,未引出波形62例。术前影像学检查：颞骨CT检查103例中正常颞骨形态84例,内耳畸形19例,其中双耳大前庭导水管畸形ll例、Mondini畸形7例、前庭与外半规管共同腔畸形1例。脑常规MRI检查,正常98例、脑白质轻度异常5例。行为和智力测试：格雷费斯智力测试〉86分99例、〈86分4例。术前检查结果与综合性医院检查结果比较,无显著差异。②术中麻醉风险：全麻插管、拔管中出现心电、氧、二氧化碳监测问题、气管支气管痉挛并发症0例,综合性医院发生率为0．37％,有明显的安全优势。③人工耳蜗植入手术结果：103例手术均成功,与综合性医院比较,无明显差异。④围手术期护理与并发症的处理：103例术前常规静脉采血、术中,术后常规建立静脉通道未出现失败,综合性医院出现静脉采血、建立静脉通道失败率约5%右,?     

老年性耳聋患者人工耳蜗植入术后效果评估

目的：对老年性耳聋患者人工耳蜗植入术后的效果进行评估,探讨老年性耳聋患者人工耳蜗植入的意义。方法对24例行人工耳蜗植入术的老年性耳聋患者进行术前、术后听力学评估和言语评估并比较差异。听力学评估采用助听听阈测试、听觉行为分级评估（Categories of Auditory Performance,CAP）和词表识别率评估(word recognition score, WRS);言语评估采用言语可懂度分级标准（Speech Intelligibility Rating,SIR)。结果术后患者各频率的助听听阈较术前有显著提高,P＜0.05。术后CAP、WRS、SIR均较术前显著提高,P＜0.05。结论人工耳蜗植入可作为重度以上听力损失且助听器效果不佳的老年性耳聋患者的干预方法。     

一例神经纤维瘤患者植入人工耳蜗的效果观察

目的：探讨神经纤维瘤听力下降患者人工耳蜗植入手术可行性及疗效。方法对一例多发性神经纤维瘤伽马刀术后患者带瘤行CS-10A人工耳蜗植入,术前和术后3个月分别进行裸耳/助听听阈评估、单音节和双音节言语识别测试。结果患者术前右侧重度、左侧极重度感音神经性聋,术前言语识别率左耳最大声输出患者无反应,右耳最大单音节词言语识别率为12%,双耳双音节词言语识别率均为0%。听觉行为分级量表为2级。患者右侧成功植入人工耳蜗。术后3个月助听后声场评估右耳（人工耳蜗植入耳）平均听力42.5 dB HL,单音节词最大言语识别率为64%,双音节词最大言语识别率为47%,听觉行为分级量表为7级。结论在影像学证明听神经完整的情况下,神经纤维瘤伽马刀术后重度聋患者可植入人工耳蜗,以提升听力水平。     

综合听力学评价对小龄聋儿人工耳蜗术前适应证筛选的临床意义

目的探讨综合听力学评价对判断小龄聋儿人工耳蜗植入适应证的临床意义。方法对50名3岁以内小龄聋儿进行听觉脑干诱发电位（auditory brainstem responses,ABR）、耳声发射（otoacoustic emissions,OAE）、声导抗等客观测试。行为观察（behavioral observation audiometry。BOA）、视觉强化定向反应（visual reinforcement audiometry,VRA）、游戏测听（play audiometry,PA）等行为测听及听觉言语评估,用其结果综合判断听力损失程度。术后开机3个月对所有小儿进行听觉言语评估,与术前结果进行对比。结果术后50名聋儿的听觉言语识别率有明显提高。结论综合听力学评价能够准确筛选出小龄聋儿人工耳蜗适应证患者,筛选出来的患者术后可以取得较好的康复效果。     

人工耳蜗植入术中圆窗耳蜗电图评价耳蜗残余听功能

目的应用术中圆窗耳蜗电图评估极重度感音神经性聋患者耳蜗残余听功能。方法20例患者全麻下人工耳蜗植入手术过程中,行术中圆窗耳蜗电图测试,测出的复合动作电位（CAP）阈值与术前纯音测听或其他听力测试之阈值进行比较。结果20例患者术中圆窗耳蜗电图测试测出的复合动作电位（CAP）阈值与术前1、2、4kHz听力测试阈值分别有较好的相关系数（0．20429,0．04076,0．38163）。结论术中圆窗耳蜗电图可以较准确客观地评估极重度感音神经性聋患者耳蜗残余听功能,且是人工耳蜗植入术前听力学评估方法的有意义的补充。     

人工耳蜗植入在Waardenburg综合征Ⅱ型患儿中的应用

目的:探讨Waardenburg综合征(WS)患者人工耳蜗植入方法及手术前后听力评估和术后言语康复效果。方法:回顾性分析2000-2008年确诊的12例WSⅡ型行人工耳蜗植入患儿的临床资料,所有患儿均经乳突面隐窝进路行人工耳蜗植入,将患儿植入后听力情况与12例内耳发育正常的人工耳蜗植入者(对照组)进行比较。结果:12例WS患儿术中电极植入鼓阶顺利,术后无面瘫及脑脊液漏现象发生,术后听阈与对照组无明显区别。经过超过0.5年的言语康复训练,患儿的听力及言语能力均有不同程度提高。结论:人工耳蜗适用于WS患儿,术前应进行全面的听力学及影像学评估。     

人工耳蜗植入的术前评估与术中处理

目的 总结人工耳蜗植入术前评估和术中处理经验,以提高手术安全性和术后效果。方法 对158例行人工耳蜗植入患者的术前听力学与影像学信息进行评估,与术中术后结果进行比较。结果 158例人工耳蜗植入者,中耳内耳形态正常者116例,中耳内耳有异常改变42例。6例术中出现井喷,除1例井喷术前未预料外,余157例均与术前评估吻合。术后全部患者重新建立了新的听觉,平均纯音听力(声压级)37.6 dB。结论 人工耳蜗植入手术的安全性主要依靠术前影像学评估,使用高分辨率CT指导手术可以降低手术失败率,减少并发症。     

人工耳蜗植入的术前评估与术中处理

目的总结人工耳蜗植入术前评估和术中处理经验，以提高手术安全性和术后效果。方法对158例行人工耳蜗植入患者的术前听力学与影像学信息进行评估，与术中术后结果进行比较。结果158例人工耳蜗植入者，中耳内耳形态正常者116例，中耳内耳有异常改变42例。6例术中出现井喷，除1例井喷术前未预料外，余157例均与术前评估吻合。术后全部患者重新建立了新的听觉，平均纯音听力(声压级)37．6dB。结论人工耳蜗植入手术的安全性主要依靠术前影像学评估，使用高分辨率CT指导手术可以降低手术失败率，减少并发症。     

人工耳蜗植入后术耳残余听力跟踪分析

目的观察人工耳蜗植入后植入耳残余听力的变化。方法对人工耳蜗植入术前能较好配合行为测听的58例听障儿童,人工耳蜗植入后利用游戏测听或纯音测听评估其术耳残余听力,58例术后随访3个月,43例术后随访1年,17例术后随访2年。结果与术前0．25～4 kHz残余听力相比较,58例术耳术后3个月残余听力较术前明显下降（P＜0．05）,43例术后1年残余听力明显下降（P＜0．05）,但0．25～0．5 kHz残余听力较术后3个月提高,差异有统计学意义（P＜0．05）;17例术后2年0．25～0．5 kHz残余听力较术后3个月明显提高。结论人工耳蜗植入后可导致0．25～4 kHz各频率残余听力下降,但术后1、2年时0．25、0．5 kHz处的残余听力较术后3个月有所提高,1、2、4 kHz残余听力无明显改变。     

儿童人工耳蜗植入年龄下限降至9月龄的启示与应对

食品与药品管理局(FDA)批准将儿童人工耳蜗植入年龄下限降至9月龄表明：有必要更早地植入人工耳蜗，以收获聋儿植入后更佳的听力、言语和语言康复成效。在低龄婴幼儿中进行人工耳蜗植入，离不开一批训练有素的医护及麻醉团队提供围手术期支持，对诊断、麻醉风险、外科技术、术中测试和术后编程、长期安全等方面提出了更高要求。同时也对婴幼儿听力学诊断、干预和评估带来了挑战。9~24月龄儿童植入人工耳蜗的指征仍为双侧极重度感音神经性听力损失，围绕“先天聋儿植入人工耳蜗的指征和时机”“植入前是否试配助听器”等话题，耳外科专家与听力学专家应携起手来，审慎、稳妥、积极地开展低龄儿童人工耳蜗植入的循证医学研究。     

人工耳蜗手术前后使用小儿主观测听法的意义

目的探讨主观听力学测试方法在低龄儿童人工耳蜗植入手术前后的作用。方法和结果103名5岁以下拟接受人工耳蜗植入低龄儿童,术前均完成非助听和助听主观听力测试。31名游戏测听(playaudiometry,PA)法、62名视觉强化测听(visualreinforcementaudiometry,VRA)法、10名行为观察测听(behavioralobservationaudiometry,BOA) VRA法获得左右侧单耳/或双耳裸耳听阈;30名PA法、63名VRA法、10名BOA VRA法分别在声场中获得每侧耳的助听听阈,并结合其他客观测试结果评估了听通路的功能。术后开机调试后103名患儿均有听觉反应并获得T、C值,其中48名由VRA、PA测试方法得到;27名经BOA法得到;28名经神经反应遥测(neuralresponsetelemetry,NRT)结合BOA法获得,患儿的听觉能力有明显改善。结论主观听力测试方法在人工耳蜗植入术前对评估听通路完整性非常重要,对预测低龄患儿术后听觉康复可能的疗效有重要意义。     

Preservation of residual hearing in children and post-lingually deafened adults after cochlear implantation: an initial study

OBJECTIVE: To investigate whether the residual hearing of severely hearing-impaired children and adults could be preserved using the soft surgery approach. PATIENTS AND METHODS: This project employed a prospective study design. All testing and surgery took place in the Institute of Physiology and Pathology of Hearing, Warsaw, Poland. Twenty-six patients (7 children and 19 post-lingually deafened adults) with residual hearing were assessed. Subjects were assessed using conventional pure-tone audiometry at least 1 month prior to surgery. Cochlear implant surgery with a Med-El Combi 40/40+ standard electrode array was conducted, using the soft surgery approach. Pure-tone audiometry thresholds were re-assessed at least 1 month after surgery. The researchers assessed change in auditory thresholds using pure-tone audiometry to determine preservation of residual hearing. RESULTS: Sixteen of 26 patients (62%) retained their residual hearing within 5 dB HL of pre-operative scores. Only 5 of 26 patients (19%) lost all measurable residual hearing after cochlear implantation. This suggests that surgeons are often able to preserve residual hearing during cochlear implant surgery using the soft surgery technique. CONCLUSIONS: Preservation of residual hearing is an important consideration in cochlear implantation in the light of changing selection criteria for cochlear implant candidates, and as younger children are receiving implants. This is important, as we do not know yet the long-term effects of inner ear damage due to traumatic insertions of electrodes. This finding suggests a good prognosis for future possibilities of re-implantation.     

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.     

Cochlear implant hearing performance at the University of Minnesota

The hearing performance of six post-lingually deaf adults implanted with the Nucleus 22-channel device are presented. All patients achieved measurable open set speech recognition with implant alone. The best hearing performance was achieved with a combination of lipreading and cochlear implant. For this condition our group achieved an average open set speech discrimination score of 85% (CID sentences) and an average speech tracking rate of 70 words per minute. We attribute the success of our group to careful pre-operative selection, including attention to candidate motivation toward hearing rehabilitation.     

92例人工耳蜗术后不同阶段康复评估效果分析

目的通过对92例7岁以下植入人工耳蜗的语前聋儿童进行分阶段的听觉、言语康复效果评估,探讨7岁以下儿童植入人工耳蜗后在不同阶段的听觉、语言康复效果及其影响因素。方法本研究采用评估词表及标准评估程序,对测试对象进行听觉能力及语言能力评估。结果听觉言语识别率:术后3个月平均达到46%,6个月达到71%,9个月达到84%,12个月达到89%;语言能力:术后3个月语言年龄平均达到1.3岁,6个月平均达到2.0岁,9个月平均达到2.5岁,12个月平均达到2.9岁。结论人工耳蜗能够帮助重度听力障碍者改善听力,术后经过一年系统康复训练,在听觉识别和语言能力上较术前有显著提高。     

Speech perception and language criteria for paediatric cochlear implant candidature

Existing criteria for cochlear implantation of children with impaired hearing aim to select children who will eventually achieve better speech perception scores with an implant than with a hearing aid. It is difficult to predict the eventual outcomes with hearing aid and implant because speech perception scores typically increase with age, and because the distribution of scores for implant and hearing aid users overlap considerably at all ages. This paper shows how speech perception scores can be combined with spoken language measures to arrive at an objective criterion for implant selection. The method also allows estimation of the likely increase in speech perception score within a few months of implantation and estimation of the probability that the child will perform better with the implant than the hearing aid. The criteria were based on data from 135 evaluations of 50 children using cochlear implants with monosyllabic words, open-set sentences, the Clinical Evaluation of Language Fundamentals, and the Peabody Picture Vocabulary Test. Data from 114 evaluations of 43 children using hearing aids were used to illustrate the sensitivity of the criteria.     

Rehabilitation and assessment of aural-oral speech development in children with cochlear implants

Updated models of cochlear implants provide good speech audibility and thus complete rehabilitation of children who have lost hearing after learning speech. All the children who lost hearing before learning speech can hear sounds of normal loudness and orient in sound media by means of cochlear implant. However, they need long-term audio-vocal rehabilitation the results of which depend on the age of the child's operation and hi(her) individual traits. Cochlear implants in children aged under 3 years are most perspective. Russian language methodology including 7 tests and 2 questionnaires is described. It is intended for assessment of audio-vocal development in children with cochlear implants and results of audio-vocal rehabilitation as well as of effectiveness of using cochlear implant in children over 2 years of age. Establishment of centers for cochlear implantation and introduction of cochlear implantation state program are recommended.     

语前聋患儿一侧人工耳蜗对侧助听器效果分析

目的:通过对人工耳蜗植入对侧耳不同听力损失的患儿联合使用助听器与人工耳蜗语前聋患儿的听觉、语言及学习能力进行评估和比较,探索对患儿更为有效的助听方法,帮助患儿获得最大限度的言语交流。方法:将30例3～6岁语前聋患儿按照植入人工耳蜗对侧耳听力损失程度及是否佩戴助听器,分为一侧人工耳蜗+对侧重度听力损失助听器组(CI+SHA组)、一侧人工耳蜗+对侧极重度听力损失助听器组(CI+PHA组)、单耳人工耳蜗组(CI组)。评估各组在康复3、6、9、12、15、18个月时听觉、语言及学习能力,并记录结果。结果:随着术后康复时间的延长,聋儿听觉、语言及学习能力逐渐提高(P<0.05),CI+SHA组听觉能力优于CI+PHA组及CI组(均P<0.05),语言能力及学习能力无明显差异(P>0.05)。结论:语前聋患儿单耳人工耳蜗植入后,若对侧耳尚有残余听力,佩戴助听器后听觉能力效果显著,长期佩戴有助于患儿的康复。     

人工耳蜗与助听器对听障儿童嗓音音质的影响研究

目的：探讨人工耳蜗与助听器对聋儿嗓音音质的影响机制。方法：随机选择昕障儿童组成健听组、助听器组、人工耳蜗组以及裸耳听障组,其中健听组与裸耳听障组作为对照控制组。采用“嗓音疾病评估仪”（TigerDRS）进行嗓音音质评估,要求儿童发／越／音,持续3s。测试的声学参数为：F0、SDF0、Jitter、Shimmer、NNE、HNR、SNR。结果：人工耳蜗组的嗓音F0显著小于其他各组（均P〈0．05）,助听器组、健听组、裸耳听障组之间的嗓音F0无显著性差异（P〉0．05）;人工耳蜗组与助听器组的SDF0显著大于健听组和裸耳听障组（P〈0．05）,助听器及人工耳蜗对听障女性患儿嗓音SDFo的影响大于昕障男性患儿,其交互作用达显著临界水平（P〉0．05）;各组之间的嗓音音质参数（Jitter、Shimmer、NNE、HNR、SNR）差异无统计学意义（P〉0．05）。结论：人工耳蜗与助听器主要影响的是嗓音F0及SDF0,而对其他音质参数影响不大。