成人语前聋和语后聋人工耳蜗植入效果分析

目的分析成人人工耳蜗植入术后听觉及言语康复效果情况,探讨成人行人工耳蜗植入适应症的选择。方法对中国医科大学附属第一医院耳鼻咽喉科收治的18岁以上行人工耳蜗植入术患者52例进行测试,分为语前聋无干预组(9例)、语前聋佩戴助听器组(27例)、语后聋(16例)三组。采用声场助听听阈测试、电刺激听觉反应阈值(Threshold,THR)、最大舒适阈值(Maximum comfort level,MCL)评价其声音感知能力;采用普通话言语测听材料MSTMs中双音节词表评价其言语分辨能力。分别在开机6个月及24个月进行评估。结果开机6个月后三组声场助听阈值、THR、MCL均值无统计学差异。双音节识别率在开机6个月时语前聋无干预组8.78%、语前聋助听器组16.44%、语后聋组53.13%;在开机24个月时各组双音节识别率均上升,语前聋无干预组达18.22%、语前聋助听器组达52.89%、语后聋组达84.31%,语前聋助听器组提高明显。结论成人语前聋患者术后可获得与语后聋相近的听觉感知水平,长期使用人工耳蜗可加强言语识别能力,对术前有听觉言语基础的成人语前聋患者应积极行人工耳蜗植入术。     

语后聋人工耳蜗植入者的心理健康状况分析

目的探讨重度听力损失者借助人工耳蜗重获听力后的心理健康状况及其与听力正常人群的差异。方法采用症状自评量表(symptom checklist 90,SCL-90)和艾森克人格问卷(Eysenck personality questionnaire,EPQ)对18例语后聋人工耳蜗使用者(耳蜗组)的心理健康状态及人格特质进行评估,并与45例听力正常组(对照组)进行比较。结果①SCL-90评分结果显示:耳蜗组在人际关系、焦虑、敌对、恐怖、偏执、精神病性六个因子方面的得分均明显高于对照组(P<0.01);躯体化、强迫、抑郁三个因子的得分两组间差异无统计学意义(P>0.05)。②EPQ评定结果显示:耳蜗组在人格特质的内外倾、神经质、精神质三个维度评分与对照组相当,两组差异无统计学意义(P>0.05)。结论植入人工耳蜗有利于改善重度聋患者的心理健康状况,但人工耳蜗植入者在社会交往过程中仍存在人际关系敏感、焦虑、偏执等不良心理状态,提示在进行听觉言语康复的同时,还应关注其心理和社会交往状况,以帮助其改善生活质量、回归主流社会。     

语后聋多通道人工耳蜗使用者的普通话言语识别

普通话是我国的规范语言，其语音学特点有别于西方语系，特别是声调。人工耳蜗植入作为治疗重度感音性聋的最重要手段，目前多为基于西方语系设计的国外产品，能否充分地体现汉语、特别是汉语普通话的语音学特点，一直备受关注。我国多通道人工耳蜗使用者、特别是更具代表性的语后聋使用者的普通话言语识别状况，目前仅报道5例。     

多通道人工耳蜗植入患者声场听阈测试结果分析

目的 探讨声场测试对多通道人工耳蜗植入术后听觉评估的意义。方法 对１１例Ｎｕｃｌｅｕｓ多通道人工耳蜗植入患者定期进行声场听阈测试,并对结果进行统计学处理。结果 全部患者声场测试（啭音）听阀为１５￣４０ｄＢ（ｎＨＬ）,语后聋组术后半年声场听阈明显低于同期语前聋组（Ｐ〈０．０１）,语前聋组术后一年的声场听阈比术后半年时显著下降（Ｐ〈０．０１）,接近语后聋组半年时的听觉水平（Ｐ〉０．０５）。结论 多通道     

语后聋患者人工耳蜗植入后听觉行为及言语可懂度分级的相关因素分析

目的：应用听觉行为分级（CAP）和言语可懂度分级（SIR）评估语后聋患者人工耳蜗植入后言语交流状况,探讨其得分与听力下降时间、植入时间、术前助听器使用情况的关系。方法：回顾分析23例语后聋人工耳蜗植入者的临床资料,收集其听力下降时间、植入时间、术前助听器使用情况等相关资料,应用CAP、SIR分级评估其言语交流状况。运用IBM SPSS Statistics19软件进行统计描述及结果分析。结果：CAP分级平均得分为6．13分,统计分析示CAP分级与听力下降时间、植入时间、术前助听器使用时间无显著相关关系（均P〉0．05）。患者均为语后聋,其SIR分级的平均得分为4．91分。结论：语后聋患者人工耳蜗植入后CAP分级与听力下降时间、植入时间、术前助听器使用情况无相关性。这可能是由于CAP分级的精确性和细节上的欠缺或该研究样本量限制,未显示出其与3个变量之间的关系。SIR不适用于评估语后聋患者人工耳蜗植人后的言语状况。     

汉语语后聋患者双侧人工耳蜗植入一例

人工耳蜗主要是帮助通过助听器得不到有效补偿，不能满足听觉和言语交流目的的重度听力障碍人群。对于健听者，双耳聆听较单耳聆听时具有声音信号更清晰饱满，提高噪声环境时的交流能力和对声源定位等优点。然而目前绝大多数人工耳蜗是单侧植入，且非植入耳使用助听器效果很差。因此如何进一步提高言语交流能力，特别是在噪声环境时及对声源定位等是亟待解决的问题。     

语后聋患者人工耳蜗植入后短期内失匹配负波的表现

目的了解语后聋人工耳蜗植入者听觉中枢重塑过程中不同时期失匹配负波(mismatch negativity,MMN)的表现,探讨利用MMN评估其听觉中枢重塑的可能性。方法对6例语后聋人工耳蜗植入(CI)者(CI组)于开机时、开机后1、3及6个月分别行MMN检查,记录其MMN潜伏期及波幅,并与6例正常人(对照组)的MMN潜伏期及波幅相比较。结果 CI组3例(50%)患者在开机时引出MMN,6例(100%)开机后1、3、6个月均引出MMN,对照组6例(100%)正常人均引出MMN。CI组开机时、开机后1、3、6个月MMN的潜伏期分别为230.67±15.50、197±53.72、136.00±31.71、132.17±9.41ms;波幅分别为-2.53±3.09、-1.60±1.15、-1.83±0.96、-1.31±1.38mV;对照组MMN的潜伏期为142.0±23.10ms,波幅为-2.17±1.17mV。CI组开机时、开机后1个月MMN的潜伏期均较对照组延长,差异有统计学意义(P=0.001和P=0.044);开机后3、6个月MMN潜伏期与对照组比较差异无统计学意义(P=0.716和P=0.357)。CI患者在开机时、开机后1、3个月,MMN潜伏期逐渐缩短,差异有统计学意义(P<0.001),开机后3、6个月MMN潜伏期比较,差异无统计学意义(P=0.778)。开机时至开机后6个月,MMN波幅变化无明显规律。结论语后聋人工耳蜗植入者开机后3个月内其MMN潜伏期逐渐缩短,开机后3个月时其MMN波形分化达正常人水平,但波幅变化无明显规律。     

老年性聋患者人工耳蜗植入效果分析

目的 探究老年性聋患者人工耳蜗植入术后听觉言语康复效果及生活质量的变化。方法 对31例行人工耳蜗植入的老年性聋患者进行听力学、言语功能及生活质量评估并比较差异。听力学评估采用助听听阈,言语能力评估采用词表识别率,评估时间为术前、开机后6个月及开机后12个月。生活质量评估采用Nijmegen 人工耳蜗植入量表(NCIQ),评估时间为术前及开机后12个月。结果 共纳入31例患者,31例患者术前、开机后6个月及开机后12个月助听听阈分别为(62.55±3.69)、(46.58±5.14)、(38.68±4.26)dBHL,差异具有统计学意义(P＜0.05)。术前、开机后6个月及开机后12个月单音节词识别率分别为(9.55±5.81)%、(54.77±8.90)%、(68.52±7.21)%,差异具有统计学意义(P＜0.05);术前、开机后6个月及开机后12个月双音节词识别率分别为(19.87±9.72)%、(64.00±6.53)%、(74.26±6.79)%,差异具有统计学意义(P＜0.05);术前、开机后6个月及开机后12个月短句识别率分别为(28.00±10.58)%、(68.52±7.78)%、(77.61±8.59)%,差异具有统计学意义(P＜0.05)。术前及开机12个月NCIQ总量表得分分别为(35.90±5.80)、(65.16±8.18)分,差异具有统计学意义(P＜0.05)。结论 人工耳蜗植入可以改善老年性聋患者的听觉言语能力及生活质量,对于重度以上听力损失且助听器效果不佳的老年性聋患者可以选择人工耳蜗植入。     

语前聋人工耳蜗植入患者听觉和言语康复效果的问卷分级评估

目的使用听觉和言语问卷分级的方法评估人工耳蜗植入患者的听觉言语康复效果，分析康复效果的相关影响因素。探讨人工耳蜗术后听觉言语康复效果的问卷评估方法。方法对97例语前聋人工耳蜗植入患者的家长和康复教师进行调查随访。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)对患者的听觉感知能力和言语产生能力进行分级评估。CAP共分1—8级，SIR共分1—5级。用组内单因素秩和检验和多因素Logistic回归分析CAP和SIR分级结果与植入电极类型、植入年龄、病因、病程、术前助听器使用情况、植入深度、植入时间、康复模式、家庭经济状况等9个因素的关系。结果单因素分析结果显示：植人体型号(P=0．0439)、植入时间长短(P=0．0001)、康复模式(P=0．0460)、家庭经济状况(P=0．0140)与CAP有关；植入时间长短(P=0．0001)、康复模式(P=0．0271)与SIR有关。植入年龄、病因、病程、植入深度以及术前助听器的佩戴与CAP和SIR均无关。多因素Logistic回归分析结果显示：植入时间长短和家庭经济状况与CAP显著相关：植入时间长短与SIR显著相关。结论植入时间越长，人工耳蜗对患者听觉言语发展的效果越明显。康复模式与手段对人工耳蜗植入后患者的言语和康复能力有着决定性的影响。     

语前聋患儿人工耳蜗植入术后康复效果分析

目的:研究不同年龄段语前聋患儿接受人工耳蜗植入后的康复效果,以及随使用人工耳蜗时间的延长康复效果的改变趋势.方法:按接受人工耳蜗植入时的年龄将患儿分为2组(≤3岁组和＞3～6岁组),分别在术后开机3、6、9、12个月时评估其听觉、语言及学习能力,并记录结果.结果:随着使用人工耳蜗时间的增加,聋儿听觉、语言及学习能力康复效果逐渐提高(P＜0.05),≤3岁组听觉及言语能力的康复速度优于＞3～6岁组(P＜0.05),学习能力无明显差别(P＞0.05).结论:语前聋患儿接受人工耳蜗植入术后,植入年龄与使用时间的长短共同影响其康复效果,小龄植入并经足够长时间的康复训练,可以实现康复效果的最优化.     

Speech-ABRs in cochlear implant recipients: feasibility study

Abstract

Objective: The aim of this study was to assess the feasibility of recording speech-ABRs from cochlear implant (CI) recipients, and to remove the artefact using a clinically applicable single-channel approach.

Design: Speech-ABRs were recorded to a 40?ms [da] presented via loudspeaker using a two-channel electrode montage. Additionally, artefacts were recorded using an artificial-head incorporating a MED-EL CI with stimulation parameters as similar as possible to those of three MED-EL participants. A single-channel artefact removal technique was applied to all responses.

Study sample: A total of 12 adult CI recipients (6 Cochlear Nucleus and 6 MED-EL CIs).

Results: Responses differed according to the CI type, artefact removal resulted in responses containing speech-ARB characteristics in two MED-EL CI participants; however, it was not possible to verify whether these were true responses or were modulated by artefacts, and artefact removal was successful from the artificial-head recordings.

Conclusions: This is the first study that attempted to record speech-ABRs from CI recipients. Results suggest that there is a potential for application of a single-channel approach to artefact removal. However, a more robust and adaptive approach to artefact removal that includes a method to verify true responses is needed.     

Auditory rehabilitation with cochlear implantation in patients with neurofibromatosis type 2

Conclusions: New technological developments will most probably improve the efficiency of auditory brainstem implantation (ABI). Meanwhile, cochlear implantation in patients who have undergone prior reductive surgery, and who have maintained a positive electric stimulation, is an excellent alternative for rehabilitating complete and bilateral hearing loss in patients with neurofibromatosis type 2 (NF2). Auditory results are far better than those reported after ABI. Long-term follow-up will be necessary to demonstrate the validity of this strategy. Objectives: ABIs restore some degree of auditory perception in NF2 patients with bilateral and complete hearing loss, but results are often inadequate for maintaining social and professional activities. The aim of this study was to report the results of auditory rehabilitation by cochlear implantation in three cases of NF2. Patients and methods: This was a retrospective study undertaken in a tertiary referral center. The first patient had undergone previous surgery for a left grade III vestibular schwannoma (VS) and then underwent irradiation for a right grade I VS. Two years after irradiation, he suddenly lost his remaining hearing. Electric promontory stimulation was positive and cochlear implantation was performed. The second patient had undergone surgery for a left grade III VS and followed for a right grade II VS. She suddenly lost her remaining hearing. A cytoreductive surgery was performed and the cochlear nerve was preserved. Postoperative electric stimulation was positive. She was then implanted with a cochlear implant. The third patient presented with a right stage III and a left stage I VS. She first underwent a subtotal removal of the left VS with immediate cochlear implantation. She then underwent removal of the right VS stage III with no possible preservation of the cochlear nerve. Results: All three patients had excellent postoperative speech performance and were back to work 3 months after implantation. Imaging follow-ups at 4, 2, and 1 year, respectively, do not show any evolution of the tumor.     

多导人工耳蜗植入术后耳蜗X线显像

目的 探索适合于评价多导人工耳蜗植入手术效果的术后影像学检查技术。方法 多导人工耳蜗植入术69例69耳,其中Nucleus直电极53耳,Nucleus弯电极11耳,Nucleus22导5耳。手术采用耳后面神经隐窝入路。建立放射线耳蜗显像技术,并且所有多导电子耳蜗植入病例术后7-10天均行耳蜗位头颅X-线检查。结果 在69例69耳手术中均成功地植入多导人工耳蜗电极。术后1.0-1.5月进行开机调试,听阈和言语分辨率均达到比较满意的水平。耳蜗位头颅X-平片显示上半规管和前庭易于辨认,可以作为影像学解剖的重要标志。耳蜗X线显像可以直接而且清晰地显示一个完整的人工耳蜗植入术后的电极在耳蜗内的图像,并且每一个电极阵列都可以很清楚地被识别。影像学检查可以作为植入手术结果的客观资料,而且如果电极扭曲或术后移位很容易发现。对于内耳畸形人工耳蜗植入术后,耳蜗位X-线检查则更现必要,是判断手术结果的重要依据。结论感音神经性耳聋患者植入多导人工耳蜗效果良好。头颅X-线耳蜗显像可以应用于对多导人工耳蜗植入术后结果的评价,而且简单、低放射量、快速和经济,值得广泛推广。     

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。     

Follow-up of cochlear implant use in patients who developed bacterial meningitis following cochlear implantation

Objectives/Hypothesis: The present study is a long‐term follow‐up of speech perception outcomes and cochlear implant use in three cases of meningitis that occurred after cochlear implantation. Study Design: Case series study. Methods: Study was performed on three children implanted with different models of Clarion® devices, two of them with positioner. Recognition and comprehension were assessed via the Italian adaptation of GASP (TAP) test, and phonetically balanced bi‐syllabic words in open‐set. High resolution computed tomography scan acquisition was performed to obtain axial coronal and oblique multiplanar reconstructions of the cochlea. Results: Two patients were affected by enlarged cochlear acqueduct and Mondini malformation the first carrying positioner. One patient had a normal cochlea, and the positioner could have been the main cause of bacterial spread. As a consequence of meningitis the child with normal cochlea and the other with enlarged vestibular acqueduct developed cochlear ossification, increased M‐level and worsening of hearing outcomes. The child with Mondini malformation developed facial nerve stimulation. Contralateral implantation was performed in the first two patients. Conclusion: Bacterial meningitis occurring after cochlear implantation may induce cochlear ossification, facial nerve stimulation, and permanent or temporary loss of implant use. Planned follow‐up with high resolution computed tomography and evaluation of M‐levels could be useful prognostic tools in the management of these patients.