耳蜗骨化患者的人工耳蜗植入术

目的：探讨耳蜗骨化患者手术的技巧及术后效果。方法：回顾我科1997—2011年期间共29例耳蜗骨化的患者行人工耳蜗植入术。术前影像学及植入前骨化状况及电生理评估患者耳蜗功能。术后对患者进行言语评估及听觉行为分级标准和言语可懂度分级标准评估术后效果。结果：在29例耳蜗骨化患者中骨化程度为Ⅱ级的患者19例,骨化程度为Ⅰ级的患者4例,骨化程度Ⅲ级的患者4例。其中耳蜗骨化Ⅰ、Ⅱ级的患者中17例电极完全植入耳蜗,其余6例为部分植入电极。耳蜗骨化Ⅲ级的患者全部为部分植入。耳蜗植入术后大部分患者取得了较好的听力及语言的能力。结论：耳蜗骨化患者在完善术前评估的基础上可以完成人工耳蜗植入术并且部分患者可以取得较好的术后效果。术中电刺激听觉诱发电位的检测为评估残存螺旋神经的功能提供了一个很好的方法。     

外伤引起的极重度聋行人工耳蜗植入术1例

患者，男，37岁。2002年3月因车祸头部受外伤后昏迷，在当地住院治疗，清醒后对声音无反应。后又在他院行颞骨CT检查（图1），诊断为颞骨横行骨折。双耳全聋，给予扩血管及营养神经治疗无效，配助听器后效果差。遂来我院就诊，以“双耳极重度感音神经性聋”于2003年10月22日入院。检查：双耳耳廓对称、完整，外耳道通畅，鼓膜外观正常。纯音测听示：左耳骨导0．25、0．5kHz分别为40、60dB nHL，其余频率未引出反应，气导在各个频率未引出反应；右耳骨导0．25、0．5kHz分别为40、60dB nHL，其余频率未引出反应，     

感音神经性聋100耳的耳蜗电图分析

报道感音神经性聋100耳的耳蜗电图AP波和SP波的反应阈、两者的振幅、潜伏期及SP／AP波幅度比的测试结果。并对Metz重振阳性和阴性的AP反应阈与纯音听阈的关系。AP和SP波的振幅、潜伏期的关系以及SP／AP波幅比与Metz重振的关系等进行分析和讨论。     

聋儿早期人工耳蜗植入的分析

人工耳蜗装置和人工耳蜗植入手术近三十年的广泛应用．使越来越多的聋人改善听觉。随着科技的发展和经验的积累．早期诊断婴幼儿听力障碍和判断人工耳蜗适应症的可行性越来越高。人工耳蜗装置越来越适合小年龄聋儿。只要经过全面的医学检查和康复．使用合适的人工耳蜗装置进行手术．聋儿早期可以在听觉的发展．语言的获得等各方面取得实效．尽快地回归主流社会。给个体、家庭及社会减轻负担。早期人工耳蜗植入将逐渐成为聋儿早期干预和康复的常规手段之一。     

16例Nucleus 24导弯电极人工耳蜗植入体会

目的 通过总结16例Nucleus24导弯电极人工耳蜗植入体会,比较其与24导直电极手术方法的不同,就其临床手术植入中有关情况做出评价。方法 所有患者均于耳后切口经面神经隐窝入路植入电极,术中均进行电极阻抗测试和听神经遥测反应(NRT)测试。结果 所有患者电极全部顺利植入蜗内,阻抗测试均正常。术中均引出满意NRT反应。结论 Nucleus24导弯电极人工耳蜗由于其独特的设计和性能,使得人工耳蜗植入手术适用年龄更小,手术更安全,操作更简便、更容易。术后并发症更少。     

人工耳蜗植入的研究

人工耳蜗植入的研究曹克利用耳蜗植入（电子耳蜗）的方法使全自病人恢复听觉，是近二十年来生物医学工程领域内的又一进展，它是涉及耳科学、听大学、听生理学、心理物理学、电子学及高分子材料学等多学科综合研究的产物。随着微电子学和计算机科学等高技术的出现，近年来...     

人工耳蜗与助听器有何不同?

人工耳蜗又称电子耳蜗，是一种模拟耳蜗功能的声-电换能装置，它可以帮助患有重度或极重度耳聋的小儿和成人重建听力、获得听觉。     

腮腺炎后双耳全聋患者人工耳蜗植入术后短期效果的观察

目的：探讨腮腺炎后双耳深度聋患者人工耳蜗植入术后短期听力与言语康复效果。方法：报告3例腮腺炎后双耳全聋患者的临床资料，观察人工耳蜗植入术后3个月时听力及言语康复效果。结果：3例均在腮腺肿胀3～7d内突然听力下降，呈极度感音神经性聋，2例伴前庭障碍症状。经保守治疗均无效。人工耳蜗植入术中均将全部电极顺利植入耳蜗鼓阶内。开机3个月时2例具有开放性言语识别能力，其中1例语言清晰准确，基本听不出聋人特有的语音特征；另1例发声准确性明显提高。余1例仅具有封闭性言语识别能力。发声准确性进步缓慢。结论：腮腺炎后双耳聋起病急，中高频听力损失最重。人工耳蜗植入术后听力康复效果好，但言语识别能力和发声的准确性与耳聋时间长短和佩戴助听器语训时间有关。     

耳蜗性耳硬化症人工耳蜗植入的应用研究

分析耳蜗性耳硬化症患者的临床特点、人工耳蜗植入术中情况及人工耳蜗植入术后听觉言语康复效果,为该疾病的诊治提供参考。方法分析4例耳蜗性耳硬化症患者病史资料、听力学检查结果及影像学结果,观察人工耳蜗植入手术的术中所见,并定期对4例患者进行听力学及影像学随访。结果①所有患者人工耳蜗电极均经圆窗膜径路完全植入鼓阶。其中1例于术中发现镫骨完全固定,导致术中鼓阶开孔时外淋巴波动不明显;1例发现圆窗膜骨化,术中鼓阶开孔定位困难;其余2例患者镫骨活动好,圆窗结构清晰。所有患者术中电极阻抗检测均正常,且引出标准的神经反应遥测波形;②术后随访1~5年无术后并发症出现,声场测听示平均听阈为40.8 dBHL,平均言语识别率为77.3%,言语及交流能力较术前提高;颞骨高分辨率CT提示双侧内耳病变范围无明显进展。结论耳蜗性耳硬化症进展缓慢,严重时可导致重度/极重度感音神经性聋,当使用助听器无效时,人工耳蜗植入能帮助患者获得较满意的听觉康复效果。     

Ameliorative Effects of Exposing DBA/2J Mice to an Augmented Acoustic Environment on Histological Changes in the Cochlea and Anteroventral Cochlear Nucleus

DBA/2J (D2) mice, which exhibit very early progressive sensorineural hearing loss, were treated nightly with an augmented acoustic environment (AAE) initiated before the onset of hearing, and consisting of repetitive bursts of a 70-dB sound pressure level (SPL), 4–25 kHz noise band. At 55 days of age, AAE-treated mice exhibited less elevation of auditory brainstem response thresholds, fewer missing hair cells, and greatly reduced loss of anteroventral cochlear nucleus (AVCN) volume and neuron number compared to untreated control mice. It was hypothesized that the central neuroprotective effect was associated with increased afferent input to AVCN neurons evoked by the AAE as well as a healthier cochlea.     

The large vestibular aqueduct syndrome: the role of cochlear implantation in its management

In recent years the large vestibular aqueduct syndrome has become an increasingly recognized cause of a progressive sensorineural hearing loss. Cochlear implantation, although not correcting the bony abnormality, does offer an avenue for rehabilitation for affected individuals and initial results are encouraging. Of 15 patients identified with the large vestibular aqueduct syndrome we have implanted seven (five adults and two children). All patients underwent an uneventful electrode insertion with uncomplicated postoperative periods. Three of our adult patients are showing very good initial results with BKB speech recognition scores of 100%, 74% and 66% with the implant alone. It is still early days with the children, but initial results are encouraging. A full review of the large vestibular aqueduct syndrome is given along with our results.     

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,     

地塞米松不同给药方式治疗突发性聋的疗效观察

目的:探讨地塞米松不同给药方式治疗突发性聋的疗效。方法:回顾性分析100例突发性聋患者,将其分为2组,A组(50例)全身静脉注射地塞米松,B组(50例)鼓室内注射地塞米松。结果:A、B组治疗总有效率分别为66%、68%,差异无统计学意义(P>0.05)。结论:不管全身方式给药,还是局部鼓室给药,使用地塞米松治疗突发性聋的疗效相仿。     

Prevalence of labyrinthine ossification in CT and MR imaging of patients with acute deafness to severe sensorineural hearing loss

Abstract

Objective: To evaluate the prevalence of labyrinthine ossification, and especially cochlear ossification, in a cohort of patients with unilateral sudden deafness or severe sensorineural hearing loss. Design: Retrospective data collection. Study sample: Sixty-four consecutive patients with unilateral sudden deafness or severe sensorineural hearing loss and either high-resolution CT (HRCT) of the temporal bone (isotropic spatial resolution ≤ 0.8 mm; n = 18) or high resolution CISS MRI (isotropic spatial resolution ≤ 1 mm; n = 55) were included. Nine patients underwent both imaging modalities. A standardized reading regarding labyrinthine ossifications was performed by an experienced head and neck radiologist blinded to clinical symptoms. Results: Radiologic signs of cochlear ossification were present in 14 patients (12 CT and 2 MRI). Eight patients showed unilateral and six patients bilateral signs of cochlear ossification. In all except one of the unilateral cases, the deafened ear was affected. Conclusions: Signs of cochlear ossification were found in an unexpectedly high rate (14/64, 22%) of patients with acute deafness. The data suggest HRCT of the temporal bone to be more sensitive to detect labyrinthine ossification than MRI. HRCT of the temporal bone should therefore be considered in patients with impaired recovery of acute deafness to exclude cochlear ossification; if present, and, in cases of early signs, the patient should be evaluated further to facilitate early cochlear implantation before progression impedes electrode insertion, reflecting latest developments considering cochlea implants for single-sided deafness to be effective.     

Cochlear implantation trough the middle cranial fossa: a novel approach to access the basal turn of the cochlea

The classic approach for cochlear implant surgery includes mastoidectomy and posterior tympanotomy. The middle cranial fossa approach is a proven alternative, but it has been used only sporadically and inconsistently in cochlear implantation.ObjectiveTo describe a new approach to expose the basal turn of the cochlea in cochlear implant surgery through the middle cranial fossa.MethodFifty temporal bones were dissected in this anatomic study of the temporal bone. Cochleostomies were performed through the middle cranial fossa approach in the most superficial portion of the basal turn of the cochlea, using the meatal plane and the superior petrous sinus as landmarks. The lateral wall of the internal acoustic canal was dissected after the petrous apex had been drilled and stripped. The dissected wall of the inner acoustic canal was followed longitudinally to the cochleostomy.ResultsOnly the superficial portion of the basal turn of the cochlea was opened in the fifty temporal bones included in this study. The exposure of the basal turn of the cochlea allowed the visualization of the scala tympani and the scala vestibuli, which enabled the array to be easily inserted through the scala tympani.ConclusionThe proposed approach is simple to use and provides sufficient exposure of the basal turn of the cochlea.     

突发性聋伴良性阵发性位置性眩晕预后影响的Meta分析

目的探讨突发性聋伴良性阵发性位置性眩晕对其预后产生的影响。方法在中国知网、万方、维普、中国生物医学文献数据库(China biology medicine diss,CBMdisc)、超星数字图书馆等中文数据库和Medline、Embase、Cochrane Library、Ovid SP等英文数据库中检索2010~2020年公开发表的伴BPPV对于SSNHL预后影响的病例对照研究,采用Cochrane Handbook 6.0评价纳入文献的质量,并用RevMan 5.4和Stata软件包对符合质量标准的研究进行Meta分析,选用I2和P值进行异质性检验,根据纳入文献的异质性使用随机效应模型或固定效应模式,在95%置信区间内计算比值比(odds ratio,OR)。结果共检索文献数量541篇,最终纳入10篇,均为中文文献,Meta分析结果表明SSNHL伴BPPV的总有效率显著低于不伴BPPV(OR=0.50,95%CI为0.39~0.65,P<0.01);SSNHL伴的痊愈率显著低于不伴BPPV(OR=0.37,95%CI为0.16~0.88,P=0.02)。结论SSNHL并发BPPV的患者预后较不并发BPPV的患者差。