人工耳蜗不同电极植入术后听觉康复效果比较

目的通过对澳大利亚Nucleus（直电极和弯电极）、奥地利Medel和美国Advanced Bionics人工耳蜗不同电极植入者开机后的调试情况，以及听觉和言语康复效果进行观察比较，探讨不同植入电极患者术后效果是否存在差异。方法我科自1997年3月至2007年6月共植入人工耳蜗313例，选择其中植入年龄、植入时间、术前残余听力、术后康复条件等各方面条件相近的语前聋人工耳蜗植入者70例，将其按植入产品的不同分为4组，包括澳大利亚Nucleus直电极组22人，澳大利亚Nucleus弯电极组25人，奥地利Medel C40＋组12人和美国AB公司90K组11人。比较4组人工耳蜗植入患者开机半年后的阈值（T-levels）．最大舒适强度（C-levels／M-levels）和动态范围（dynamic range）有无差异，并根据听觉行为分级标准（categories of auditory performance，CAP）和言语可懂度分级标准（speech intelligibility rating，SIR）对4组人工耳蜗植入者进行评估，用统计学方法分析不同电极人工耳蜗植入者听觉水平和言语可懂度康复效果是否存在统计学差异。结果经单因素方差分析，4组耳蜗植入者CAP分级和SIR分级得分的差异无统计学意义（P〉0．05）。调试时澳大利亚弯电极组和直电极组的T-levels、C-levels和动态范围大小无统计学差异（P〉0．05）；奥地利C40＋组与其它三组相比，最大舒适强度和动态范围更大；美国90K组阈值最低，所需刺激量最小。结论人工耳蜗不同电极植入术后均能产生良好效果，其阈值，最大舒适强度和动态范围有差别，但不同植入电极术后的听觉水平和言语可懂度等康复效果无明显差异。     

直电极与弯电极序列人工耳蜗植入深度的比较

目的测量比较Nucleus CI 24M直电极序列和CI24 Contour弯电极序列两种型号植入体的电极植入深度。方法对41例CI 24M和8例CI 24 Contour植入者,术后拍摄耳蜗位X线平片。应用图像处理技术,比照耳蜗螺旋模板,建立电极序列的极坐标图形,测量第22号电极与耳蜗开窗处的极坐标角度,两者之差代表了电极序列的植入深度。以t检验比较两种型号植入体的植入深度状况。结果 无内耳畸形、手术条件相当的情况下,CI 24 Contour植入体的平均插入角度为413°,CI 24M植入体的平均插入角度为316°,P=0.0001。结论CI 24 Contour植入体的植入深度明显深于CI 24M。前者更有利于医师进行植入。     

直电极与弯电极人工耳蜗植入患者神经兴奋分布空间的比较

目的 比较Nucleus 24M型直电极与Nucleus 24Contour型弯电极人工耳蜗植入患者的神经兴奋分布空间的宽度,评估电极类型和电极位置对于电极问刺激干扰程度的影响.方法 18名人工耳蜗植入患儿分为两组,其中24M和24Contour植入患者各9名,年龄1.3～7.9岁.按照病因、病程、植入年龄、电极植入角度4个因素将两组患者进行配对.使用NRT3.1测试软件分别对每名患者的5、10、15三个电极进行听神经电诱发复合动作电位(electrically evoked compound action potential,ECAP)测试.测试时,探测脉冲固定加在测试电极,掩蔽脉冲按顺序分别加到1至22号电极,得出一系列的ECAP波形,将ECAP波形幅度从最高降到70.7%所覆盖的电极范围定义为神经兴奋分布空间的宽度.分析电极类型、电极位置这两个因素对神经兴奋分布空间宽度的影响.结果 电极类型、电极位置对神经兴奋分布空间宽度有显著影响.弯电极的兴奋空间分布宽度在5、10、15号三个电极位置均显著窄于直电极组.5、10号电极的兴奋空间窄于15号电极,但5号和10号电极之间无统计学差异.结论 在耳蜗的底部和中部,Nucleus24 Contour弯电极的电极间刺激干扰小于直电极,有助于提高患者中、高频的电极分辨能力.     

多导人工耳蜗植入后电极阻抗的初步研究

目的研究多导人工耳蜗植入后电极阻抗变化的特点,对比直电极和弯电极的阻抗差异,为人工耳蜗植入术后的调试提供参考。方法在Nucleus多导人工耳蜗编程调试界面上,应用R126V1.3和NRTV3.0软件,测试11例语前聋儿童在不同时期的阻抗值,并进行分析比较。结果CI24M和CI24Rcontour两种植入体阻抗随时间变化的基本规律是:术中较低,开机时最高,以后随时间推移逐渐降低。CI24Rcontour阻抗高于CI24M。结论人工耳蜗植入体阻抗开机后随时间推移而逐渐降低,新型CI24Rcontour植入体与CI24M相比,其阻抗值在术中至开机后3周内明显要高。     

人工耳蜗植入电极插入技巧对蜗内电极位置的影响

目的　观察不同手术技巧对多导人工耳蜗植入术后蜗内电极位置的影响。方法　采用澳大利亚Nu cleus 2 4M (直电极 )、Nucleus 2 4Contour(弯电极 )以及不同的手术技巧 ,术后以改良斯氏位X线拍片 ,测量、比较蜗内电极插入的深度。结果　 59例人工耳蜗植入病例中 ,3 2例Nucleus 2 4M型人工耳蜗常规手术的电极X片显示电极在平面图上的深度为 2 68°～ 3 53° ,平均 2 78.6° ;15例Nucleus 2 4M型人工耳蜗采用改进的电极插入方法 ,术后耳蜗电极X片在平面上显示弯成 3 60°～ 445° ,平均深度 3 91.7° ;12例Nucleus 2 4Contour型人工耳蜗植入采用标准术式 ,术后蜗内电极X片在平面上显示电极弯成 3 80～ 455° ,平均 42 3°。结论　澳大利亚Nucleus 2 4M型人工耳蜗通过改良的手术技巧可使电极插入的深度更大 ,部分病例可与弯电极相似 ,Nucleus 2 4Contour型人工耳蜗的电极则更靠近蜗轴     

Nucleus 24人工耳蜗系统直电极与弯电极神经反应遥测值的比较

目的:测试和比较Nucleus 24人工耳蜗系统中直电极与弯电极神经反应遥测(NRT)值的差别,分析内耳螺旋神经节细胞对不同电极电刺激反应特性的差异。方法:对46例进行耳蜗植入和编程的Nucleus 24人工耳蜗系统直电极与弯电极患者进行配对分析,计算患者vNRT值的均值,并进行统计学比较。结果:直电极的NRT值为160～170μV,弯电极为150～160μV,总的趋势是低频值较低而高频值较高。结论:Nucleus 24人工耳蜗系统弯电极较直电极所需电刺激量略低。     

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。     

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。     

Nucleus 24CA型人工耳蜗植入后电极阻抗及T/C值变化分析

目的观察Nucleus 24CA型人工耳蜗植入后电极阻抗、行为反应阈值(T-level,T级)及最大舒适级(C-level,C级)的变化规律,分析其内在联系,探讨其对术后调机的指导意义。方法对81例植入Nucleus 24CA型人工耳蜗患儿,分别在术中、术后1、2、6个月进行电极阻抗阈值测试,收集术后对应T、C值,并对其变化规律及相关性进行统计学分析。结果电极阻抗值术中检测最低,术后1月开机最高,此后逐渐减低(P<0.01);自蜗顶至蜗底各通道间电极阻抗值无显著差异(P>0.05)。各电极通道T值、C值随术后时间延长逐渐增高(P<0.05),并与电极阻抗值呈线性相关。结论测定电极阻抗值是评估人工耳蜗刺激电极状态的有效手段;术后2月应同时调试T值及C值,此后则应对C值进行重点调试。     

Nucleus 24 Contour在极重度聋患者中的临床应用

目的探讨Nucleus24Contour在极重度聋患者中的手术置入方法及其术后产生电听觉所需的电流量。方法对使用Nucleus24Contour组及Nucleus24M组患者的手术方法及术后产生电听觉所需要电流量进行比较。结果82例患者中,只有1例患者置入电极28环,其余81例患者32环电极全部置入。31例患者于耳蜗开窗时有少量淋巴液流出,2例耳蜗骨化者耳蜗开窗时未见淋巴液。术后7例患者出现较轻微的并发症。使用Nucleus24Contour组术中测得神经反应测试阈值明显减低,且在第一通道有统计学意义(P<0.05)。结论Nucleus24Contour手术置入容易,创伤小,耗电量少,是极重度感音神经性聋患者新型的、安全有效的置入物。     

Intra- and postoperative electrode impedance of the straight and Contour arrays of the Nucleus 24 cochlear implant: relation to T and C levels

The objective of this study was to investigate electrode impedance in cochlear implant recipients in relation to electrically evoked stapedius reflex measurements during surgery, and to electrode design, stimulation mode, and T and C levels over a nine month period after surgery. Seventy-five implant recipients, implanted with a Nucleus straight electrode array or a Contour array, were included. The results show that: (1) during surgery electrode impedance decreases markedly after electrically evoked stapedius reflex measurements, (2) after surgery, during the period without stimulation until speech processor switch-on, impedance increases, (3) after processor switch-on impedance decreases. The lower impedance values after a period of stimulation are found at the higher T and C levels. Impedances of the straight array electrodes are lower than those of the Contour array. The difference corresponds mainly to their respective surface areas. In addition, the straight array shows a larger increase of impedance in the apical direction than the Contour array, probably because of the larger fluid environment around the basal electrodes of the straight array.     

Comparison of speech perception performance between the Nucleus 24 and Nucleus 24 Contour cochlear implant systems

OBJECTIVE: To compare the 1-, 3-, and 6-month postoperative speech perception scores obtained by a group of subjects who received the new perimodiolar array (Nucleus Contour) cochlear implant with those obtained by a group of subjects implanted with the straight electrodes of the previous-generation Nucleus 24 device. MATERIAL AND METHODS: The speech performance of 10 postlingually deafened adults implanted with the Nucleus Contour device was compared with that of matched controls who received the Nucleus 24 model. Objective measures included word and sentence speech recognition scores. RESULTS: Patients implanted with the Nucleus Contour device obtained significantly higher word and sentence recognition scores after short-term use of the implant compared to those obtained by patients implanted with the Nucleus 24 model. CONCLUSION: Further long-term studies are required to determine whether the Nucleus Contour CI recipients continue to improve over time.     

ECAP, ESR and subjective levels for two different nucleus 24 electrode arrays.

OBJECTIVE: We compared behavioral judgment of maximum comfortable loudness levels (C levels) and behavioral thresholds (Ts) for straight and Contour electrode arrays with two objective thresholds, electrically elicited stapedial reflex thresholds (eSRTs) and electrically elicited compound action potential thresholds (eCAP thresholds), on experienced adult cochlear implant users. Next, we evaluated the predictive value of objective measures for the straight and Contour electrode arrays, respectively. STUDY DESIGN: This is a prospective, two-group comparison study of two objective and subjective levels for two different Nucleus 24 electrode arrays. PATIENTS: Thirty experienced adults with Nucleus 24 cochlear implant were subjects in this study. Half the subjects used the straight electrode array, and the other half used the Contour electrode array. METHODS: Subjective C levels, Ts, and eSRTs were successfully identified for each active electrode. eCAP thresholds were measured on 5 representative basal, medial, and apical electrodes. Correlation and regression analyses between subjective levels and objective thresholds were performed. RESULTS: For our study subjects, there were no significant differences between the straight and Contour electrode array in regard to stimulation requirements between C levels, Ts, and thresholds of eCAP thresholds and eSRTs. CONCLUSION: Both eSRTs and eCAP thresholds may be used equally for estimation of subjective levels for either straight electrode array or Contour electrode array.     

Psychophysical measures in patients fitted with Contour and straight Nucleus electrode arrays

The objective of this study was to compare the psychophysical performance of patients using the Nucleus Contour electrode array with that of patients using the straight banded-electrode array. In particular, we wished to consider how psychophysical parameters would differ for an electrode array positioned closer to the modiolus, and how this might influence both patient benefits and the design of speech processing strategies. Nine subjects participated in the study: four used the Nucleus straight array and five used the Nucleus Contour electrode array. Radiographic analyses found that the Contour array lay closer to the modiolus, was more deeply inserted and spanned a larger fractional length of the basilar membrane than the straight banded-electrode array. The results were analysed in terms of array type and of the position of the individual electrode band, both distance from the modiolus and longitudinal placement. Mean threshold was lower for the Contour array but maximum comfortable level was similar. Whereas threshold varied significantly with distance of electrode band from the modiolus, maximum comfortable level did not. Pitch varied fairly regularly with longitudinal position of the stimulated electrode, with the exception of one Contour subject. The forward masking profiles, using moderately loud maskers, were narrower for the Contour array, indicative of more localized neural excitation.     

Nucleus24型人工耳蜗使用者电诱发听神经复合动作电位的测定

目的 :探讨电诱发听神经复合动作电位 (ECAP)的特点及在人工耳蜗临床中的应用价值和意义。方法 :应用NRT(neuralresponsetelemetry)软件 ,通过体外言语处理器和耳蜗内的植入电极系统 ,采用单极模式电极刺激和近场记录方法 ,对 37例NucleusCI2 4M装置使用者进行ECAP的记录。对其中 12例使用者做了行为测试。结果 :87.6 %的使用者记录到ECAP波形。分析了有行为阈值的 12例测试者的ECAP阈值和行为阈值的关系 ,二者之间存在显著的相关性。结论 :ECAP的检出率高且波形稳定可靠 ,在临床人工耳蜗装置的调试中可作为对行为测试的补充 ;对于年幼儿童和首次开机的患者的调试尤其重要     

Comparison of electrically evoked whole-nerve action potential and electrically evoked auditory brainstem response thresholds in nucleus CI24R cochlear implant recipients

In this study, differences between electrically evoked whole-nerve action potential (EAP) and electrically evoked auditory brainstem response (EABR) measurements within Nucleus CI24R cochlear implant recipients were evaluated. Precurved modiolus-hugging internal electrode arrays, such as the CI24R, are designed to provide more direct stimulation of neural elements of the modiolus. If the electrode array is closer to the modiolus, electrically evoked and behavioral levels might be lower than were previously recorded for the straight electrode array, the CI24M. EAP and EABR growth functions and behavioral levels were obtained for 10 postlingually deafened adults. Results revealed no significant differences between EAP and EABR threshold levels, and these levels were not significantly lower than those obtained using the CI24M.     

Intra- and postoperative electrode impedance of the straight and Contour arrays of the Nucleus 24 cochlear implant: Relation to T and C levels

The objective of this study was to investigate electrode impedance in cochlear implant recipients in relation to electrically evoked stapedius reflex measurements during surgery, and to electrode design, stimulation mode, and T and C levels over a nine month period after surgery. Seventy-five implant recipients, implanted with a Nucleus straight electrode array or a Contour array, were included. The results show that: (1) during surgery electrode impedance decreases markedly after electrically evoked stapedius reflex measurements, (2) after surgery, during the period without stimulation until speech processor switch-on, impedance increases, (3) after processor switch-on impedance decreases. The lower impedance values after a period of stimulation are found at the higher T and C levels. Impedances of the straight array electrodes are lower than those of the Contour array. The difference corresponds mainly to their respective surface areas. In addition, the straight array shows a larger increase of impedance in the apical direction than the Contour array, probably because of the larger fluid environment around the basal electrodes of the straight array.

Sumario

El objetivo de este estudio fue investigar la impedancia de los electrodos en implantados cocleares en relación con medidas de reflejo estapedial evocado eléctricamente durante la cirugía, con el diseño del electrodo, el modo de estimulación, y los niveles T y C durante los 9 meses siguientes a la cirugía. Se incluyeron setenta y cinco sujetos implantados con un electrodo Nucleus recto o con uno Contour. Los resultados muestran que, 1) la impedancia de los electrodos disminuye marcadamente después de las mediciones del reflejo estapedial evocado eléctricamente, durante la cirugía, 2) la impedancia aumenta después de la cirugía, durante el período sin estimulación y hasta la activación de procesador de lenguaje, 3) después de la activación del procesador la impedancia disminuye. Se encontró que los menores valores de impedancia después de un periodo de estimulación se encuentran en los niveles T y C más altos. Las impedancias de los electrodos rectos son más bajas que aquellas del Contour. La diferencia corresponde a sus respectivas áreas de superficie. Además, los electrodos rectos muestran un incremento mayor de la impendacia en la dirección apical que los electrodos Contour, probablemente debida al ambiente con más líquido alrededor de los electrodos basales de los electrodos rectos.     

Comparison of speech perception performance between the nucleus 24 and nucleus 24 contour cochlear implant systems

Objective—To compare the 1-, 3-, and 6-month postoperative speech perception scores obtained by a group of subjects who received the new perimodiolar array (Nucleus Contour) cochlear implant with those obtained by a group of subjects implanted with the straight electrodes of the previous-generation Nucleus 24 device.

Material and Methods—The speech performance of 10 postlingually deafened adults implanted with the Nucleus Contour device was compared with that of matched controls who received the Nucleus 24 model. Objective measures included word and sentence speech recognition scores.

Results—Patients implanted with the Nucleus Contour device obtained significantly higher word and sentence recognition scores after short-term use of the implant compared to those obtained by patients implanted with the Nucleus 24 model.

Conclusion—Further long-term studies are required to determine whether the Nucleus Contour CI recipients continue to improve over time.     

The Nucleus Contour electrode array: a radiological and histological study

OBJECTIVES: To evaluate the handling and insertion trauma of the recently developed Nucleus perimodiolar Contour electrode array (Cochlear Ltd., Pty, Lane Cove, New South Wales, Australia) in human temporal bones compared with the Nucleus standard straight electrode array. STUDY DESIGN: E-perimental control group. METHODS: Twenty-nine fresh-frozen bones were implanted with different electrode arrays by an experienced cochlear implant surgeon, and evaluated both radiologically and histologically. RESULTS: Intracochlear insertion of the standard Nucleus straight electrode array was found to be atraumatic, confirming previous findings in the literature. Insertion of the Nucleus Contour electrode array resulted in instances of localized basilar membrane penetration causing the electrode array to move from the scala tympani into the scala vestibuli. However, this trauma did not result in any observable damage to the osseous spiral lamina or the modiolus. Basilar membrane penetration was observed in six of eight cochlear bones when a standard cochleostomy size (approximately 0.8 mm) and site (anterior and superior to the round window) were used. However, when the surgical technique was modified to use a slightly larger cochleostomy ( approximately 1.8 mm) situated closer to the round window and employ a partial stylet withdrawal technique during electrode insertion, the frequency of penetrations was restricted to two of seven bones. This trauma rate is comparable to that observed with other cochlear implants designs. CONCLUSIONS: Following our results, the design of the Nucleus Contour electrode appears to fulfill the safety requirements for an intracochlear electrode array, provided that the surgical insertion technique is modified in the manner outlined.