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。     

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。     

双耳双模式聆听的优势及目前存在的问题

近十年来,人工耳蜗植入已经成为治疗小儿和成人重度以上感音性神经性聋的标准疗法.但在耳聋患者中存在这样一群特殊患者,他们一侧耳重度或极重度聋,但对侧耳尚有一定的残余听力.在中国大多数此类患者接受了单侧人工耳蜗植入,形成了单耳听觉.然而对于这些患者,其单侧人工耳蜗植入在其音调、音乐感知以及声源定位等能力并没有达到理想状态,是以针对那些对侧耳有残余听力的单侧人工耳蜗植入者,出现了给非植入耳佩带助听器的“双耳双模装配”模式,从而使患者能够“双耳双模式聆听”.那么相对于单耳听觉或双耳耳蜗模式究竟有何优势,并且就目前的研究或是技术而言,还存在哪些主要的问题呢？本文在回顾近年文献的基础上,对这些问题做一综述.     

一侧人工耳蜗对侧助听器双模式聆听效果的研究进展

在耳聋患者中,有一部分是一侧耳重度或极重度聋,但对侧耳尚有一定的残余听力。随着人工耳蜗植入术适应症范围的不断扩大,越来越多的此类患者接受了单侧人工耳蜗植入(CI),形成了单耳听觉。然而单侧人工耳蜗植入患者的音调、音乐感知以及声源定位等能力不尽如人意。于是针对那些对侧耳有残余听力的单侧人工耳蜗植入者,出现了给非     

助听器与人工耳蜗的联合使用

人工耳蜗植入技术的适用范围已经从全聋患者扩宽到有残余听力的重度聋者，成为重度以及极重度聋患者恢复听力的重要康复手段。对于术后对侧耳仍具有残余听力的患者或者由于人工耳蜗植入电极的限制，使得植入耳的低频残余听力不能得到利用的患者，其残余频率段的言语识别率可能在随后的几年里呈进行性下降，     

耳虫呙死区的诊断和临床应用

近些年来,由于听力学及现代科学技术的飞速发展,促进了助听器和人工耳蜗技术不断发展,耳聋患者可以通过佩戴助听器和人工耳蜗植入来改善听力,提高言语交流能力,因此,助听器和人工耳蜗成为耳聋患者接受耳聋教育和进行社会交流不可缺少的工具。然而,仅有部分耳聋患者反应佩戴助听器或行人工耳蜗植入术后,听力改善效果较好,有些患者表示听力仍较差,不能获得很好的听力及言语理解力[1-3]。这些问题引起了听力师和临床耳鼻咽喉科医生极大地关注和研究。Moore等[2]于2000年提出重度至极重度聋患者的耳蜗存在“死区”,该死区的存在导致助听器增益无效,     

人工耳蜗植入术前助听器试戴的意义

对拟行人工耳蜗植入手术的双侧极重度耳聋患者进行助听器试戴和语言训练，并定期作言语识别记分（ＳＤＳ）。结果：３例患者戴助听器ＳＤＳ较未戴助听器时无明显提高，分值改变＜４０％，选择人工耳蜗植入且术后听觉效果好；另５例戴助听器后可进行一般交谈，以助听器为听力康复的最佳选择。对人工耳蜗植入术前助听器试戴的意义进行了讨论。     

人工耳蜗植入术中保存残余听力的手术技巧

近些年来,随着声电联合刺激(Electric Acoustic Stimulatlion,EAS)技术的发展,学者们越来越重视保存人工耳蜗植入患者的残余听力.EAS是一种结合了助听器功能的新型人工耳蜗装置,它通过联合使用人工耳蜗与助听器来改善患者的听觉.中、高频重度听力损失,低频区有残余听力,配戴助听器效果不佳的患者,EAS植入后能够获得良好的听功能.EAS的作用原理是中、高频区借助人工耳蜗的电刺激产生听觉,而低频区的残余听力由助听器来放大,从而有效提高植入后耳聋患者的听力表现,尤其是声音的定位、音调的感知以及噪声环境下的言语识别率[1,2].     

一侧佩戴助听器对侧植入人工耳蜗的成人患者的双耳听力优势

此项研究意在调查：①一侧植入人工耳蜗的成人患如何调节对侧的助听器；②植入人工耳蜗后再使用助听器是否会相互干扰；③一侧植入人工耳蜗、对侧使用助听器的成人是否可以获得双侧听力以满足言语识别力、定向力和日常生活要求。具体设计为21例患(女11例，男10例)，3例植     

植入人工耳蜗另侧配戴助听器个案研究

本文通过对人工耳蜗植入后另侧耳配戴助听器的个案进行观察研究，并将其与人工耳蜗植入后另侧不配戴助听器的患儿进行对比观察，发现他们在日常生活中遇突发声响的反应速度．听觉质量、辨听的反应速度有显著差别。经过历时一年的观察．评估，笔者认为人工耳蜗植入后另侧耳继续配戴助听器与不配戴助听器的聋儿在言语矫治效果、听觉理解能力．语言学习能力．声调学习能力及发音水平等方面，都有明显的差别。     

Comparative study on the morphology and the composition of the otoliths in the teleosts

Conclusion. Saccular otoliths of teleosts were mostly larger than utricular otoliths, which might relate to the three-dimensional movement. The large and heavy otolith may be better suited in saccules of the bottom and reef fishes. The quantities of iron in lagenar otoliths were found to be lower than those of birds. The function of the fish lagena remains to be elucidated by further studies. Objective. To evaluate the morphological characteristics and the chemical composition of the otoliths in fishes as related to behaviour and habitat. Materials and methods. We studied the morphology of the otoliths of 18 genera of fishes (81 samples) divided into 3 groups: saltwater fish (13 genera), freshwater fish except for the carp family (3 genera) and carp family fish (2 genera). The otoliths and the living environments were compared. The chemical composition was analysed using a synchrotron X-ray fluorescence analyser. Results. Bottom fishes generally have larger saccular otoliths, and migrating fishes have smaller saccular otoliths. In comparing the bottom/reef fishes and the migrating fishes in salt water, the former tended to have larger saccular otoliths. In saltwater bottom fishes the tendency was found that the thinner the head, the larger was the saccular otolith. We found significant quantities of iron, zinc and manganese in the lagenar otoliths.     

Comparative study on the morphology and the composition of the otoliths in the teleosts

CONCLUSION: Saccular otoliths of teleosts were mostly larger than utricular otoliths, which might relate to the three-dimensional movement. The large and heavy otolith may be better suited in saccules of the bottom and reef fishes. The quantities of iron in lagenar otoliths were found to be lower than those of birds. The function of the fish lagena remains to be elucidated by further studies. OBJECTIVE: To evaluate the morphological characteristics and the chemical composition of the otoliths in fishes as related to behaviour and habitat. MATERIALS AND METHODS: We studied the morphology of the otoliths of 18 genera of fishes (81 samples) divided into 3 groups: saltwater fish (13 genera), freshwater fish except for the carp family (3 genera) and carp family fish (2 genera). The otoliths and the living environments were compared. The chemical composition was analysed using a synchrotron X-ray fluorescence analyser. RESULTS: Bottom fishes generally have larger saccular otoliths, and migrating fishes have smaller saccular otoliths. In comparing the bottom/reef fishes and the migrating fishes in salt water, the former tended to have larger saccular otoliths. In saltwater bottom fishes the tendency was found that the thinner the head, the larger was the saccular otolith. We found significant quantities of iron, zinc and manganese in the lagenar otoliths.