人工耳蜗植入对成人语后聋患者植入侧耳鸣的影响

目的 探究成人语后聋患者人工耳蜗植入术后植入侧耳鸣的变化,并分析其影响因素。方法 2017年1月～2021年12月于郑州大学第一附属医院耳科进行单侧人工耳蜗植入的47例成人语后聋伴耳鸣患者,分别于术前和术后开机6个月进行耳鸣问卷评估,评估材料为耳鸣障碍量表(tinnitus handicap inventory, THI)和视觉模拟量表(visual analogue scale, VAS),比较人工耳蜗植入术后患者耳鸣的变化,并分析其可能的影响因素。结果 47例患者人工耳蜗植入术前、术后开机6个月时THI评分别为36.94±13.337、14.48±12.726分,VAS评分分别为5.13±1.676、2.34±1.903分,术后评分均较术前降低,差异均有统计学意义(P<0.05);其中18例患者耳鸣完全消失,13例患者耳鸣减轻,14例患者耳鸣无变化,2例患者耳鸣加重,总体耳鸣有效率为66.0%(31/47);术前耳鸣病程与耳鸣严重程度对术后耳鸣预后有影响(P<0.05),术前耳鸣病程≤5年、中度及以上耳鸣组耳鸣有效率分别高于耳鸣病程>5年(P<0.05)、轻...     

人工耳蜗植入对成人语后聋患者耳鸣的影响

目的 探讨人工耳蜗植入（CI）对成人语后聋患者耳鸣的影响。方法 回顾性分析88例于我院行人工耳蜗植入的语后聋患者资料,筛选术前有耳鸣的患者分别于术前、术后0.5、1及6个月行耳鸣残疾量表（tinnitus handicap inventory,THI）和视觉模拟评分法（visval analogue scale,VAS）评价患者耳鸣及转归情况。结果 80.7%(71/88)的成人语后聋患者术前伴有耳鸣症状,不同性别患者耳鸣严重程度无差异;THI评分在术后6个月时降低最明显,耳鸣严重程度从术前的重度（38.48±23.95）降至中度（20.59±18.38）,响度也较术前明显减小。青年组患者术后耳鸣改善情况较中年组及老年组更好。使用声音处理器时耳鸣响度明显减小。结论 人工耳蜗植入术可有效改善语后聋成人患者的耳鸣症状,术后耳鸣症状可随时间推移逐渐缓解。青年患者耳鸣症状在术后得到改善的效果更好,所需时间更短。人工耳蜗开机后,声音处理器的使用对耳鸣的抑制有显著而长期的作用。     

人工耳蜗植入对耳鸣影响的问卷调查研究

目的通过问卷调查研究人工耳蜗植入对耳鸣的影响。方法随机调查人工耳蜗植入成年患者人工耳蜗植入术前是否伴有耳鸣以及术后耳鸣改变情况,通过联合应用"视觉模拟评分法(visual analog scale,VAS)"和"耳鸣致残量表(tinnitus handicap inventory,THI)中文版"对耳鸣进行评估。VAS用于评估耳鸣响度,双耳分别打分;THI用于量化耳鸣对日常生活的影响。要求受试者对术前和术后的耳鸣情况分别打分。结果随机调查人工耳蜗植入成人52例,术前伴有耳鸣30例(57.7%)。单侧人工耳蜗植入术后,自觉耳鸣减轻或消失者25例(83.3%),其中,植入耳同侧耳鸣消失5例,这5例患者中2例患者对侧的耳鸣也消失了,即双侧耳鸣均消失;自觉耳鸣较术前无明显变化3例(10.0%);自觉耳鸣加重2例(6.7%)。VAS耳鸣响度得分:耳蜗植入侧术前得分6.5±2.4,术后得分2.8±2.3(t=6.287,P<0.01);术前对侧得分6.2±1.8,术后对侧得分3.3±2.2(t=4.763,P<0.05)。THI得分:术前得分51.9±27.7,术后得分25.3±25.8(t=4.759,P<0.01)。结论耳鸣在人工耳蜗植入候选人群中具有较高的发生率。人工耳蜗植入术后能够显著缓解耳鸣响度,减少耳鸣对患者日常生活的影响。     

人工耳蜗植入对前庭功能影响的研究进展

人工耳蜗植入术(Cochlear implant,CI)已开展三十余年,是重度、极重度感音神经性耳聋患者重获听力的重要治疗手段。CI术后儿童中前庭症状鲜有发生,而成年人CI术后出现前庭功能症状较常见,特别是老年人风险更高。绝大多数CI术后前庭功能受损的患者在经康复训练后前庭功能得到了补偿,表明术后出现的前庭症状是可恢复的。CI术后前庭功能变化的原因和影响因素众多,涉及了个体、手术、检查方法、术后康复等多个方面。结合CI术前、术后评估及术后处理对策对术后前庭功能的保留提供了参考。     

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。     

人工耳蜗电极植入耳蜗入口的定位

目的 :确定人工耳蜗电极植入耳蜗入口的位置。方法 :对 2 5具尸头 50耳标本进行人工耳蜗植入手术有关的解剖数据测量。结果 :人工耳蜗电极植入耳蜗鼓阶入口与前庭窗最近距离为 2 .77mm。结论 :该解剖参数为蜗窗难以找到的人工耳蜗植入病例提供了定位参考     

人工耳蜗再植入原因分析

随着医学科技的高速发展,目前人工耳蜗植入(Cochlear Implant, CI)已经成为治疗重度极重度感音神经性耳聋最直接有效的治疗方式。虽然CI技术日益成熟,人工耳蜗装置质量也在不断提升,但是依然存在部分患者因各种原因需要行人工耳蜗再植入。本文就近年来国内外人工耳蜗再植入原因分析最新进展予以综述。     

人工耳蜗植入经耳蜗造孔注射药物对NRT阈值的影响

目的探讨人工耳蜗植入术中鼓阶内注射药物对NRT阈值的影响。方法收集2015年6月到2016年1月在我院进行Cochlear公司CI512及CI24RE两款弯电极的人工耳蜗植入临床资料,73例双耳极重度感音神经性聋患儿(总共75术耳,其中2例同期双耳手术,平均年龄4岁2个月)分为3组,地塞米松组:耳蜗造孔后于鼓阶内注入地塞米松1ml;透明质酸组:耳蜗造孔后于鼓阶内注入透明质酸1ml;未注药物组:耳蜗造孔后鼓阶内未注射任何药物。收集术中NRT监测数据及术后2周开机NRT阈值数据,5个电极(第1,6,11,16,22电极)的阈值进行分析。以单因素方差分析(ANOVA)分析三组NRT反应电极数及阈值变化;t检验及Wilcoxon符号等级检定来检验各组术中及开机时反应电极阈值变化;以卡方检定分别检验三组间低、高频电极无反应的电极个数比率差异。结果三组间在术中可监测出NRT电极个数(P=0.64)及术后开机NRT有反应的电极个数(P=0.85)差异无统计学意义。术中监测的N、DXM、HA等三组NRT平均阈值(P=0.13)及术后开机NRT平均阈值(P=0.77)的差异无统计学意义。但在高频段电极的术中监测时,DXM组的反应阈值显著低于HA组。各组在术后开机测得的NRT阈值比较术中监测的阈值明显下降,差异有统计学意义(P<0.01)。所有低频电极的反应阈值均较高频电极的阈值为低,差异有统计学意义(P<0.01)。结论人工耳蜗植入术中于鼓阶注入地塞米松或透明质酸并不影响NRT检测时有反应的电极数量;但在高频电极中,鼓阶注入地塞米松可于术中降低NRT反应阈值。     

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。     

人工耳蜗植入对耳鸣的疗效及影响因素分析北大核心CSCD

人工耳蜗植入(CI)是治疗重度或者极重度感音神经性聋患者唯一的办法,CI在提高这类患者听力的同时,对耳鸣也有积极疗效,一系列研究均证实了这个发现,本文试对该研究领域的文献进行总结,并对其耳鸣治疗原理、疗效及影响因素进行分析归纳,以期更好指导临床工作。     

Interaction of tinnitus suppression and hearing ability after cochlear implantation

Objectives: To study the postoperative impact of cochlear implants (CIs) on tinnitus, as well as the impact of tinnitus on speech recognition with CI switched on.

Methods: Fifty-two postlingual deafened CI recipients (21 males and 31 females) were assessed using an established Tinnitus Characteristics Questionnaire and Tinnitus Handicap Inventory (THI) before and after cochlear implantation. The tinnitus loudness was investigated when CI was switched on and off in CI recipients with persistent tinnitus. The relation between tinnitus loudness and recipients’ satisfaction of cochlear implantation was analyzed by the visual analogue scale (VAS) score.

Results: With CI ‘OFF’, 42?CI recipients experienced tinnitus postimplant ipsilaterally and 44 contralaterally. Tinnitus was totally suppressed ipsilateral to the CI with CI ‘ON’ in 42.9%, partially suppressed in 42.9%, unchanged in 11.9% and aggravated in 2.4%. Tinnitus was totally suppressed contralaterally with CI ‘ON’ in 31.8% of CI recipients, partially suppressed in 47.7%, unchanged in 20.5%. Pearson correlation analysis showed that tinnitus loudness and the results of cochlear implant patients satisfaction was negatively correlated (r?=?.674, p?Conclusion: The study suggests six-month CI activation can be effective for suppressing tinnitus. The tinnitus loudness may affect patients’ satisfaction with the use of CI.     

Tinnitus after cochlear implantation

Objective

The purpose of this study was to investigate properties of tinnitus which starts after cochlear implantation. Of the 17 adult patients in our cochlear implant group, four (23.5%) who had no pre-implantation tinnitus were eligible for the study.

Methods

Each patient was requested to complete a short questionnaire regarding his or her experience with tinnitus. Tinnitus match test was performed for each patient by using an Interacoustic Clinical Audiometer (model AC40; Assens, Denmark).

Results

Tinnitus match test revealed a tinnitus frequency of a 4 KHz for three and of a 6 KHz for one patient. Mean value of the loudness score was calculated as 17.5 dB SL.

Conclusions

The results of this study emphasize the importance of counseling patients regarding risks of tinnitus after cochlear implantation.     

Investigation of the effect of cochlear implantation on tinnitus,and its associated factors

Abstract

Background: Many studies have focused on the suppressive effects of cochlear implants (CIs) on loudness of tinnitus.

Aims/objective: This study aimed to examine the effects of CIs and their activation on changes in loudness and tinnitus and explore other factors associated with this effect.

Material and methods: We recruited 26?CI recipients according to specific criteria. Participants asked to complete tinnitus questionnaires, while the CI was kept on and at 30?min after the CI was turned off. Tinnitus improvement after CI was tested using Wilcoxon signed rank tests, and correlation was tested using Spearman’s rank correlation coefficients and multiple linear regression.

Results: After CI, tinnitus reduced from 62% to 46%. Total and partial reduction in tinnitus was seen in 76% subjects with pre-CI tinnitus. However, 6% of the subjects had tinnitus since birth, and none showed worsening tinnitus. The average THI score while the CI on was significantly lower than that CI off.

Conclusions: Post-CI tinnitus improvement was seen in 76% of those with pre-CI tinnitus; however, the low risk of new or aggravating tinnitus should be considered, and reasonable expectations for tinnitus reduction should be built into the pre-CI assessment.     

Cochlear implantation for single-sided deafness and tinnitus suppression

Objective

To quantify the potential effectiveness of cochlear implantation for tinnitus suppression in patients with single-sided deafness using the Tinnitus Handicap Inventory.

Tinnitus and cochlear implantation

Tinnitus is a common experience, but there is very marked heterogeneity of aetiology, perception and the extent of distress among individuals who experience tinnitus. In view of this, a modern approach to tinnitus should consider homogeneous groups of individuals. This review considers tinnitus experiences in patients undergoing cochlear implantation, this being of interest because the prevalence of tinnitus in this patient group prior to surgery may shed some light on the link between cochlear dysfunction and tinnitus. Second, any change in tinnitus experience as a result of electrode placement surgery or cochlear implant activation has relevance for patient counselling and informed consent. Finally, in recent tinnitus retraining therapy literature there has been the suggestion that unilateral sound therapy for tinnitus patients may set up an unhelpful asymmetry of input to the auditory system, with possible exacerbation of contralateral tinnitus. Unilateral cochlear implant use represents the most dramatic asymmetry possible and hence is a test of that hypothesis. Relevant papers (n = 32) were identified from literature databases. The standard of reporting tinnitus results was inconsistent. Tinnitus is experienced by up to 86% of adult cochlear implant candidates, but is not universal and is only troublesome in a small proportion (reported as 27% in one study). Electrode insertion may induce tinnitus in a small (up to 4%) number of patients, but this is rare. Cochlear implant device use is associated with reduction of tinnitus intensity and awareness in up to 86% of patients, and rarely with exacerbation (up to 9%). There are some indications in the literature that the more complex the simulation strategy, the larger that effect. Specifically, unilateral cochlear implant use was generally associated with reduction of contralateral tinnitus (in up to 67% of individuals) rather than exacerbation, and so the assertion that unilateral sound therapy for tinnitus is contraindicated is not proven.     

Tinnitus modifications after cochlear implantation

Tinnitus can be defined as a phantom sensation in the absence of an external sound. In our study, we evaluated the effect of cochlear implant on tinnitus evolution. Among adult, postlingually deaf patients who underwent cochlear implantation at our clinic, we selected 20 subjects with pre-implantation tinnitus (group A) and 10 subjects without pre-implantation tinnitus (group B). Pre- and post-surgery tinnitus was assessed through two questionnaires: the first one dealing with tinnitus characteristics and psychosocial impact, and the second one represented by THI, an internationally validated score of evaluation of the effects of tinnitus on patient’s emotions and activities of daily living. None of the patients belonging to group B developed tinnitus after surgery. As for group A, 40% of patients declared suppression of tinnitus, 30% attenuation of tinnitus after surgery, 25% reported tinnitus was unchanged and 5% reported worsening of tinnitus. In the nine patients with bilateral tinnitus (45%), after implantation tinnitus disappeared from both sides in four patients and attenuated bilaterally in four patients. A comparison between pre- and post-implantation THI scores showed decreased score in 65% of cases, unchanged score in 30% and increased score in 5%. The beneficial effect of cochlear implant on tinnitus, reported by a majority of patients, could be due to acoustic masking, to direct electrical stimulation of the acoustic nerve, and above all to a possible cochlear implantation dependent reorganization of the central auditory pathways and associative cerebral areas. In the light of these results, the authors propose (1) to include tinnitus in the selection criteria of which ear to implant; (2) to consider implantation eligibility for patients with bilateral severe hearing loss associated with severe tinnitus; and (3) to inform patients about the small risk of post-operative tinnitus worsening.     

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。