大龄聋儿人工耳蜗植入适应证选择和人工耳蜗植入术前评估

“对听力语言障碍者干预越早效果越好”在本领域内已成为共识,但对于年龄较大儿童如何科学地选择人工耳蜗植入,仍是值得探讨的问题。结合中国“听力重建,启聪行动”项目的实施,笔者通过对几个大龄人工耳蜗植入者的康复效果调查,认为年龄并不是决定大龄儿童能否植入人工耳蜗的唯     

人工耳蜗植入术前评估

目前,人工耳蜗植入(CI)是治疗重度-极重度感音性聋最有效的方法, 选择手术适应证、制定手术方案、提高术后康复效果均依赖正确的术前评估。从听力学评估、影像学评估、患者智力和心理特征评估、患者及家属的期望值及家庭环境四方面进行分析和讨论。     

术中圆窗耳蜗电图对人工耳蜗植入电极安全性评估

目的：分析人工耳蜗电极植入前后圆窗耳蜗电图（R W EcochG）中耳蜗微音电位（CM）阈值的变化,以客观评估人工耳蜗植入手术是否对耳蜗基底膜造成损伤。方法：对40例拟行人工耳蜗植入术的患者在全身麻醉下行R W EcochG测试,分析植入电极前后CM阈值的变化。结果：40例人工耳蜗植入患者中,39例电极植入前后CM阈值相近,且在个别频率植入电极后CM阈值减小5dB;仅有1例患者电极植入后CM阈值比植入前明显增加,术中植入电极时有阻力感。结论：术中RWEcochG测试可以客观评估人工耳蜗植入手术本身是否对耳蜗基底膜造成损伤。     

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。     

人工耳蜗植入的言语评估

人工耳蜗作为使深度听障者复聪的主要方法近年来日益得到重视，我国的人工耳蜗从植入数量、科研水平上均与10年前不可同日而语。耳蜗植入的最终目的是使用者能够自如地与他人进行言语交流，其康复成功的第一个标志应该是听懂言语。与国外术前、术后言语评估大量的报告相比．我国的研究相对较少。这不仅影响了国人术后效果与全球各地的比较，而且难以解释现有的多道装置和编码策略对汉     

人工耳蜗植入者的听力康复及其评估

人工耳蜗植入是当今双侧重度和极重度感音神经性聋患者重获听力的最佳途径.通过耳蜗电极刺激螺旋神经节所产生的“声音”与自然声音有较大区别,其声音类似于电子琴或金属撞击声.耳蜗植入术后的康复工作在整个过程中占有不可忽视的地位.本文结合一例人工耳蜗植入病例谈谈言语康复的情况.1 资料和方法患者,女性,36岁.自幼双耳听力较差,其父亲和两个姐妹有不同程度的感音神经性聋.植入手术前2年因接受庆大霉素治疗而致双耳重度聋.助听器对她来说只有声感而无语感.患者讲话口齿虽较清楚,但语速较慢.平时借唇读及笔谈与他人交流.     

儿童人工耳蜗植入的术前评估和术后康复

人工耳蜗作为帮助重度．深度听力障碍患者复聪的主要手段已被专业人员和公众所认识,在我国也有2000余人接受了耳蜗植入手术。随着临床耳蜗植入后随访观察工作的不断深入,当今人工耳蜗植入的适应证也进一步放宽．年龄标准放低．开展手术和康复的单位也在增加。2003年9月在长沙举办的中华医学会全国人工耳蜗专题学术会议上,多数与会学者充分认识到,在提高手术技能的同时,术前严格．全面的适应证选择以及术后适当及有效的康复训练和心理治疗是人工耳蜗成功的重要保证。     

人工耳蜗植入患儿围手术期护理经验分析

目的总结人工耳蜗植入息儿围手术期护理经验卉法对108例人工耳蜗植入患儿进行术前术后护理,术前护理包括心理护理、协助医生完成各项术前检查及术前准备;术后护理包括观察患者意识、呼吸情况,观察是否有伤口感染、面瘫、眩晕恶心呕吐、脑膜炎等并发症的发生,以保证及时处理结果108例患儿人工耳蜗植入手术全部一次成功结论术前术后认真精心的护理,是保证人工耳蜗植入手术成功的关键因素之一。     

高分辨CT和MRI对人工耳蜗植入患者的术前评价

人工耳蜗植入术前影像学检查最佳方案迄今尚未确定，术前常用高分辨CT和MRI了解耳蜗的解剖结构、帮助选择手术入路、确定耳蜗植入侧。然而，究竟术前选择哪种检查方法可提供更多帮助仍有分歧，或两种方法联合效果更好?回顾分析爱尔兰国立人工耳蜗植入中心早期手术的88位患，     

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。     

成年人人工耳蜗植入术的病例选择

多道人工耳蜗植入已使很多成年耳聋病人获得了相当程度的开放言语（opensetspeech）识别能力。例如双耳重度感音神经性聋、使用高功率助听器无效者，植入人工耳蜗可以使病人重获音感，识别环境声音，感知危险，提高唇读，甚至达到开放言语的能力，提高病人的生活质量。但是，有的病人植入人工耳蜗后却不能收到与此相同的效果。一般来说，获得开放言语能力是植入成功的最重要的指标。然其获得常常受到诸多因素的影响。临床上，于植入人工耳蜗前对有关的影响因素进行仔细的分析，准确地选择病人，对植入后所取得的效果作出充分的估计，是一项…     

人工耳蜗植入术的并发症及处理

目的总结和分析人工耳蜗植入术并发症,探讨并发症发生的原因、临床处理方法及预后,为避免该类并发症的发生提供临床参考。方法现对中国人民解放军联勤保障部队第九四〇医院2010年5月—2019年4月由同一术者完成的497例（498耳）人工耳蜗植入术,对其发生原因进行回顾性分析。结果24 例发生并发症(24／497),占4.8％,其中眩晕9例,骨膜下血肿2例,感染或过敏1例,外耳道皮肤破裂1例,面神经及鼓索神经损伤各1例,死亡1例,术后脑脊液耳鼻漏合并颅内感染1例,术中电钻钻头断裂至鼓阶内1例,植入体局部斑秃2例、电极未植入耳蜗1例、磁铁移位2例,装置故障1例。结论如何降低人工耳蜗植入手术严重并发症的发生,目前仍然是人工耳蜗植入亟待解决的问题。     

儿童人工耳蜗手术的并发症与处理

通过复习国内外文献、内部交流及根据我院临床病例经验，回顾、总结儿童人工耳蜗手术常见并发症的发病率、临床表现、诊断和处理方法，其中包括国内外有关手术并发症的最新进展。本文着重讨论的是临床经常遇到而且较难处理的并发症，包括皮瓣感染及坏死，植入体硅橡胶过敏，面神经损伤，面神经刺激和开机后无听性反应等。认真做好术前诊断，完善手术细节，提高手术经验，手术并发症是可以避免和减少的。     

人工耳蜗植入"井喷"的判断与术中处理的体会

目的：探讨人工耳蜗植入发生“井喷”的术前判断与术中处理的方法。方法：327例人工耳蜗植入患者术前均行颞骨高分辨CT（HRCT）筛查，并行术前准备及术中处理。结果：11例术前颞骨HRCT显示内耳畸形并发内听道底骨性缺损与耳蜗、前庭相通，术中均有脑脊液喷出，经过术中对植入口的严密封闭，术后未见脑脊液耳鼻漏等并发症的发生。结论：人工耳蜗植入发生“井喷”的原因为内耳与蛛网膜腔有异常开放的通道。术前行颞骨HRCT检查不仅能对内耳畸形的患者作出准确的判断，还能为术中进行正确的处理提供准确的科学依据，从而避免并发症的发生。     

Congenital cholesteatoma and cochlear implantation: Implications for management

Abstract

Introduction

Cholesteatoma is an uncommon condition that has occasionally been associated with cochlear implantation (CI). Cases of secondary acquired cholesteatoma have been described, in which intra-operative breech of the posterior canal wall is thought to be a contributing factor. Primary acquired cholesteatoma is not typically associated with congenital sensorineural hearing loss (SNHL) or CI in children. Congenital cholesteatoma is a rarer entity yet with an incidence in the literature of 2–4% of all cholesteatomas. We present lessons learned from our experience of congenital cholesteatoma in CI candidates.

Methods

Retrospective reviews of departmental CI and cholesteatoma databases in a tertiary/quaternary pediatric center were conducted. Cases of congenital cholesteatoma were identified. The proportion of congenital cholesteatoma cases in CI candidates was compared with number of acquired cholesteatoma. Optimum management of congenital cholesteatoma in CI candidates was reviewed.

Results

In our pediatric CI population, 2/794 patients (0.25%) were recognized as having a congenital cholesteatoma during their evaluation for CI. No cases of primary acquired cholesteatoma were identified in this population at presentation or at follow up to 18 years.

Discussion

The 0.25% incidence of congenital cholesteatoma in our population of CI patients is higher than expected of this rare condition. It is surprisingly common given the absence of any cases of primary acquired cholesteatoma, which is considerably more common even in the pediatric population. Both patients likely had an inherited form of hearing loss and a genetic contribution to the presence of congenital cholesteatoma cannot be excluded. The presence of congenital cholesteatoma has implications for the algorithm currently employed for the assessment of CI. We consider that surgery should be staged to ensure complete removal of the cholesteatoma before implantation. Thus bilateral CI should be provided sequentially rather than simultaneously in the presence of unilateral cholesteatoma.     

Bilateral cochlear implantation: an evidence-based medicine evaluation

OBJECTIVES/HYPOTHESIS: The aim of this study was to evaluate the extent and quality of evidence reported on the outcomes of bilateral cochlear implantation and thereby to inform opinion about future patient management. STUDY DESIGN: Retrospective literature review. METHODS: A detailed search of the medical literature was performed using the Medline, Embase, and CINAHL databases starting from the date of their conception. The quality of evidence in each article was assessed according to the categories of evidence as defined by the Oxford Centre for Evidence-based Medicine, Levels of Evidence (May 2001). RESULTS: A total of 37 studies were included; 28 (76%) investigated adult participants only, 7 (19%) investigated child participants, and 2 (5%) contained both groups. Of the studies presented, 9 (24%) studies contained level 2b evidence, 2 (6%) level 3b, 16 (43%) level 4, and 10 (27%) level 5 evidence. No studies were identified as representing evidence level 1. Adult bilateral recipients demonstrated an increase in sentence recognition of 21% correct over their first implanted ear (P < .001) and mean bilateral localization errors of 24 degrees against a monaural error of 67 degrees (P < .005). CONCLUSIONS: The available evidence indicates that bilateral cochlear implantation confers material benefits not achievable with unilateral implantation, specifically in terms of sound localization and understanding of speech in noise. Well-designed prospective studies of sufficient size are now needed to precisely quantify these benefits, to validate outcome measures, especially in children, and to define the criteria for intervention.     

人工耳蜗植入脑脊液井喷原因及处理

目的分析人工耳蜗植入（cochlear implantation，CI）发生脑脊液井喷的原因，总结术中井喷处理方法和预后。方法对1997年3月-2007年1月在我科接受工耳蜗植入发生脑脊液井喷的情况做回顾性分析。结果本组耳蜗植入术中发生脑脊液井喷共8例，患者均有内耳畸形，包括Mondini畸形3例，大前庭水管综合征（1arge vestibular aqueduct syndrome，LVAS）4例，非综合征型x连锁隐性遗传性聋伴内耳畸形1例。8例均在术中封闭耳蜗造瘘口，其中7例术后未出现脑脊液耳漏，而1例Mondini畸形患者术后出现迟发性脑脊液耳漏及脑膜炎，经治疗后痊愈。结论本组脑脊液井喷均发生于内耳畸形患者，但人工耳蜗植入顺利，仅1例患者术后出现脑脊液耳漏和脑膜炎，经适当处理痊愈，预后良好。