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。     

骨锚式助听器植入手术临床分析

目的 通过分析骨锚式助听器(bone-anchored hearing aid,BAHA)植入患者临床资料,探讨BAHA植入手术的适应证、手术方式及效果.方法 回顾性分析16例BAHA植入患者的临床资料,其中男9例,女7例;年龄8 ～53岁,平均31岁;外中耳畸形9例,慢性化脓性中耳炎术后2例,耳硬化症2例,单侧重度感音神经性聋3例.术前进行纯音测听、言语识别率测试、颞骨CT等评估,术后3个月左右开机时测试助听后的声场纯音听阈和言语识别率.结果 术后随访4 ～16个月,未见明显术后并发症.16例患者术前平均气导听阈(x±s,下同)为(63.2±19.0)dB HL,术后声场下助听听阈为(35.5±10.9)dB HL.术后噪声下言语识别率测试较术前提高了37.0％ ±31.7％,术后单音节言语识别率测试较术前提高了76.0％±19.7％.结论 BAHA是一种临床上安全、有效的人工听觉植入装置,在严格选择适应证的前提下可以在临床推广应用.     

老年及老年前期人工耳蜗植入的临床初步研究

目的 探索人工耳蜗在双耳重度或极重度聋和全聋的老年患者中的临床应用安全性和效果.方法 2008年11月至2009年11月解放军总医院先后对8例50岁以上患者行人工耳蜗植入术,其中男5例,女3例;年龄52～76岁,中位数58岁.所有患者术前均为双侧极重度感音神经性听力损失,佩戴助听器无效或效果不佳.观察患者手术耐受及并发症情况.开机后3个月进行助听听阈评估和言语评估.结果 8例患者手术顺利,术中神经反应遥测均引出反应.术后康复顺利,无任何并发症.开机3个月后声场内言语频率平均助听听阈啭音(听力级)为35～50 dB,但言语测听结果个体差异较大.部分患者单音节、双音节、安静及噪声环境下的句子可实现较好识别率.结论 老年前期及老年患者可耐受全身麻醉状态下的人工耳蜗植入,只要术前准备充分则为安全的手术,但部分病例为中耳炎(胆脂瘤)或颞骨外伤等因素导致,需要特别注意中耳情况.老年重度以上听力损失患者人工耳蜗植入可明显改善言语识别能力.     

先天性外中耳畸形早期听力学干预验证方法的初步研究

目的　应用软带式骨导助听器对双侧先天性外中耳畸形听力损失儿童进行听力补偿，对不同的调试参数验证方法对听觉发育情况的影响进行评估。方法　对20例符合要求的儿童应用软带骨导助听器，根据骨导多频稳态测试结果及患者家属意愿分为佩戴经颅骨模拟器验证调试组（实验组）和经Genie调试软件最佳选配调试组（对照组），用视觉强化测听法测试助听听阈及听觉言语发育情况。结果　在500～2000 Hz两组助听听阈均显著改善，其中4000 Hz处实验组（21.00±2.58）dB HL好于对照组（27.50±2.64）dB HL；6个月时儿童格拉斯格受益列表问卷（the Glasgow children's benefit inventory，GCBI）得分，实验组为36.11±10.35，对照组为35.55±10.87；12个月时实验组得分为43.39±11.31，对照组得分为38.28±12.81。结论  对外中耳畸形患儿早期验配骨导助听器时进行颅骨模拟器验证调试参数，助听听阈更接近正常值，有助于听觉言语功能的康复。     

双侧先天性外中耳畸形患者骨锚式助听器效果分析

目的 评估双侧先天性外中耳畸形患者应用骨锚式助听器(bone-anchored hearing aid,BAHA)后的听力效果及满意度.方法 双侧先天性耳廓畸形合并外耳道闭锁患者7例,单侧耳廓畸形伴双侧中耳畸形3例,佩戴软带BAHA后单侧植入BAHA钛植入体.分别测试患者在声场中裸耳与应用软带BAHA、植入式BAHA后的平均听阈、言语识别率及言语识别阈.以BAHA应用情况调查问卷和儿童格拉斯格受益列表(Glasgow children's benefit inventory,GCBI)分析患者应用BAHA后的生活质量提高程度和满意度.结果 患者裸耳平均听阈为(64.8 ±5.9)dBHL,佩戴软带BAHA后平均听阈降至(30.2±3.7) dBHL,佩戴植入式BAHA后平均听阈为(20.3±3.9) dBHL,三者两两比较,差异均具有统计学意义(P值均＜0.05).佩戴软带BAHA后患者听阈较裸耳平均下降(36.1±8.0)dB;植入式BAHA听阈较软带BAHA平均下降(12.2 ±3.4)dB.在45dBHL和65dBHL给声强度下,裸耳言语识别率分别为(3.00±1.07)％和(57.55 ±10.30)％,植入BAHA后言语识别率提高至(89.39±5.83)％和(91.19 ±4.16)％,二者差异具有统计学意义(P值均＜0.05).裸耳平均言语识别阈为(63.1±5.9) dBHL,佩戴植入式BAHA后为(24.7±3.5) dBHL,二者差异具有统计学意义(P＜0.05).BAHA应用情况调查问卷显示患者应用软带BAHA和植入式BAHA均获得满意效果,GCBI平均受益分数为(35.59 ±14.35)分.结论 对于双侧先天性外中耳畸形患者,应用BAHA可显著改善其听力及生活质量,患者满意度较高.     

大前庭水管综合征患者人工耳蜗植入术后效果分析

目的探讨轻度耳蜗结构畸形对人工耳蜗植入术后患者听觉及言语识别能力康复的影响。方法 14例(年龄2.5~7.5岁,人工耳蜗植入年龄4.71±1.94岁)大前庭水管综合征(large vestibular aqueduct syndrome,LVAS)伴重度或极重度感音神经性聋患者为大前庭水管综合征组,另选择临床资料相匹配的耳蜗结构正常的重度或极重度感音神经性聋患者14例(年龄2.5~7.5岁,人工耳蜗植入年龄4.68±1.80岁)为对照组。两组均行单耳人工耳蜗植入术,术后12个月分别进行声场助听听阈(0.5~4.0 kHz)、婴幼儿有意义听觉整合量表/有意义听觉整合量表(meaningful auditory integration scale, MAIS)、听觉行为分级(categorical auditory performance criteria,CAP)以及言语可懂度分级(speech intelligibility rating scale,SIR)评估,并进行言语识别能力(包括自然环境声响识别、声母识别、韵母识别、声调识别、单音节词识别、双音节词识别、三音节词识别、短句识别)评估。结果大前庭水管综合征组及对照组术后12个月声场助听平均听阈(分别为36.88±5.73、35.36±6.29 dB HL)差异无统计学意义(P>0.05),两组的MAIS得分率(分别为87.85%±8.01%、87.85%±9.75%)、CAP评分(分别平均为7级和6.5级)、SIR评分(分别平均为5级和4.5级)的差异均无统计学意义(P>0.05),两组八项言语识别能力评估的言语识别率差异无统计学意义(P>0.05)。结论大前庭水管综合征语前聋儿童植入人工耳蜗后听觉言语能力的发展水平与非综合征型先天性聋患儿相当。     

先天性外中耳畸形听力植入技术研究进展

先天性外中耳畸形是面部最常见的出生缺陷之一,临床表现多样。除了面部缺陷,患者通常伴有中重度的传导性听力损失。这类患者需要早期干预和治疗以减少对言语发育和社会适应的不良影响。随着科学技术发展及人工听觉植入设备的出现,先天性外中耳畸形患者的听力重建有了更多选择和听力获益。本文对先天性外中耳畸形听力植入技术研究进展进行综述。     

骨桥在先天性小耳畸形伴外耳道闭锁中的应用

目的探讨骨桥在先天性小耳畸形伴外耳道闭锁患儿临床应用的效果。方法对5例先天性小耳畸形伴外耳道闭锁的患儿,行高密度聚乙烯(MEDPOR)支架植入耳廓再造术的同时于乳突腔骨质表面植入骨桥的骨传导装置(BCI),术后3～4周佩戴骨桥听觉处理器,评价患儿听力及言语功能的改变。结果随访3～14个月,术后纯音测听平均听力改善29.62 dB HL,平均气骨导差为20.58 d B HL,平均言语识别阈值提高43.46 dB HL,无眩晕、耳鸣、脑脊液漏及皮瓣感染等并发症发生。结论骨桥植入对于先天性小耳畸形伴外耳道闭锁患儿听力及言语功能改善明显,该方法操作简单,手术可与耳廓再造同期进行,减少了手术周期和费用,并发症少,值得临床推广应用。     

老年语后聋患者人工耳蜗植入的听觉康复效果分析

目的探讨双耳极重度感音性聋的老年患者人工耳蜗植入后的听觉康复效果。方法 14例语后聋老年患者在我院进行人工耳蜗植入,平均年龄为67.7±4.0岁,观察其手术耐受及并发症,于开机后不同时间(3月、6月和12月)进行助听听阈和言语能力评估。结果 14例患者手术顺利,无明显严重并发症,开机后12个月助听听阈达42.1±9.4d BHL,单音节识别率为43%±15%,安静时句子识别率为63%±17%,听觉行为分级评估为5.7±1.4,人工耳蜗获益好/最好为11例(占78.6%)。结论 60岁以上极重度语后聋患者进行人工耳蜗植入是安全有效的,大部分患者术后可以获得好的言语识别率和听觉行为,年龄不应成为老年人工耳蜗植入的限制因素。     

老年性听力损失患者普通话双音节词表测试结果分析

目的 探讨老年性听力损失患者的言语识别特点.方法 以59例老年性听力损失患者(老年听损组)为研究对象,年龄61～84岁,平均71.3±6.7岁,其中男23人,女36人,根据较好耳0.5、1、2、4 kHz平均气导听阈(pure tone average,PTA)分为轻度听力损失组(10例)、中度听力损失组(35例)、重度以上听力损失组(14例);以11例听力正常老年人作为对照组;以普通话言语测听材料中的9张双音节词表分别测试各组的言语识别阈(speech recognition threshold,SRT)和言语识别率,并建立识别-强度函数曲线(P-I函数曲线),比较各组的结果.结果 老年听损组PTA(51.65±11.98 dB HL)、SRT(50.98±16.05 dBHL)明显高于对照组(PTA19.55±4.55 dB HL、SRT 18.79土7.45 dB HL),老年听损组P-I函数曲线平均斜率(2.63％±1.59％/dB)低于对照组(4.65％±1.46％/dB) (P＜0.01);老年听损男性组SRT值(56.54±17.23 dB HL)高于女性(47.99±15.63dBHL) (P＜0.05);三组不同程度老年听损组的PTA和SRT明显高于对照组,随着听力损失程度的加重,PTA、SRT阈值明显增高,组间比较差异有统计学意义(P＜0.01);不同程度听损各组的P-I函数曲线斜率(轻度组2.47％±1.59％/dB,中度组2.76％±1.59％/dB,重度以上组2.42％±1.69％/dB)明显低于对照组(4.65％±1.46％/dB)(P＜0.01),不同程度听损组间P-I函数曲线斜率比较差异无统计学意义(P＞0.05).结论 老年性听力损失患者言语识别阈升高,且男性高于女性,P-I函数曲线平均斜率下降,曲线右移呈平缓型;随着听力损失程度的加重,其言语识别阈升高更显著.     

索菲康骨导助听器助听效果的多中心研究

目的 评估软带或头带佩戴新型经皮传导索菲康骨导助听器对传导性聋或混合性聋、单侧聋患者的助听效果.方法 以来自国内4家三级甲等医院的109例传导性或混合性聋患者及11例单侧聋(single-sided deafness,SSD)患者为研究对象,均以纯音测听(≥6岁患者)或听性脑干反应(ABR)(<6岁患者)评估裸耳听阈后予以头带或软带佩戴索菲康Alpha 2 MPO骨导助听器;并在声场下进行未助听、佩戴当日及佩戴2周后的助听听阈(0.5~4 kHz)测试;≥6岁患者进行未助听、佩戴当日及佩戴2周助听下的言语识别阈(speech recognition threshold, SRT)测试,并记录患者佩戴后的不良反应.结果 传导性或混合性聋患者中≥6岁患者助听耳裸耳骨导及气导平均听阈均值分别为18.55±8.99、71.45±10.25 dB HL,<6岁组助听耳裸耳骨导及气导ABR阈值均值分别为18.33±8.36、70.80±8.24 dB HL;SSD患者助听耳裸耳听阈不能测出;佩戴2周后,三组助听后纯音听阈均值分别为32.21±10.00、37.33±14.15、34.38±10.76 dB HL,较未助听时明显改善,差异有统计学意义(P<0.05);≥6岁传导性或混合性聋组和SSD组患者佩戴2周后助听下各方向SRT较未助听时均显著降低,差异有统计学意义(P<0.05);各组患者均无与佩戴助听器相关的不良皮肤反应等.结论 使用软带、头带佩戴索菲康骨导助听器,可有效改善传导性或混合性聋、SSD患者听阈和安静环境下言语识别阈.     

对称性聋患者单耳助听后双耳言语识别率差别探讨

目的通过检测对称性聋患者单耳助听后双耳言语识别率的差别来进一步研究听觉剥夺效应。方法选取右耳助听4～5年的双耳对称性感音神经性聋患者15名,在标准隔声室中,测试其双耳的纯音气导和骨导听闻,然后再采用汉语普通话单音节词表分别进行左右裸耳言语识别率测试,并将所得数据进行对比研究。结果15名受试者右耳配戴助听器前及配戴4～5年后两耳间平均听阈无显著性差异（P〉0．05）;受试者右耳助听前及助听4～5年后左、右耳平均听阀前后无显著性差异（P〉0．05）;右耳助听4～5年后,受试者左、右耳裸耳言语识别率存在显著性差异（t=2．76,P=0．02〈0．05）。结论对称性感音神经性聋患者单耳助听后裸耳平均听阈无显著改变,但非助听耳言语识别能力显著下降。     

Análisis de la potencia de salida y del rendimiento auditivo de los dispositivos auditivos osteointegrados

Background and objectiveOsseointegrated auditory devices are hearing gadgets that use the bone conduction of sound to produce hearing improvement. The mechanisms and factors that contribute to this sound transmission have been widely studied, however, there are other aspects that remain unknown, for instance, the influence of the processor power output. The aim of this study was to know if there is any relationship between the power output created by the devices and the hearing improvement that they achieve.Materials and methodsForty-four patients were implanted with a percutaneous Baha® 5 model. Hearing thresholds in pure tone audiometry, free-field audiometry, and speech recognition (in quiet and in noise) were measured pre and postoperatively in each patient .The direct bone conduction thresholds and the power output values from the processors were also obtained.ResultsThe pure tone average threshold in free field was 39.29 dB (SD 9.15), so that the mean gain was 29.18 dB (SD 10.13) with the device. This involved an air-bone gap closure in 63.64% of patients. The pure tone average threshold in direct bone conduction was 27.6 dB (SD 10.91), which was 8.4 dB better than the pure tone average threshold via bone conduction. The mean gain in speech recognition was 39.15% (SD 23.98) at 40 dB and 36.66% (SD 26.76) at 60 dB. The mean gain in the signal-to-noise ratio was ?5.9 dB (SD 4.32). On the other hand, the mean power output values were 27.95 dB μN (SD 6.51) in G40 and 26.22 dB μN (SD 6.49) in G60. When analysing the relationship between bone conduction thresholds and G40 and G60 values, a correlation from the frequency of 1,000 Hz was observed. However, no statistically significant association between power output, functional gain or speech recognition gain was found.ConclusionsThe osseointegrated auditory devices generate hearing improvement in tonal thresholds and speech recognition, even in noise. Most patients closed the air-bone gap with the device. There is a direct relationship between the bone conduction threshold and the power output values from the processor, but only in mid and high frequencies. However, the relationship between power output and gain in speech recognition is weaker. Further investigation of contributing factors is necessary.     

GJB2基因突变致聋患儿人工耳蜗植入效果分析

目的 比较GJB2基因突变致聋患儿与非GJB2基因突变且内耳结构正常聋儿人工耳蜗植入术后的听觉言语康复效果.方法 对37例经C下及MRI检查排除内耳畸形的聋儿术前行GJB2基因检查,根据结果 分成A组(GJB2基因突变10例)和B组(非GJB2基因突变27例),术后随访0.5～2年,进行术后的听阈、言语识别率及言语能力评估.结果 37例聋儿人工耳蜗植入手术全部成功,均建立了主观听性反应.A组的声场听阈水平平均为34.41±6.12 dB HL.言语识别率平均为76%; B组的声场听阈水平平均为36.23±4.16 dB HL.言语识别率平均为79%,两组均达到平均言语康复级别二级;两组听觉及言语能力测试结果 均无统计学意义(P>0.05).结论 人工耳蜗患者中GJB2基因突变率高,可能是内耳结构正常的人工耳蜗植入人群耳聋的主要致聋原因;GJB2基因突变致聋患儿与非GJB2基因突变且内耳结构正常聋儿人工耳蜗植入术后效果基本一致.人工耳蜗植入可作为GJB2基因突变致聋患儿的有效治疗手段.     

Outcome prediction for Bonebridge candidates based on audiological indication criteria

ObjectiveTo re-evaluate current indication criteria and to estimate the audiological outcomes of patients with Bonebridge bone conduction implants based on preoperative bone conduction thresholds.MethodsWe assessed the outcome of 28 subjects with either conductive or mixed hearing loss (CMHL) or single-sided deafness (SSD) who were undergoing a Bonebridge implantation. We used linear regression to evaluate the influence of preoperative bone conduction thresholds of the better/poorer ear, indication group, and language (German- and French-speaking patients) on aided sound field thresholds. In addition, aided word recognition scores at 65 dB sound pressure level were fit with a logistic model that included preoperative bone conduction thresholds of the better/poorer ear, indication group, and language as effects.ResultsWe found that both aided sound field thresholds and word recognition were correlated with the preoperative bone conduction thresholds of the better hearing ear. No correlation between audiological outcomes and the preoperative bone conduction thresholds of the poorer ear, language, or indication group was found.ConclusionBone conduction thresholds of the better hearing ear should be used to estimate the outcome of patients undergoing Bonebridge implantation. We suggest the indication criteria for Bonebridge candidates considering maximal bone conduction thresholds of the better ear at 38 dB HL to achieve an aided sound field threshold of at least 30 dB hearing level and an aided word recognition score of at least 75% for monosyllabic words.     

Audiological evaluation and self-assessed hearing problems in subjects with single-sided congenital external ear malformations and associated conductive hearing loss

Previously, unilateral hearing impairment (UHI) has been considered of little consequence. However, a recent meta-analysis of children with UHI displayed educational and behavioural problems and possible delays of speech and language development. Further, patients with UHI consequently report hearing difficulties. Our study investigated hearing function, possible inner ear protection, and self-assessed hearing problems in 57 subjects aged between 3–80 years with single-sided congenital ear malformations and conductive UHI. Pure-tone thresholds and speech recognition (quiet, noise) were measured, and all patients completed a self-assessment questionnaire. Pure-tone thresholds corresponding to sensorineural function did not significantly differ between the normal (air conduction) and affected ear (bone conduction). However, speech recognition in both quiet and in noise was normal on the non-affected side but significantly worse on the malformed side. A moderate to high degree of self-assessed hearing problems were reported. In conclusion, hearing function in the affected ear was found to be subnormal in terms of supra threshold signal processing. Furthermore, a high degree of hearing difficulty was reported. Therefore, active treatment, surgery, or hearing amplification, might be considered.     

鼻咽癌患者放疗后引起感音神经性聋的临床观察

目的探讨鼻咽癌患者放疗后不同时期感音神经性聋的程度及发生率。方法选择无分泌性中耳炎的鼻咽癌患者28例，利用纯音测听和听性脑干反应（ABR），结合声导抗和耳声发射测试患者放疗前和放疗后1个月、1年、2年和5年的纯音听阈及波Ⅰ、Ⅲ、Ⅴ潜伏期、Ⅰ～Ⅴ波间期、鼓室压和镫骨肌声反射，以及部分受放射耳的诱发性耳声发射。结果语频（0．5～4．0kHz）和高频（8kHz）平均骨导听阈情况：①放疗后1个月较治疗前分别提高7．1dB和25．7dB，与放疗前比较差异有统计学意义（P〈0．001）；②放疗后1年分别提高17．6dB和28．1dB，与放疗前比较差异有统计学意义（P〈0．001），与放疗后1个月比较差异也有统计学意义（P值均〈0．001或P〈0．05）；③放疗后2年分别提高21dB和27．4dB，与放疗后1年比较差异仅语频有统计学意义（P〈0．05）；④放疗后5年分别提高26．7dB和35．8dB，与放疗前、放疗后1个月、1年和2年比较差异均有统计学意义（P值均〈0．001）。其中语频和高频听力损害大于15dB的发生率分别为37．5％～94．7％和85．4％～97．4％；听力损害大于30dB的发生率分别为14．6％～63．2％和37．5％～73．7％。平均ABR波Ⅰ、Ⅲ和Ⅴ潜伏期及Ⅰ～Ⅴ波间期的情况：放疗后1个月与放疗前比较无明显延长（P〉0．05）；放疗后1年和2年，均较放疗前和放疗后1个月明显延长，差异有统计学意义（P〈0．05），1年和2年组比较差异无统计学意义（P〉0．05）；放疗后5年较放疗前显著延长（P〈0．001），与放疗后1年和2年比较，波Ⅰ、Ⅲ和Ⅴ潜伏期明显延长（P〈0．05），而Ⅰ～Ⅴ波间期无明显延长（P〉0．05）。放疗1年后10耳中有7耳，放疗5年后7耳中有4耳诱发性耳声发射正常，但ABR均明显异常。结论放射所致的感音神经性聋可发生在部分患者放疗后的早期，特别是高频；随放疗后时间延长，听力损害的发生率增加，程度加重；损害可发生在耳蜗或（和）蜗后听觉通路，表明听觉系统不同部位和不同个体对放射损伤的敏感性可能存在差异。     

Monosyllable speech perception of Japanese hearing aid users with prelingual hearing loss: implications for surgical indication of cochlear implant

OBJECTIVE: The monosyllable speech perception ability after years of educational intervention was compared between prelingually deafened pediatric hearing aid users and their cochlear implant counterparts. DESIGN: An open-set monosyllabic speech perception test was conducted on all subjects. The test required subjects to indicate a corresponding Japanese character to that spoken by the examiner. Fifty-two subjects with prelingual hearing impairment (47 hearing aid users and 5 cochlear implant users) were examined. RESULTS: Hearing aid users with average pure-tone thresholds less than 90 dB HL demonstrated generally better monosyllable perception than 70%, which was equivalent or better performance than that of the cochlear implant group. Widely dispersed speech perception was observed within the 90-99 dB HL hearing-aid user group with most subjects demonstrating less than 50% speech perception. In the cluster of >100 dB HL, few cases demonstrated more than 50% in speech perception. The perception ability of the vowel part of each mora within the cochlear implant group was 100% and corresponding to that of hearing aid users with moderate and severe hearing loss. CONCLUSION: Hearing ability among cochlear implant users can be comparable with that of hearing aid users with average unaided pure-tone thresholds of 90 dB HL, after monosyllabic speech perception testing was performed.     

Relationships among speech perception, production, language, hearing loss, and age in children with impaired hearing.

Eighty-seven primary-school children with impaired hearing were evaluated using speech perception, production, and language measures over a 3-year period. Forty-seven children with a mean unaided pure-tone-average hearing loss of 106 dB HL used a 22-electrode cochlear implant, and 40 with a mean unaided pure-tone-average hearing loss of 78 dB HL were fitted with hearing aids. All children were enrolled in oral/aural habilitation programs, and most attended integrated classes with normally hearing children for part of the time at school. Multiple linear regression was used to describe the relationships among the speech perception, production, and language measures, and the trends over time. Little difference in the level of performance and trends was found for the two groups of children, so the perceptual effect of the implant is equivalent, on average, to an improvement of about 28 dB in hearing thresholds. Scores on the Peabody Picture Vocabulary Test (PPVT) and the Clinical Evaluation of Language Fundamentals showed an upward trend at about 60% of the rate for normally hearing children. Rates of improvement for individual children were not correlated significantly with degree of hearing loss. The children showed a wide scatter about the average speech production score of 40% of words correctly produced in spontaneous conversations, with no significant upward trend with age. Scores on the open-set Consonant-Nucleus-Consonant (CNC) monosyllabic word test and the Bench-Kowal-Bamford (BKB) sentence test were strongly related to language level (as measured by an equivalent age on the PPVT) and speech production scores for both auditory-visual and auditory test conditions. After allowing for differences in language, speech perception scores in the auditory test condition showed a slight downward trend over time, which is consistent with the known biological effects of hearing loss on the auditory periphery and brainstem. Speech perception scores in the auditory condition also decreased significantly by about 5% for every 10 dB of hearing loss in the hearing aid group. The regression analysis model allows separation of the effects of language, speech production, and hearing levels on speech perception scores so that the effects of habilitation and training in these areas can be observed and/or predicted. The model suggests that most of the children in the study will reach a level of over 90% sentence recognition in the auditory-visual condition when their language becomes equivalent to that of a normally hearing 7-year-old, but they will enter secondary school at age 12 with an average language delay of about 4 or 5 years unless they receive concentrated and effective language training.     

有低频残余听力感音神经聋的人工耳蜗植入术

目的介绍一种有低频残余听力感音神经聋的人工耳蜗植入技术,探讨人工耳蜗植入手术对有残余听力患者的治疗效果和价值。方法15例有残余听力的患者接受了保护残余听力的人工耳蜗植入手术。术中电极植入深度在19mm～24mm左右。术后分别检测单纯使用助听器、单纯使用人工耳蜗、人工耳蜗结合助听器三种不同状态下的听力。结果15例患者中,有13例术后残余听力保存良好,仅分别丢失5～20dB听力,但另2例术后残余听力全部丧失。术后在安静、信噪比15dB和10dB三种不同状态下的言语测试结果显示,人工耳蜗结合助听器使用者测试得分始终保持在很高水平;单纯使用人工耳蜗者也有较好的成绩,但在信噪比达10dB的条件下,测试成绩下降;而单纯使用助听器者,不仅在安静状态下听力成绩不甚理想,一旦加入竞争性噪声,听力测试成绩急剧下降。结论保护和利用残余听力的人工耳蜗植入技术,使人工耳蜗植入手术对象从重度或极重度聋扩大到高频为重度或极重度聋,低频（≤500Hz）为中、轻度聋的患者。接受这项技术患者的听力和言语识别能力均明显优于其单纯配戴助听器和单纯使用人工耳蜗时的听力和言语识别能力。