人工耳蜗植入者颅脑磁共振成像检查一例

人工耳蜗术后行磁共振成像(magneticresonanceimaging,MRI)一直被视为禁忌。近年来国外学者研究发现一定条件下,耳蜗植入者行颅脑MRI检查是安全的[1,2 ] 。我们对1例人工耳蜗植入患者行颅脑MRI扫描,报道如下。一、资料与方法患儿男,双耳语前全聋,于1岁3个月时行左耳人工耳蜗植入术,植入NucleusCI2 4M型耳蜗(该装置磁铁可移出) ,术后定期调机。2 5岁时出现全身瘫软、乏力,3岁时出现抽搐,脑电图有癫痫波,为除外颅内病变,需要行颅脑MRI检查。步骤如下。1.用氯胺酮和咪唑安定静脉维持麻醉,保留自主呼吸,未行气管插管。2 .人工耳蜗磁铁取…     

人工耳蜗植入者颅脑磁共振成像检查一例

人工耳蜗术后行磁共振成像(magnetic resonance imaging MRI)一直被视为禁忌。近年来国外学者研究发现一定条件下，耳蜗植入者行颅脑MRI检查是安全的。我们对1例人工耳蜗植入患者行颅脑MRI扫描，报道如下。     

电子耳蜗植入术后残余听力的损失

作者1985年7月至1988年6月间在美国科罗拉多耳科诊所用听力测验法评价接受电子耳蜗植入40例术后患者的听力,其中12例术前有残余听力。患者男性9例,女性3例,年龄为18～63岁(平均40.5岁)。患者均由一位经验丰富的电子耳蜗植入专家施术。植入的电子耳蜗为Nucleus多导电子耳蜗,电极长25mm,有22个电极。术后其中10人平均每日应用电子耳蜗9.6小时(5～16小时),另2例因皮瓣问     

内听道斜矢状位磁共振成像在人工耳蜗置入术前评估中的初步应用

目的:探讨内听道(IAC)斜矢状位MRI在人工耳蜗置入术前评估中的应用价值。方法:应用斜矢状位三维快速自旋回波T2加权MRI技术对15例(30耳)拟行人工耳蜗置入术患者的IAC进行扫描。结果:所有患者顺利完成检查,IAC内神经结构显示清楚。13例蜗神经正常的患者行人工耳蜗置入术并已成功开机,2例双侧蜗神经异常者未行耳蜗置入。结论:IAC斜矢状位MRI能清晰显示IAC内蜗神经的形态、大小及IAC的大小,是人工耳蜗置入术前判断蜗神经发育状况的良好方法。     

脑白质异常小儿人工耳蜗植入手术适应证的讨论

目的讨论小儿人工耳蜗植入术前常规MRI检查中发现脑白质异常的手术适应证，为小儿人工耳蜗植入手术适应证选择的准确性提供依据。方法对2004年10月-2006年12月期间，351例年龄在0．9-3．0岁的重度或极重度感音性聋小儿，人工耳蜗植入术前进行常规影像学MRI检查，通过检查结果发现MRI形态有异常改变，对有脑白质异常的病例提出总结讨论，选择手术适应证，进行术后随访。结果351例患儿中选择了347例进行了人工耳蜗植入手术。351例患儿常规MRI检查提示：脑白质形态异常20例，占5．7％，其中轻、中度异常16例，进行了人工耳蜗植入手术，术后随访2年以上未见恶化趋势。严重异常4例，取消了人工耳蜗植入手术，进行长期随访。结论幼小儿人工耳蜗植入术前常规MRI检查不可忽视，通过术前的常规MRI检查可以了解患儿的脑形态和发育状况，从中发现听力障碍患儿伴有脑部罹患。轻度脑白质异常进行人工耳蜗植入手术未发现预后恶化，严重脑白质异常由于临床经验不足，采取MRI长期随访，如有明显影像学和症状的改善方可慎重考虑人工耳蜗植入手术。     

一例迷路震荡致极重度耳聋植入人工耳蜗后效果观察

<正>患者,男性,26岁,2009年初因车祸致胸腹部联合创伤、颈椎挥鞭伤伴昏迷入外院抢救手术,清醒后即出现双耳听力丧失,检查双耳听力属极重度感音神经性耳聋,颞骨CT及头颅MRI未见颞骨骨折及颅内异常,经多院积极治疗后听力无恢复,于2010年7月入我院拟行人工耳蜗植入手术以提高听力。术前检查,双耳道通畅,鼓膜完整,纯音听力检查双耳全聋,各频率最大输出均未引出反应,鼓室图双耳A型,多频稳态、ABR检查最大输出亦均无反应,     

耳蜗植入者耳蜗电刺激时听皮层激活:功能性磁共振成像评价

电子耳蜗植入前必须对植入效果进行客观预测。耳蜗植入效果的术前评价传统上通过鼓呷电刺激，当鼓呷刺激时有声音感觉称为阳性反应。植入前电测试缺乏主观感觉通常被视为耳蜗植入的禁忌症，但有报道少数患者即使植入前测试阴性亦植入成功，而术前测试阳性并不是可能成功的唯一标准，因为耳蜗植入后重新进行语言编码综合的中枢过程不能通过这一方法检测。因此，通过功能性磁共振成像（MRI）技术观察耳蜗电刺激后产生的皮层反应可能有助于对耳蜗植入效果进行术前客观评价。7例拟行耳蜗植入的深度耳聋患者，均为后天性语后登．无全身及其他神…     

Nucleus~(R)22导电子耳蜗在老年人的应用

自Medicare提供Nucleus~(R) 22导电子耳蜗解决语后(postlingual)重度感音神经性聋以来,接受这种治疗的老年患者日益增多。作者用含26项内容的调查表对101例65岁以上因这种耳聋行Nucleus~(R) 22导电子耳蜗植入的患者进行调查,该表包括;①耳蜗植入前病史;②植入后的应用;③语言交流的改善;④生活情况。对67份返回的调查表进行统计学分析结果如     

迷路切除术耳的鼓岬电兴奋

双侧耳聋可能发生于一耳接受迷路切除术的梅尼埃病患者。为探讨迷路切除耳植入电子耳蜗的可行性,作者对6例经乳突行迷路切除术6周至5年的患者作鼓岬电兴奋试验。所有患者对刺激均有反应,每例对四个频率的音调感觉亦不相同。5例电刺激引起中潜伏期反应。这些资料与其他原因所致聋耳及已成功地作电子耳蜗植入者的行为及电生理学反应相比,结果提示梅尼埃病行迷路切除侧耳仍能保存听神经及听觉中枢通道的部分功能多年;但可发生局限于耳蜗基底周的耳蜗纤维化和骨     

迷路纤维化的诊断及人工耳蜗植入3例分析

目的：探讨迷路纤维化的影像学诊断及对人工耳蜗植入术的效果。方法：结合文献复习，报告3例迷路纤维化患者行人工耳蜗植入术的临床资料。结果：术前CT扫描3例均未发现异常。1例术前MRI提示耳蜗基底间纤维状，1例术后提示对侧耳蜗纤维化。2例病变较轻者成功地进行了人工耳蜗植入术，术后恢复良好；1例因病变严重电极未能植入。结论：MRI在迷路纤维化的诊断中有重要价值。慢性化脓性中耳炎为迷路纤维化的病因之一。慢性化脓性中耳炎一期手术清理中耳病变后，具有进行人工耳蜗植入的可行性。     

Image analysis of the inner ear with CT and MR imaging: pre-operative assessment for cochlear implant surgery]

Recent progress in magnetic resonance imaging (MRI) has made it possible to obtain detailed images of the inner ear by delineating the lymphatic fluid within the labyrinth. We analyzed CT scans and MR images in 70 ears manifesting profound deafness owing to inner ear lesions and compared their detective ability for inner ear lesions. The following results were obtained. 1) CT scan examination showed slight to extensive ossification of the labyrinth in six ears (9%), whereas MRI examination revealed low to absent signal intensity of the inner ear in nine ears (13%). Therefore, it was concluded that MRI is more sensitive in detecting abnormalities of the inner ear than CT scan. 2) MRI provided useful information as to whether the cochlear turn is filled with lymphatic fluid or obstructed. This point was one of the greatest advantages of MRI over CT scan. 3) Abnormal findings in either or both the CT scan and the MRI were detected in suppurative labyrinthitis occurring secondary to chronic otitis media, bacterial meningitis and in inner ear trauma. However, such abnormal findings were not detected in patients with idiopathic progressive sensorineural hearing loss, ototoxicity or sudden deafness. These findings should be taken into consideration in pre-operative assessment of cochlear implant candidates.     

Die Rolle der Halswirbelsäule und des Kiefergelenks bei Tinnitus

The causes of tinnitus, vertigo, and hearing disturbances may be pathological processes in the cervical spine and temporomaxillary joint. In these cases, tinnitus is called somatosensory tinnitus (SST). For afferences of the cervical spine, projections of neuronal connections in the cochlear nucleus were found. A reflex-like impact of the cervical spine on the cochlear nucleus can be assumed. The tinnitus treatment concept of the Charité University Hospital in Berlin involves the cooperation of ENT specialists with many other disciplines in an outpatient clinic. A standardized examination protocol has been established, and physical therapy has been integrated into the interdisciplinary tinnitus treatment. For tinnitus-modulating therapy of muscular trigger points, local anesthetics as well as self-massage or treatment by a physiotherapist or osteopath are useful.     

影像学评估对耳蜗骨化患者人工耳蜗植入手术及术后效果的影响

目的探讨影像学评估对耳蜗骨化患者人工耳蜗植入手术及术后效果的影响。方法回顾性研究解放军总医院2009～2012年间7例耳蜗骨化的人工耳蜗植入患者的影像学检查结果、手术方式等资料,总结分析其术后康复效果。结果术前颞骨高分辨率CT和MRI检查,特别是耳蜗MRI仿真内窥镜可判断耳蜗骨化范围及程度。植入时1例患者因一侧耳蜗完全骨化而失败,另一侧植入顺利,其余6例均手术顺利,无手术并发症。人工耳蜗开机后7例患者均有听觉反应,但CAP）及SIR分级不同（因病例数量少未做统计学分析）。结论耳蜗骨化患者的术前影像学评估需将颞骨高分辨率CT和MRI结合,MRI仿真内窥镜重建可清晰显示耳蜗病变程度及范围。对于耳蜗轻度骨化患者,经典面神经隐窝入路一圆窗龛前方开窗术可顺利植入电极。人工耳蜗植入术可以作为伴有耳蜗骨化的极重度感音性聋患者的治疗手段,术后康复效果影响因素较多。     

Topographic analysis of inner ear lesions in profoundly deafened patients with tympanogenic and meningogenic labyrinthitis using three-dimensional magnetic resonance imaging.

OBJECTIVE: High-resolution magnetic resonance imaging (MRI) provided clear images of three-dimensional (3D) reconstruction of the inner ear in candidates for cochlear implantation. In this study. semiquantitative analysis of the 3D MRI findings was performed to investigate topographic lesions of the inner ear caused by tympanogenic and meningogenic labyrinthitis. STUDY DESIGN: This was an observational study. SETTING: The study was performed in an academic, comprehensive, multispecialty group practice. PATIENTS: Postlingual deafened patients with cochlear implantation. The cause of deafness was tympanogenic or meningogenic labyrinthitis. INTERVENTION: High-resolution 3D MRI and postoperative speech recognition tests were used. RESULTS: Abnormal findings in the inner ear detected with MRI were found before surgery in 58.3% of the patients with meningogenic labyrinthitis, although the incidence was lower in patients with tympanogenic labyrinthitis. Abnormal MRI findings were frequently observed in the cochlear basal turn and semicircular canals more than in the middle and apical turn in cases with meningogenic etiology. Patients with tympanogenic labyrinthitis suffered less with a vestibular apparatus than did those patients with meningogenic labyrinthitis. Regarding the analysis of the inner ear lesions at the implanted side, the postoperative speech recognition ability did not correlate to the extent of abnormal MRI findings of the implanted ear. CONCLUSION: Improvement in 3D MRI technology provided an accurate preoperative picture of the inner ear apparatus. In cochlear implant patients with infectious labyrinthitis, the extent of the inner ear lesion detected with 3D MRI was different among etiologies of deafness.     

Frequency of cochlear enhancement on magnetic resonance imaging in patients with autoimmune sensorineural hearing loss

OBJECTIVE: To evaluate magnetic resonance imaging (MRI) scans for enhancement of inner ear structures of patients with sensorineural hearing loss and documented antibodies to the 68-kd inner ear antigen. STUDY DESIGN: Retrospective case review with reexamination of MRI scans. SETTING: Outpatient office. PATIENTS: Thirty-five patients with autoimmune sensorineural hearing loss defined by audiograms documenting a sensorineural hearing deficit in one or both ears and the presence of an anti-inner ear antibody (68-kd band) in serum samples who underwent precontrast and postcontrast T1-weighted axial and coronal MRI scans of the inner ear, which were performed concurrently with the hearing loss. INTERVENTIONS: Diagnostic. MAIN OUTCOME MEASURES: Frequency and intensity of cochlear enhancement on MRI scans. RESULTS: One patient demonstrated +2 cochlear enhancement. However, that finding was thought to represent postoperative inflammatory change. CONCLUSION: No correlation was found between the presence of antibodies to inner ear antigen in patients with hearing loss and cochlear enhancement on MRI scans.     

人工耳蜗植入术中发生脑脊液“井喷”病例的影像学分析

目的分析人工耳蜗植入术中发生脑脊液“井喷”的原因及影像学特点。方法回顾性分析1998年1月～2011年7月2238例人工耳蜗植入患者中,发生脑脊液井喷的134例患者术前的影像学特征。结果134例人工耳蜗植入术中发生脑脊液“井喷”的病例中,大前庭导水管合并与内耳有骨性交通11例,大前庭导水管伴Mondini畸形合并内听道与内耳骨性交通28例,Mondini畸形伴内听道底与内耳骨性交通88例,耳蜗与内听道共同腔畸形7例。结论伴有内听道底骨缺损与内耳相通的任何内耳畸形患者,人工耳蜗植入术中必然发生脑脊液“井喷”。     

Lermoyez syndrome. Clinical aspects and follow-up

The clinical data and follow-up of five patients with Lermoyez syndrome are reported. Three of them presented with marked lesions of the cervical spine. Serological antibodies against nuclei and sarcolemma as well as against heart muscle and gastric cells were found. Tests of the sera against guinea pig cochlear tissue showed antinuclear antibodies in one patient and against basilar membrane structures in another. Three sera were negative despite positive heterologous finding. Therapy included infusions active on the inner ear, decompression of the saccus endolymphaticus in two cases and physiotherapy for the cervical spine. These achieved marked improvement or long term relief. The available literature supports the conclusions based on pathophysiological considerations of our results. We cannot postulate an independent immunopathogenesis for Lermoyez Syndrome, but we think that the immunological findings conform with the clinical and experimental data found in the literature.     

小儿蜗神经发育不良

目的报道一组蜗神经发育不良(cochlear nerve deficiency,CND)小儿的临床特征,以提高对本病的认识。方法回顾性分析2007年1月到2008年4月就诊的、内耳MRI及听力学资料完整的20例(37耳)CND小儿(其中男13例,女7例,年龄10个月到4岁)的影像学、听力学表现及人工耳蜗植入效果。结果 85%(17/20)的患儿为双侧发病,15%(3/20)为单侧发病;16.22%(6/37)合并前庭神经发育异常,8.11%(3/37)合并面神经发育异常。根据是否伴有内耳畸形分为三组:32.43%(12/37)伴耳蜗畸形或同时伴有前庭畸形(第一组);13.51%(5/37)仅伴前庭畸形(第二组);54.05%(20/37)独立发病,不伴内耳畸形(第三组)。听力学测试结果:86.49%(32/37)ABR最大输出(100 dB nHL)无反应,13.51%(5/37)在非常高的刺激强度仅有分化不良的波Ⅴ;9耳有行为听阈结果者均为极重度感音神经性聋;第一组12耳DPOAE和CM均未引出,第二组60%(3/5)DPOAE和CM均未引出,40%(2/5)DPOAE和/或CM引出;第三组45%(9/20耳)DPOAE和CM均未引出,55%(11/20耳)DPOAE和/或CM引出。人工耳蜗植入效果:2例术前、术后资料完整者中1例术后开机一年婴幼儿有意义听觉整合量表(infant and toddler meaningful auditory integration scale,IT-MAIS)评估得分与蜗性聋儿相当,另1例无效。结论 CND患儿多无特殊病史,根据是否伴有内耳畸形及内耳畸形的种类,其听力学表现多样,诊断主要依据影像学检查,应注意鉴别诊断,以便制定合理有效的干预措施。     

Evaluation of cochlear nerve imaging in severe congenital sensorineural hearing loss

The route of the cochlear nerve can be imaged using computed tomography (CT) or magnetic resonance imaging (MRI). To gain information about the cochlear nerve, we conducted a trial measuring the width of the cochlear nerve canal (CNC) using CT. When we examined images of the route of the cochlear nerve on MRI, both in ears with congenital sensorineural hearing loss (SNHL) and normal ones, we found that in ears in which the CNC was narrower than 1.5 mm with CT, images of cochlear nerve deficiency could be seen in that ear with MRI.     

Cochlear blood circulation studied with microspheres

The cochlear blood flow was studied with the microsphere method in guinea pigs, rats and cats. Results from experiments using different sizes of microspheres were compared and the effect of middle ear infection or perforation of the otic capsule on the cochlear microcirculation was investigated. Neither the opening of the cochlear bony wall nor the middle ear infection influenced the blood flow in the cochlea. 9- and 15-micrometer spheres were given simultaneously and the results were equivalent, indicating no more shunting of the smaller ones than of the bigger ones. Thus, the smaller spheres are to be preferred, since the smaller ones can be used in a larger number without negative effects on the general circulation. In cats, the cochlear blood circulation was determined before and during cervical sympathetic stimulation. Sympathetic stimulation caused a reduction of 25% of the cochlear blood flow.