多导人工耳蜗的临床应用(附11例报告)

目的：探讨多导人工耳蜗植入对深度感音神经性耳聋患者的治疗效果。方法：对11例深度耳聋患者行MiniSystem22导和Nucleus24导人工耳蜗植入术,其中语前聋6例,语后聋5例。术后1～1．5个月开机调试。结果：11例患者全部恢复了听力;语后聋患者不需要经过唇读或简单的语言训练就能进行对话和打电话,患者能回到有声世界进行正常的生活和工作;对语前聋患者进行评议训练,都有不同程度的进步。结论：深度感音神经性耳聋患者植入22导及24导人工耳蜗后效果良好,尤其对语后聋和年龄较小的儿童效果更好。     

人工耳蜗咨询问题解答(2)

什么是语前聋与语后聋？ 在学会语言之前发生的耳聋称为语前聋，包括先天性聋，各种婴幼儿时期出现的耳聋。由于语言尚处于发育学习期，如果耳聋严重，且未得到早期干预和康复，将会形成聋哑。 言语形成以后出现的耳聋称为语后聋。什么样的耳聋患者适合接受人工耳蜗植入？ 经使用助听器听力语言康复效果不好的双耳重度或深度的感音神经性耳聋，包括各种先天性耳聋、药物性中毒性耳聋、病毒性感染所致的耳聋、突发性聋以及噪声性聋等。人工耳蜗植入的年龄一般在１岁以上（最适年龄是ｌ～４岁）。一般说来，语前聋患者年龄越小越好，语后聋患…     

人工耳蜗植入术35例报告

多导电极人工耳蜗植入己经成为解决重度或极重度耳聋听力障碍问题的唯一成熟手段。我科于2011-06-2012-06期间对35例重度和极重度感音神经性耳聋患者行多导人工耳蜗植入术,效果满意,现报告如下。1资料与方法1.1临床资料35例患者,男21例,女14例;年龄14个月～17岁,平均9.6岁。语前聋33例,语后聋2例。其     

语后聋成人多通道人工耳蜗植入后的听觉效果及影响因素

近几年，国内陆续开展了多通道人工耳蜗植入手术，有关病例选择和手术方法主要借鉴国外的经验，听觉评估尚无统一的方法和标准。我科于１９９６～１９９８年对５例植入Ｎｕｃｌｅｕｓ多通道人工耳蜗的语后聋成人进行声场测试、言语识别记分和日常听力调查，综合评估听觉效果。全部患者均显示了良好的言语分辨能力，报道如下。一、材料与方法１．临床资料：５例患者中男３例，女２例；年龄２９～４６岁。例１、２为耳毒药物性聋；例３为慢性中耳炎；例４右耳自幼患慢性中耳炎，左耳突发性聋，双耳听力丧失３月余；例５原因不明，双耳聋长达６…     

推动中国成人语后聋人工耳蜗植入

对于成人重度以上语后聋患者来说,人工耳蜗植入是重获听力的惟一有效手段,但目前仍未得到应有的重视。本文针对语后聋致病因素,成人语后聋人工耳蜗植入适应证选择,手术安全性和术后效果等方面进行阐述,旨在让更多医务工作者和从事耳聋康复事业的各界人士,对成人语后聋的人工耳蜗植入有更多的了解,从而积极推动成人语后聋人工耳蜗植入在中国的开展,让更多的耳聋患者得到及时合理的治疗,这对于提高耳聋患者生活质量具有重大的意义。     

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     

语前聋青少年人工耳蜗满意度问卷设计和调查分析

目的：人工耳蜗植入技术(Cochlear Implant)使双侧重度及极重度感音神经性耳聋的语后聋患者和年龄较小的语前聋患者在言语识别方面改善较大，但对语前聋青少年人工耳蜗植入患者术后是否受益尚存在争议。本文研究语前聋青少年人工耳蜗的获益情况。方法：以语前聋青少年为研究对象，关注交流能力和生活质量改善等情况，设计语前聋青少年CI使用效果和满意度的调查问卷并分析患者人工耳蜗术后获益效果和满意度以及相关影响因素。结果：调查结果显示所有家长均对孩子植入人工耳蜗后的声音获得非常满意，且认为人工耳蜗对整体综合交流能力的改善有一定帮助，患者本人及家长都愿意选择CI。结论：对语前聋青少年CI植入者不应把言语测试识别率得分的提高作为评判人工耳蜗获益情况的唯一标准，还应考虑人工耳蜗在提高患者综合交流能力和生活质量方面的帮助效果。     

22导人工耳蜗植入4例报告

对3例语后聋、1例请前聋患者进行22导人工耳蜗植入，4例耳聋的原因分别为慢性中耳炎、分娩后不明原因、耳毒性药物和先天性聋，术前CT等检查未见耳蜗异常，但术中发现迷路严重骨化和耳蜗畸形各1例。水后1．0～1．5月进行开机调试，均恢复了听力和有满意的语言分辨率。文中对人工耳蜗植入的有关问题进行了讨论。     

人工耳蜗咨询问题解答（1）

我国目前有近二千万听力残疾人士，其中有许多为重度或极重度的感音神经性聋。该类耳聋如果发生于语前聋儿童，极可能发展为聋哑症：发生于语后聋成人，则会造成严重的听力语言交流障碍。多导人工耳蜗的成功应用为帮助该类极重度感音神经性聋患者克服听力残障、重返有声世界提供了非常有效的手段。目前世界范围内已有近３万人工耳蜗使用者，我国近年来成功接受人工耳蜗植入者也已达到近２００例。虽然人工耳蜗的研制和临床使用历史已有３０年以上，我国也曾在８０年代研制和应用过单导人工耳蜗，由于没有语言分析，效果很差。只是在近几年国…     

人工耳蜗植入后耳蜗内影响心理物理感应的因素

现已证明人工耳蜗植入后的言语识别能力与心理物理感应如阈水平（Ｔ水平）、最大舒适响度水平（Ｃ水平）和动态范围（ＤＲ）有关，本文探讨上述心理物理感应参数与蜗内组织病理学因素的关系。总共５例（５耳）成年语后聋行Ｎｕｃｌｅｕｓ２２导人工耳蜗植入，年龄为１９～...     

Role of neck ultrasound during follow-up care of head and neck squamous cell carcinomas

Cantonese language rehabilitation in 28 prelingually deaf children who underwent cochlear implantation was evaluated. All patients were implanted with multichannel devices and the operations went smoothly. They all had improved scores on audiological assessments and speech perception tests. The speech evaluation tests included the recognition of sounds, vowels, consonants and tone. Sentence recognition and story comprehension were both improved after training for 2 years. Cochlear implantation is a useful measure for the speech rehabilitation of prelingually profound deaf children when hearing aids are of no benefit. The multichannel implant device is of clinical significance in the rehabilitation of those patients using tonal language.     

Chinese tonal language rehabilitation following cochlear implantation in children

Cantonese language rehabilitation in 28 prelingually deaf children who underwent cochlear implantation was evaluated. All patients were implanted with multichannel devices and the operations went smoothly. They all had improved scores on audiological assessments and speech perception tests. The speech evaluation tests included the recognition of sounds, vowels, consonants and tone. Sentence recognition and story comprehension were both improved after training for 2 years. Cochlear implantation is a useful measure for the speech rehabilitation of prelingually profound deaf children when hearing aids are of no benefit. The multichannel implant device is of clinical significance in the rehabilitation of those patients using tonal language.     

Performance of prelingually and postlingually deaf patients using single-channel or multichanel cochlear implants

The auditory and aided lipreading performance of 8 prelingually and 11 postlingually deaf patients who had received a single-channel or multichannel cochlear implant was evaluated during 2 years of follow-up. Although all the patients improved on both closed-set pattern recognition and speech drimination tests and on a Continouous Discourse Tracking task, the most significant improvement was observed in the postlingually deaf patients who were using a multichannel implant. These patients were the only ones to achieve open-set speech recognition in the auditory-only condition. Only small differences were found between prelingually deaf patients who were using a single-channel system and those who were using a multichannel system. The users' evaluations, obtained by means of a questionnaire, were generally positive in all patients. Based on the study results, the authors concluded that it is feasible to use cochlear implants in highly motivated prelingaully deaf patients who have learned to use oral-aural communication.     

Speech perception after cochlear implantation over a 4-year time period

OBJECTIVE: To evaluate the long-term speech perception of cochlear implantees and to compare the developing auditory performance patterns of prelingual children and postlingual deaf adults. MATERIAL AND METHODS: Twenty-nine prelingually deaf children and 17 postlingually deaf adults who had been followed up for 4 years were included in the study. Speech perception ability was assessed by means of vowel and consonant confusion tests and the Korean version of the Central Institute of Deafness (K-CID) test (performed without visual cues). The test results were analyzed at 3 and 6 months after implantation and then annually. RESULTS: In the prelingually deaf children, the average results continuously improved over the 4-year period. In the postlingually deaf adults, the average results did not improve further after the first 2 years. Individuals with < 5 years of deafness had a faster rate of recovery of speech perception than those who had been deaf for > 5 years. The K-CID scores were negatively correlated with age at implantation for the prelingually deaf group and with the duration of deafness in the postlingually deaf group. Children fitted with implants at a younger age showed better speech perception ability than those fitted with implants at an older age. Interestingly, prelingually deaf children aged 5-7 years at implantation showed the widest variation in individual outcomes. Amongst this group of children with highly variable outcomes, the metabolic status of brain cortices determined by means of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) was available for three patients. The individual with the widest hypometabolic area had the best speech perception ability. CONCLUSION: The extent of hypometabolism as assessed by FDG-PET seemed to be one of the major factors predicting the outcome of cochlear implantation.     

The additional hospital costs of the LAURA cochlear implant in the department of Otorhinolaryngology, Head and Neck Surgery of the University Hospital of Leuven

From the start of 1994 until 1996 ten patients (eight adults and two children) received cochlear implants after careful preoperative selection in our department. Only the deaf adults implanted with the LAURA cochlear implant were included in this retrospective analysis. In this study, the additional hospital costs associated with cochlear implantations were estimated. In doing this, a differentiation was made between ‘fixed’ costs and ‘variable’ costs. In general, the average cost of cochlear implantation was 1,186,741 BF (29,418.54 EUR) per implanted adult and a direct fixed cost of 262,880 BF (6,516.62 EUR) was needed for the computer requisites. In general, the cochlear implant enhance speech-perception scores in the postlingually deafened patients as well as in the prelingually deafened adults. After intensive training, all implanted adults of the University Hospital Leuven could recognize the segmental aspects of speech with scores above the level of significance. Received: 11 May 1998 / Accepted: 4 March 1999     

Results of speech perception and speech production training for three prelingually deaf patients using a multiple-electrode cochlear implant.

Five studies were conducted to measure changes in the perception and production of selected speech targets, with training, in three prelingually deaf patients. The two adults and one adolescent were implanted with the Cochlear (Nucleus) multiple-electrode prosthesis. The studies were perception and production of nasal consonants; perception of syllable-final consonants; perception and production of alveolar consonants; auditory-visual perception of alveolar consonants; and perception and production of vowels. Perceptual data were collected in the audition (implant)-alone condition, except for the auditory-visual perception of alveolar consonants where the audition-alone, vision-alone, and auditory-visual conditions were used. Speech perception data in the audition-alone condition were also collected from four postlingually deaf adult implant patients, without training, to indicate differences between the two classes of patients. The three prelingually deaf patients generally showed some improvements in speech production. In perception, improvements were recorded only for individual patients in some studies. The performance of the adolescent was better than that of the two adults in all cases. The perceptual performance of the postlingually deaf patients was superior to that of the prelingually deaf patients in all cases.     

Altered Cortical Activity in Prelingually Deafened Cochlear Implant Users Following Long Periods of Auditory Deprivation

Auditory stimulation during childhood is critical for the development of the auditory cortex in humans and with that for hearing in adulthood. Age-related changes in morphology and peak latencies of the cortical auditory evoked potential (CAEP) have led to the use of this cortical response as a biomarker of auditory cortical maturation including studies of cortical development after deafness and subsequent cochlear implantation. To date, it is unknown whether prelingually deaf adults, with early onset deafness (before the age of 2 years) and who received a cochlear implant (CI) only during adulthood, would display absent or aberrant CAEP waveforms as predicted from CAEP studies in late implanted prelingually deaf children. In the current study, CAEP waveforms were recorded in response to electric stimuli in prelingually deaf adults, who received their CI after the age of 21 years. Waveform morphology and peak latencies were compared to the CAEP responses obtained in postlingually deaf adults, who became deaf after the age of 16. Unexpectedly, typical CAEP waveforms with adult-like P1-N1-P2 morphology could be recorded in the prelingually deaf adult CI users. On visual inspection, waveform morphology was comparable to the CAEP waveforms recorded in the postlingually deaf CI users. Interestingly, however, latencies of the N1 peak were significantly shorter and amplitudes were significantly larger in the prelingual group than in the postlingual group. The presence of the CAEP together with an early and large N1 peak might represent activation of the more innate and less complex components of the auditory cortex of the prelingually deaf CI user, whereas the CAEP in postlingually deaf CI users might reflect activation of the mature neural network still present in these patients. The CAEPs may therefore be helpful in the assessment of developmental state of the auditory cortex.     

Speech perception and speech intelligibility in children after cochlear implantation

OBJECTIVE: This study aimed to evaluate the long-term speech perception and speech intelligibility of congenitally and prelingually deaf children after cochlear implantation. It was a longitudinal study following 63 congenitally or prelingually deaf children up to 5 years after implantation. They each received a nucleus multichannel cochlear implant before they were 10 years old. METHODS: Perception is evaluated using the Test for the Evaluation of Voice Perception and Production (TEPP) and concerns closed- and open-set word and sentence perception without lip-reading. The intelligibility is classified according to the Speech Intelligibility Rating (SIR). The evaluations have been made every 3 months for 1 year, then at 18 months, 2 years, 3 years and 5 years after the cochlear implantation. RESULTS: After 5 years of implantation, the median percentage of closed-words speech perception (CSW) is 95.5%-93.67% for closed-sentence speech perception (CSS) and 76.3% for open-sentence speech perception (OSS); the median Speech Intelligibility Rating is 3.83. CONCLUSIONS: Congenitally and prelingually deaf children who receive cochlear implant before the age of 10 years develop speech perception and speech intelligibility abilities. The closed-set perception progresses quickly and seems to reaching a plateau at 5 years post implantation. The improvement of open-sentence perception is not significant until the first year post implantation. The speech intelligibility improves regularly the five first year post implantation.     

The influence of contextual information on the perception of speech by postlingually and prelingually profoundly hearing-impaired Hebrew-speaking adolescents and adults.

OBJECTIVE: To study linguistic context effects on speech perception by prelingually (N = 10) and postlingually (N = 10) hearing-impaired Hebrew-speaking adolescents and adults. DESIGN: Participants were cochlear implant surgery candidates with profound sensorineural hearing loss (95 dB HL+). Four levels of speech perception materials were presented through the auditory-visual modality: monosyllabic nonsense syllables (phonological content), monosyllabic meaningful words (semantic-lexical), sentences without presented topics (semantic-syntactic), and sentences with topics (topical). Data were analyzed via percentage correct recognition and via k andj factors (Boothroyd & Nittrouer, 1988). RESULTS: Both participant groups performed better when speech material having more contextual information was presented, with no significant intergroup differences. CONCLUSIONS: This similar usage of contextual information among prelingually and postlingually hearing-impaired participants is encouraging and suggests the role of factors other than age of onset.