人工耳蜗植入临床适应证的进展

人工耳蜗是20世纪最伟大的科技成果之一。近10年来,人们对听觉病理、生理认知的不断深入,以及人工耳蜗软硬件技术的不断发展,使得人工耳蜗植入手术对内耳组织结构的保护以及声音精细结构的重建水平得到显著提高。人工耳蜗植入临床适应证已有明显拓展,体现在人工耳蜗植入低龄化、双侧人工耳蜗植入、残余听力保护及内耳畸形人工耳蜗植入等方面。未来更为先进的言语编码策略、植入电极设计及全植入式人工耳蜗的问世,将为更多的人群带来更完美的听觉解决方案。     

前庭水管扩大行人工耳蜗植入言语康复效果分析

目的:探讨使用听觉和言语问卷分级评估比较前庭水管扩大伴耳蜗畸形与前庭水管扩大不伴耳蜗畸形耳聋患儿人工耳蜗植入术后的听觉言语康复效果.方法:按术前影像学检查将前庭水管扩大人工耳蜗植入患儿分为耳蜗正常组和耳蜗畸形组,并配对组合,应用问卷式听觉行为分级标准和言语识别率分级标准分别评估人工耳蜗植入患者术后的言语感知及言语产生能力,并对两组患者的耳蜗圈数与康复效果之间的相关性进行统计学分析.结果:经统计学分析,前庭水管扩大伴耳蜗畸形与前庭水管扩大伴耳蜗正常组行人工耳蜗植入术后听觉言语无显著性差异.结论:前庭水管扩大伴耳蜗畸形患者人工耳蜗植入术后,听力言语康复效果与耳蜗解剖结构正常植入者相同;人工耳蜗植入术可帮助前庭水管扩大伴耳蜗畸形的重度耳聋患者重建听力;听觉行为分级标准和言语识别率分级标准是评估人工耳蜗术后听觉言语能力的客观标准.     

放射卫生

072126儿童人工耳蜗植入术作CT扫描时眼球的放射防护/刘昌盛…∥中华放射医学与防护杂志.-2006,26(6).-603~605优化儿童人工耳蜗植入术前、后作颞骨CT扫描的曝光参数,减少其辐射危害。对疑有颞骨内耳病变者87例(其中人工耳蜗植入手术接受者31例),行颞骨薄层高分辨CT扫描(HRCT),     

人工耳蜗植入术前后患者的护理体会

目的探讨人工耳蜗植入术前后护理方法。方法选取2009年6月—2012年6月收治的行人工耳蜗植入手术的耳聋患者36例临床护理资料进行分析。结果所有患者均顺利度过围手术期,降低患者人不适度,伤口无感染。掌握术后护理及了解言语训练的相关知识。结论做好术前协助患者进行各种检查,做好呼吸道、皮肤及术前准备工作。术后注意病情观察、做好一般护理工作及健康教育工作。     

人工耳蜗植入术前后患者的护理体会

目的探讨人工耳蜗植入术前后护理方法。方法选取2009年6月—2012年6月收治的行人工耳蜗植入手术的耳聋患者36例临床护理资料进行分析。结果所有患者均顺利度过围手术期,降低患者人不适度,伤口无感染。掌握术后护理及了解言语训练的相关知识。结论做好术前协助患者进行各种检查,做好呼吸道、皮肤及术前准备工作。术后注意病情观察、做好一般护理工作及健康教育工作。     

低场磁共振胰胆管成像（MRCP）技术的临床应用价值

目的：探讨低场磁共振胰胆管成像（MRCP）技术的临床应用价值。方法：以0.2T低场磁共振扫描仪重T2加权水成像技术检查胆系结石患者157例。结果：157例中24例正常,133例患者有胆胰疾病,其中116例经手术后病理证实。阳性患者均能显示各类疾病的形态改变,阴性患者可显示正常胆系形态。结论：低场磁共振胰胆管成像（MRCP）技术能够反映胆系正常、异常及胆胰疾病部位、梗阻程度。结合MRI平扫可提高胆胰疾病诊断效率。     

35例人工耳蜗植入术围手术期心理护理体会

目的：探讨人工耳蜗植入术围手术期的心理护理方法,以促进患者人工耳蜗植入术前配合及术后听力语言康复,提高生活质量。方法：回顾对35例重度以上感音神经性耳聋患者行人工耳蜗植入术,围手术期有针对性的心理护理干预。结论：围手术期积极有效心理护理干预,可以使患者尽快建立良好的信心,配合治疗,预防和1或减少术后并发症的发生,从而达到满意效果。     

输尿管扩张陛疾病的MR诊断价值

目的评价磁共振（MR）检查对输尿管扩张性疾病的诊断价值。方法对56例已行静脉肾盂造影（IVP）检查的输尿管扩张患者做磁共振成像（MRI）及磁共振尿路成像（MRU）检查，并对其中6例做MR梯度回波序列动态增强扫描。结果MR检查显示56例输尿管扩张，35例结石，13例结核或炎症，3例输尿管肿瘤，3例发育异常，1例输尿管外肿瘤，1例神经源性膀胱；IVP检查显示51例输尿管扩张，5例不显影，32例结石，10例结核或炎症，3例发育异常，1例神经源性膀胱。结论MR检查能清楚显示输尿管扩张的情况，帮助分析扩张的病因。     

臂丛神经磁共振成像技术的临床应用

目的：探讨臂丛神经磁共振成像技术的临床应用价值。方法：采用1．5T磁共振对60例患者进行臂丛神经MRI扫描，并根据病变情况进行多角度、多层面以及曲面等重建。结果：60例患者中，创伤性病变50例，其中正常神经表现型6例，神经变性型12例，神经疤痕型8例，神经消失型24例。非创伤性病变10例，其中肿瘤7例，炎症3例。所有序列成像清晰，3D序列图像经后处理重建后对臂丛神经根及神经节显示率明显较高。结论：用MRI检查臂丛神经．是准确显示臂丛神经及其相关结构非常有效的技术。作为一种最理想的新型无创影像检查手段．MRI对臂丛神经病变的诊断和治疗具有重要意义。     

磁共振及听性脑干诱发电位在大前庭水管综合征早期诊断的特征

目的 分析磁共振内耳水成像及听性脑干诱发电位在大前庭水管综合征早期诊断中的优势及特征.方法 对125例突聋及中重度以上感音神经性聋患者分别进行纯音测听、声导抗、耳声发射、听性脑干诱发电位、磁共振内耳水成像检查,总结大前庭水管综合征在磁共振内耳水成像及听性脑干诱发电位特点.结果 1例大前庭水管综合征听性脑干诱发电位检查V波潜伏期延长,9例V波消失;10例磁共振内耳水成像前庭导水管口直径≥1.5 mm.结论 听性脑干诱发电位对大前庭水管综合征能做到早诊断和早治疗,磁共振内耳水成像检查发现导水管口直径≥1.5 mm是诊断的标准.     

Postmeningitis deafness in young children: action warranted before obliteration of the cochlea

Meningitis may cause inflammation of the cochlea, which may result in deafness and also in rapid obliteration ofthe cochlea with fibrous tissue or even ossification, conditions that obstruct the placement ofa cochlear implant. In the first of two cases of postmeningitis deafness, in a boy aged 6 months and a girl aged 1 year and 9 months, ignorance about the time of audiological follow-up threatened the options for restoration of hearing. In the other case, a long diagnostic programme and an unsuccessful attempt at cochlear implantation caused a long delay in optimal restoration of hearing. Both cases illustrate the difficulties in connection with postmeningitis deafness in relation to the option of a cochlear implant operation. To increase the chances of a successful implantation, the time span between meningitis and audiological and radiological follow-up must be short. Auditory brain stem responses (ABR) and MRI are the keystones of the work-up.     

颞骨HRCT对儿童先天性耳聋的诊断价值

目的:了解河南省儿童先天性耳聋颞骨畸形的发生率及特点,为临床提供必要的依据。方法:225例听力障碍的婴儿及先天性耳聋的儿童人工耳蜗植入前行颞骨HRCT筛查常规行横断面薄层扫描和多平面重组。结果:CT共检出颞骨畸形79例(104耳),包括外耳畸形25例(30耳)、中耳畸形16例(20耳)、内耳畸形54例(74耳),其中16例为合并畸形;单纯鼓室积液30例(42耳);其余116例颞骨无异常。35.1%患儿颞骨有畸形,51.6%患儿颞骨结构正常。结论:HRCT能很好显示儿童先天性耳聋的颞骨解剖异常,为临床治疗方案的正确制定提供重要的参考依据。     

人工耳蜗植入体刺激器外壳气密性检测方法

在人工耳蜗植入系统中,刺激器是接收、处理电信号、保证刺激电极正确刺激人体耳蜗神经的核心部件。刺激器外壳的密封性保证了刺激器内部电路与人体之间的有效隔离,既可以防止内部电路所含的有害成分渗入到人体,又可以保证体液不会腐蚀内部电路,对患者的生命安全及患者感知声音的效果有着重要影响。YY0989.7-2017是针对人工耳蜗植入系统的专用要求,现分析影响该标准规定整体泄漏检测的准确性因素,阐述整体泄漏检测过程中所遇到的问题,并给予解决方法和注意事项。     

Otoacoustic emission audiometry in neonates and adults]

The authors discuss the clinical use of the otoacoustic emission audiometry. During the physiological process of sound amplification in the cochlea vibration energy escapes from the inner ear. By the analysis of this sound it is possible to gain information about the function of the cochlea. According to the experiences of the authors the method is extremely useful for screening audiometry in pathological and normal neonates. In adults it can be used for monitoring the cochlear function during ototoxic therapy or noise exposure.     

Audiology

An audiogram is a hearing test conducted under ideal listening conditions in a soundproof booth. The test includes different pitches and intensities and the results are conveyed in graphical form. If there is hearing loss an audiogram helps distinguish conductive loss (outer/middle ear) from sensorineural loss (cochlea/cochlear nerve).     

MRI对先天性肛门直肠畸形的诊断价值

目的探讨MR I对先天性肛门直肠畸形手术前后的诊断价值。方法对5例正常对照组,14例先天性肛门直肠畸形病例均行盆腔、骶尾部MR检查。观察肛门内、外括约肌、耻骨直肠肌形态,肛门直肠本身发育缺陷以及骶椎、泌尿生殖系统等畸形。结果本组MR显示耻骨直肠肌、括约肌群发育好13例,发育较好3例,发育差3例,T1W I不抑脂序列为显示肛周肌群较好的序列。7例合并骶尾椎畸形,5例合并泌尿系统畸形。结论MR I对先天性肛门直肠畸形具有重要诊断价值,可从形态上了解盆底肌的发育,并能明确骶骨、椎管、泌尿系统等畸形,在确定手术方式及评价手术疗效方面具有重要意义。     

磁共振SE-EPI-DWI成像技术诊断中耳胆脂瘤及其常见颅脑并发症的研究

目的:研究磁共振自旋回波-回波平面成像-弥散加权成像(SE-EPI-DWI)技术在中耳胆脂瘤及其常见颅脑并发症诊断中的应用.方法:选择医院收治的疑似中耳胆脂瘤并均经病理检查的82例患者,根据病理检查结果将其分为胆脂瘤组(55例)和非胆脂瘤组(27例).患者术前均行耳部常规MRI及SE-EPI-DWI检查,分析SE-EP...     

How Japanese parents of deaf children arrive at decisions regarding pediatric cochlear implantation surgery: a qualitative study

In recent years, many children with severe or profound congenital hearing loss have undergone treatment to receive cochlear implants; however, the efficacy and risks associated with pediatric cochlear implants are still unknown. Some deaf adults are opposed to parents making the decision regarding cochlear implants for their children. To elucidate the benefits and risks perceived by parents and to investigate parents' decision-making processes, we interviewed 26 parents of deaf children (aged 12 years or younger) who live in the wider Tokyo area, Japan. The results showed that the participants perceived auditory and speech improvements as benefits. On the other hand, participants pointed out various risks associated with cochlear implantation such as medical complications, restrictions on daily activities, cost of cochlear implant upgrades, low effectiveness, and the negative psychosocial impact associated with the implants. Participants who emphasized the benefits of the surgery tended to approve of cochlear implants. Participants who emphasized the risks of the surgery tended to disapprove. All participants, however, were reluctant to make the decision to undergo cochlear implants on behalf of their children due to the uncertain benefits and risks. Participants who believed that early implantation during infancy would be associated with better outcomes regarded their surrogate decision-making as necessary and approved the treatment. This decision, however, was made with certain stipulations; for example, these parents resolved to discuss the decision with their children as they got older, and would give their children the option of having the implant removed. Those who did not believe claims about the effectiveness of early implantation postponed decision-making. These results suggest that guardians face difficulty in decision-making and need information and support from various professionals, deaf adults, parents of children with implants, and children with implants themselves.