糖尿病大鼠耳蜗病变的形态学观察

目的观察糖尿病大鼠耳蜗超微结构变化，了解病变的范围和程度。方法大鼠皮下注射链脲霉素诱发糖尿病，分别于造模后3个月及5个月进行耳蜗基底膜铺片、扫描电镜及透射电镜观察。结果造模3个月后外毛细胞纤毛排列紊乱、倒伏，有融合，外毛细胞和螺旋神经节细胞内细胞器肿胀，线粒体空泡化、嵴断裂，血管纹毛细血管基底膜增厚；5个月后病变进一步加重。内毛细胞在各个时期无明显病变。结论糖尿病可引起大鼠耳蜗外毛细胞、螺旋神经节细胞及神经纤维等的器质性病变，病变以线粒体的损伤最为明显。     

成人不同病因人工耳蜗植入术经验总结及效果观察

目的：总结成人不同致聋病因人工耳蜗植入术前后注意事项,探讨各种病因对术后听力、言语能力康复的影响。方法：接受人工耳蜗植入手术,并开机、复诊的患者30例,共涉及12种致聋病因,使用《Nijmegen人工耳蜗植入量表》,在每例患者佩戴人工耳蜗1年时进行问卷随访,并测试其助听听阈。按病因顺序,汇总每例患者量表中6个侧面问题的平均分,声场测试各频率听阈及平均听阈。结果：所有患者的平均助听听阈均好于35dBHL;28例患者在基本声音感知、高级声音感知及自信心方面平均得分≥75分;26例活动能力平均得分≥75分;22例在社交能力和言语能力方面平均得分≥75分。结论：符合植入手术指征的不同致聋病因成人患者,植入后听觉感知能力都得到大幅提高,手术前后需要对原发病因加以控制;各类致聋原因对患者言语能力康复的影响,取决于耳聋发生时语言中枢的发育状况;各类病因成人患者使用人工耳蜗后能够增强自信心和社会认同感,后天致聋患者表现尤为显著。     

荣昌猪电子耳蜗植入方法建立及听功能初步观察

目的建立在大型哺乳动物-猪体内植入电子耳蜗的方法,观察电子耳蜗植入前后听功能变化。方法荣昌猪6只,雌雄不限,40-45日龄,体重8~12Kg,均选自重庆畜牧科学院养猪研究所。分为听力正常组(Mitf+/+),与突变耳聋组(Mitf-/-),每组3只。在全麻下进行电子耳蜗植入术。于手术前,手术后即刻以及手术后1周记录听性脑干反应(Auditory Brainstem Response,ABR),和电刺激脑干诱发电位(Electrical Auditory Brainstem Response,EABR);头颅X片观察电极植入位置。结果 6只动物电子耳蜗植入手术成功,耳蜗电极位置正确,在耳蜗内盘绕1.5~1.75圈。电子耳蜗植入即刻,手术侧(右耳)各频率ABR阈值在120 dB SPL无法引出;手术后7天,手术侧(右耳),低频ABR阈值在100dB SPL左右,高频在120 dB SPL仍无法引出。听力正常荣昌猪组(Mitf+/+),电子耳蜗植入手术即刻及一周后EABR阈值在90CL左右,明显低于突变耳聋荣昌猪组(Mitf-/-)的190CL。结论本研究建立的荣昌猪电子耳蜗植入方法确实可行,通过植入电极进行EABR测试方法设计合理。为更加直接地研究电子耳蜗植入设备在体内的工作状态和各项数据,研究电极植入后耳蜗的生理病理改变创造了条件。     

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。     

Monitoring of cochlear function during cochlear implantation

OBJECTIVE: To report the feasibility of monitoring cochlear function during cochlear implantation. STUDY DESIGN: Case report. SETTING: Tertiary care referral center. METHODS: A child with audiologic features typical of bilateral auditory neuropathy underwent cochlear implantation. The scala tympani was entered inferior and slightly anterior to the round window membrane margin and smooth electrode insertion was achieved. Using single polarity click stimuli, the cochlear microphonic was measured at several steps during surgery. RESULTS: Cochlear microphonics were present at all stages during the implantation process and were clearly distinguished from neural responses by stimulus polarity inversion and constant latencies, despite changes in stimulus level. With the electrode in situ, amplitudes were smaller but persisted until the final measurement at 10 minutes after insertion. At follow-up 2 weeks after surgery, behavioral audiometry results indicated profound hearing loss in the operated ear. CONCLUSIONS: This paper demonstrates the feasibility of monitoring cochlear function during cochlear implantation. The routine surgical approach did not appear to adversely affect the functional measurements. Standard size, full electrode insertion did diminish the amplitude of the cochlear microphonics, possibly as a result of intracochlear mechanical impairment. Ultimately, profound hearing loss was documented, indicating that factors other than immediate changes induced by electrode insertion were likely responsible for the loss of cochlear function.     

人工耳蜗植入术后改良耳蜗位平片的探讨

目的 探讨改良后耳蜗位平片摄影位的临床应用价值。方法 21例人工耳蜗植入术后患儿(年龄30d～4岁)分别摄许氏提倡的耳蜗位平片摄影位和我们改良后的许氏耳蜗位平片摄影位,用Cohen(c)方法测出蜗管内电极数,将术中得数与2种片所得共3组数据行统计处理t检验。结果 2种平片均能清晰地显示蜗管内电极的位置和形态,2组X片结果与手术结果基本吻合,3组数据比较差异无统计学意义。结论 改良后耳蜗位平片摄影位方法简便,易使4岁以下患儿接受,且能满足了解人工耳蜗植入术后精确状态的需要。     

Intra-operative monitoring of cochlear function during cochlear implantation

The objective of this study was to determine if intra-operative auditory monitoring is feasible during cochlear implantation and whether this can be used as feedback to the surgeon to improve the preservation of residual hearing. This prospective non-randomised study was set in a paediatric tertiary referral hospital. Thirty eight consecutive paediatric patients undergoing cochlear implantation who had measurable auditory thresholds pre-operatively were divided into two cohorts. The unmonitored cohort included the first 22 patients and the monitored cohort included the last 16 patients. The main outcome measure(s) were pre-operative, intra-operative and more than one month post-operative average auditory thresholds at 500, 1000 and 2000 Hz measured using auditory steady-state response audiometry. The average pre-operative thresholds were 103.5 dB HL and 99.7 dB HL in the unmonitored and monitored cohorts, respectively. These were not statistically different (p > 0.3). In the monitored cohort, we measured auditory thresholds to assess cochlear function at multiple time points during the operation. Compared to baseline, thresholds were increased 0.7 dB after drilling the mastoidectomy and well, 0.2 dB after opening the cochlea and 4.6 dB after inserting the electrode array. One month post-operatively, the average thresholds were 114.0 dB HL in the unmonitored cohort but only 98.8 dB HL in the monitored cohort (p < 0.001). Both the use of intra-operative auditory monitoring and higher pre-operative thresholds were associated with improved preservation of residual hearing (p 相似文献   

Contralateral recovery of cochlear function after cochlear implantation

Significant recovery of sensorineural hearing loss in either ear after cochlear implantation (CI) is rare. We present the case of a 57-year-old lady with medically treated depression and a background of chronic suppurative otitis media (CSOM) in the non-implanted ear, who clearly fulfilled audiological criteria for CI. Two years post-implantation her CSOM in the non-implanted ear was addressed with blind sac closure of the ear. Post-operatively the hearing thresholds in this ear had improved to the extent that a bone-anchored hearing aid became a viable option. The literature is carefully reviewed to consider possible explanations of this phenomenon.     

CT三维重建对人工耳蜗植入术后电极位置的观察

目的：探讨建立CT扫描及三维重建技术观察人工耳蜗植入（CI）电极的方法,并比较不同CT扫描三维重建方法的耳蜗内植入电极的影像学特征及其临床应用价值。方法：6例CI患者全部作术后CT扫描并分别应用多层面重建的容积再现（VR）、平均密度投影（AIP）、表面遮盖显示技术（SSD）3种方法进行三维重建,观察人工耳蜗植入术后耳蜗内电极。结果：3种方法的三维重建图均可直观地显示电极形态、走行及其在耳蜗内植入的深度和植入电极与内耳的空间关系,并可清晰识别耳蜗内的电极数目。结论：CT扫描三维重建方法可直接观察植入电极的形态及位置,可准确判断电极在耳蜗内电极数目,有其独特的临床应用价值。     

Facial traumas among females through violent and non-violent mechanisms

IntroductionInjuries stemming from facial trauma have both physical and emotional consequences among affected individuals as well as an economic impact on the healthcare system.ObjectiveThe aim of this retrospective study was to determine the occurrence of facial trauma among females of different age groups treated at an urgent care ward in the northeast of Brazil in a two-year period.Materials and methodsA cross-sectional study was carried out involving 247 charts. Data on patient age, etiological agent and site of trauma were recorded.ResultsAdults accounted for 48.6% of the sample. Falls were the most frequent cause of trauma (38.5%); soft tissue injuries were the most prevalent ones (67.6%); age was significantly associated with the etiology of the injuries; falls were the most common cause among children/adolescents and elderly individuals, and acts of violence were more common among adults.ConclusionAdult females were affected by facial trauma more than the other age groups studied, with a predominance of soft tissue injuries and injuries to the mandible, maxilla, zygomatic arch and nasal bones. Falls were the most prevalent cause of facial trauma and significantly associated with the youngest (children/adolescents) and oldest (elderly individuals) age groups.     

Outcome of cochlear implantation in children with cochlear malformations

European Archives of Oto-Rhino-Laryngology - The objective of the study was the evaluation of outcomes of cochlear implantation (CI) in children with cochlear malformations. A retrospective...     

Implications from cochlear implant insertion for cochlear mechanics

It is usually thought that the displacements of the two inner ear windows induced by sound stimuli lead to pressure differences across the basilar membrane and to a passive mechanical traveling wave progressing along the membrane. However, opening a hole in the sealed inner ear wall in experimental animals is surprisingly not accompanied by auditory threshold elevations. It has also been shown that even in patients undergoing cochlear implantation, elevation of threshold to low-frequency acoustic stimulation is often not seen accompanying the making of a hole in the wall of the cochlea for insertion of the implant. Such threshold elevations would be expected to result from opening the cochlea, reducing cochlear impedance, altering hydrodynamics. These considerations can be taken as additional evidence that it may not be the passive basilar membrane traveling wave which elicits hearing at low sound intensities, but rather factors connected with cochlear fluid pressures and fluid mechanics.     

Effects of stimulation by cochlear implant on the cochlear nerve

Degeneration of the cochlear nerve before and after placement of the cochlear implant might influence the efficacy of the device. We examined histological characteristics, including the caliber of the cochlear nerve fibers of the central segment proximal to the porus acusticus, in three profoundly deaf patients. Two of them used a cochlear implant for many years longer in one ear than in the other, and one used an implant in one ear only. No qualitative or quantitative differences between the two sides were found. However, in all three cases we found that the cochlear nerves on both sides were substantially degenerated. These results indicated no noticeable effects of stimulation by the cochlear implant on the central portion of the cochlear nerve.     

多导人工耳蜗植入术后耳蜗X线显像

目的 探索适合于评价多导人工耳蜗植入手术效果的术后影像学检查技术。方法 多导人工耳蜗植入术69例69耳,其中Nucleus直电极53耳,Nucleus弯电极11耳,Nucleus22导5耳。手术采用耳后面神经隐窝入路。建立放射线耳蜗显像技术,并且所有多导电子耳蜗植入病例术后7-10天均行耳蜗位头颅X-线检查。结果 在69例69耳手术中均成功地植入多导人工耳蜗电极。术后1.0-1.5月进行开机调试,听阈和言语分辨率均达到比较满意的水平。耳蜗位头颅X-平片显示上半规管和前庭易于辨认,可以作为影像学解剖的重要标志。耳蜗X线显像可以直接而且清晰地显示一个完整的人工耳蜗植入术后的电极在耳蜗内的图像,并且每一个电极阵列都可以很清楚地被识别。影像学检查可以作为植入手术结果的客观资料,而且如果电极扭曲或术后移位很容易发现。对于内耳畸形人工耳蜗植入术后,耳蜗位X-线检查则更现必要,是判断手术结果的重要依据。结论感音神经性耳聋患者植入多导人工耳蜗效果良好。头颅X-线耳蜗显像可以应用于对多导人工耳蜗植入术后结果的评价,而且简单、低放射量、快速和经济,值得广泛推广。     

Multichannel cochlear implantation in children with cochlear ossification.

OBJECTIVE: To compare results of post-meningitic children who had cochlear implantation with partial or complete drill-out to those who had no drill-out. STUDY DESIGN: This study is a retrospective case review. SETTING: The Atlanta Cochlear Implant Group is a private, tertiary, outpatient clinic. PATIENTS: Eligibility included all our post-meningitic patients, 2-17 years, having a cochlear implant between June 1990 and July 1997. INTERVENTIONS: All subjects had a Nucleus 22 cochlear implant surgically implanted, speech processor programming and follow-up testing in our center, and aural rehabilitation in a variety of therapy settings. MAIN OUTCOME MEASURE: Open and closed set speech discrimination tests. RESULTS: Test performance for speech understanding was highest in the non-ossified group and lowest, but above chance, in the ossified group with complete drill-out. CONCLUSIONS: While children with non-ossified cochleas performed best, even children with extensive ossification requiring complete drill-out benefited from cochlear implantation.