关于扩大人工耳蜗项目救助对象申报渠道的思考

目的 探讨如何扩大人工耳蜗项目救助对象的申报渠道.方法 对重庆市2009～2010年人工耳蜗项目申请救助对象的申报渠道进行统计.结果 150例人工耳蜗筛查者中,60%来自城镇,40%来自农村;救助信息的来源有6种,其中残联通知占67.33%、咨询告知占16%、他人推荐占5.33%、媒体宣传占5.33%、医院推荐占4.67%、网络信息占1.33%.结论 人工耳蜗项目救助申报比例较小;救助信息渠道单一;城、乡比例严重失调.建议建立以残联为主线、卫生为骨干的工作模式,整合资源,进一步开辟申请渠道,从而使更多的昕障儿童得到救助.     

部分农村地区双侧重度聋患儿干预状况调查

目的了解部分农村地区双侧重度聋患儿的听力干预、语训及言语发育状况。方法研究对象为2004年6月～2008年7月在河南省安阳市妇幼保健院、江西省九江市妇幼保健院及山东省莱州市人民医院诊断为双侧重度聋的61例患儿（年龄2～72个月,中位数为14个月）。设计调查问卷表．通过电话随访,对患儿是否选配助听器或行人工耳蜗植入术及听力言语训练、言语发育和交流能力等情况进行调查。结果61例患儿中选配助听器者33例54．10％,33／61）．其中助听后语训者10例（30．30％,10／33）,助听后无语训者23例（69．70％,23／33）;人工耳蜗植入者2例（3．28％,2／61）;未选配助听器、未行人工耳蜗植入者26例（42．62％,26／61）。2例人工耳蜗植入者言语发育良好,33例配戴助听器的患儿中2例言语发育较好,31例存在不同程度的言语障碍。26例末行助听器配戴及人工耳蜗植入者均为聋哑状态。结论在农村地区,重度聋患儿未接受听力干预和语训者比例高,言语障碍明显,加强对聋儿家长进行佩戴助听器和言语训练必要性的宣传和教育至天重要。     

语前聋人工耳蜗植入患者术后问卷调查分析

目的 采用问卷调查的方式对人工耳蜗植入患者和家长进行术后的随访调查，以期了解术前检查、术后听力康复和言语训练情况，为人工耳蜗植入提供宝贵经验，为植入患者和家长提供康复指导和帮助。方法 对56例重度和极重度语前聋植入人工耳蜗的患者家长进行问卷调查，调查主要包括患儿的术前评估、植入装置，植入年龄，手术后的言语康复训练、恢复时间、言语发展水平满意度和目前患儿存在的问题，以及为待植入人工耳蜗的家庭提供的建议等内容。结果 调查显示①手术前的听力学和影像学检查较完善，但言语评估不足；②助听器配戴率（47／56），术前配戴助听器者植入人工耳蜗后的满意度与未配戴者无明显差异；③术后66．1％的患儿选择康复机构进行言语康复，9％在家庭训练；两种方式皆选者占16．1％：④75％的家庭对人工耳蜗有适当的期望值。75％认为植入效果与预期一致或更好；⑤53．6％的孩子于术后3-6个月内在听力言语方面表现出明显进步，一年和一年半后表现出明显进步的儿童分别占25％和5．4％，16.2％的植入者尚未表现出明显效果；⑥70％家长认为如不能通过助听器获得很好的听力补偿应尽早植入人工耳蜗。产品的选择、售后服务和持久的康复训练也是至关重要的。结论 ①家长及专业人员应重视术前的全面评估；②家长应充分了解人工耳蜗知识，有助于聋儿术后得到及时有效的康复语言训练：③调查显示植入时间越长，人工耳蜗植入患者的听觉发育效果越明显，故应重视听觉言语的长期培建。     

人工耳蜗植入术中圆窗耳蜗电图评价耳蜗残余听功能

目的应用术中圆窗耳蜗电图评估极重度感音神经性聋患者耳蜗残余听功能。方法20例患者全麻下人工耳蜗植入手术过程中,行术中圆窗耳蜗电图测试,测出的复合动作电位（CAP）阈值与术前纯音测听或其他听力测试之阈值进行比较。结果20例患者术中圆窗耳蜗电图测试测出的复合动作电位（CAP）阈值与术前1、2、4kHz听力测试阈值分别有较好的相关系数（0．20429,0．04076,0．38163）。结论术中圆窗耳蜗电图可以较准确客观地评估极重度感音神经性聋患者耳蜗残余听功能,且是人工耳蜗植入术前听力学评估方法的有意义的补充。     

小儿综合听力学评估

随着新生儿听力筛查的普及、人工耳蜗技术的引进以及国家救助项目的广泛实施．越来越多的听障儿童．特别是低龄听障儿童得到了及时诊断和干预。小儿听力检测及诊断要求听力学专业人员具备更全面的听力学知识、更高的评估技能．以保证小儿得到准确的听力诊断。     

儿童人工耳蜗植入后康复安置及其效果分析

目的分析儿童人工耳蜗植入后康复安置效果，为继续做好捐赠项目受赠聋儿术后集中安置工作及进一步提升术后康复效果提供经验。方法本研究采用教育行动研究法，按照捐赠项目受赠聋儿术后安置要求，将200名聋儿安置在18个具备资质的聋儿康复机构，定期跟踪．指导。在安置期满后，整理．对比材料相对完整的受赠聋儿康复评估数据和家长对康复效果的满意度调查结果，分析儿童人工耳蜗植入后康复安置效果。结果①受赠聋儿康复安置一年后，言语识别率、语言年龄和学习能力商成绩都较安置初期取得明显效果（P〈0．01）；②家长对受赠聋儿康复安置效果的满意度评价前后具有非常显著差异（P〈0．01）；③人工耳蜗植入年龄因素和术后一年内接受康复安置时间的长短是影响言语识别率平均成绩的关键因素（P〈0．01）。结论已经实施的康复安置策略效果明显，儿童人工耳蜗植入后接受康复安置的时间最少为1年是合理的，有效的康复安置策略还应囊括更大范围的内容，尽快建立起儿童人工耳蜗术前和术后一体化康复服务机制是确保儿童人工耳蜗植入后康复效果的长远考虑。     

成人人工耳蜗植入者音乐旋律和音色感知研究

目的评价成人人工耳蜗植入者对音乐旋律及音色的感知能力。方法对13例人工耳蜗植入者（男8例,女5例,平均年龄26．5±6．9岁）分别进行音乐聆听行为评估和旋律辨别、乐器辨别测试。实验使用慕尼黑音乐经验问卷MUMU（Munich music questionnaire）和人工耳蜗音乐评估软件Mu．S．I．C（musical sounds in cochlear implant）进行评估。对照组为40例听力正常受试者（男21例,女19例,平均年龄26．8±6．7岁）。结果①人工耳蜗组与听力正常组的年龄及音乐经验相互匹配。②人工耳蜗组旋律辨别平均正确率为69．3％,乐器辨别平均正确率为51．2％,听力正常组旋律辨别平均正确率为80．4％,乐器辨别平均正确率为85．3％。两组比较,差异存在统计学意义（P=0．000）。结论成人人工耳蜗植入者的旋律感知能力和音色感知能力明显落后于听力正常者。     

38例人工耳蜗植入儿童康复效果及其影响因素研究

目的通过对38例7岁以下语前聋植入人工耳蜗儿童进行分阶段的听觉言语康复效果评估,探讨经过1年术后康复,植入人工耳蜗儿童的听觉言语康复效果及其影响因素。方法本研究采用评估词表、标准评估程序及希内智力测试标准,对植入人工耳蜗的38例语前聋聋儿进行听觉、言语,智力评估,同时采用f检验和单因素方差分析检验康复各个阶段聋儿的听觉言语能力是否存在差异。结果听觉识别率平均值由康复训练3个月的44．2％上升至12个月的88．0％,语言平均年龄由康复训练3个月的1．1岁上升至12个月的2．7岁,统计表明差异显著（P〈0．01）。结论经过1年系统的术后康复,聋儿在听觉能力和语言能力上较术前均有显著提高,人工耳蜗术后康复具有普遍有效性。在术后康复中,年龄、智力、随读家长类型及其文化程度等是影响术后康复效果的重要因素。     

HRCT多平面重组耳蜗形态测量在人工耳蜗植入术的应用

目的：运用颞骨高分辨率CT（HRCT）多平面重组（MPR）技术测量人工耳蜗植入患者的耳蜗形态,探讨其在人工耳蜗植入术前评估中的应用价值。方法：收集符合入组标准的80例人工耳蜗植入患者资料,根据患者的性别、年龄及有无内耳畸形进行分组;对患者术前颞骨CT进行MPR,在标准方位图像下分别测量耳蜗长径A、宽径B及底转角度7,对测量的数据进行可重复性评价及对不同组间的结果进行比较。结果：各组测量参数值在测量者自身和测量者之间的一致性较好;内耳正常组男性耳蜗长径A[（8．79士0．34）mm]及宽径B[（6．58士0．28）mm]均大于女性耳蜗长径A[（8．534士0．47）mm]和宽径B[（6．22±0．43）mm],差异均有统计学意义（P〈O．05）,但底转角度7无性别差异（P〉0．05）;耳蜗长径A及宽径B不随年龄的增长而变化（P〉O．05）,但底转角度7随着年龄的增长呈逐渐减小趋势（r=-0．25,P〈0．05）;内耳畸形组患者耳蜗宽径B较耳蜗正常组小（P〈0．01）,但两组的耳蜗长径A及底转角度7差异无统计学意义（P〉O．05）。结论：术前应用HRCTMPR技术测量耳蜗形态方法简单可行、重复性好,可用于指导手术及为设计个性化电极提供客观依据,值得临床推广。     

多地区农村的新生儿听力筛查

目的：探讨在农村地区开展新生儿听力筛查的可行性,为在全国农村地区推广此项工作提供参考依据。方法：研究对象为2004—01—2005—12出生于农村地区九个县的新生儿12638例。采用瞬态诱发性耳声发射的快速筛查程序对出生后2～7d的新生儿实施听力筛查;筛查未通过者于出生后4～6周复筛,复筛未通过者进行跟踪随访和听力学诊断性检查。结果：12638例中10845例（85．8％）新生儿接受了筛查,其中正常新生儿9963例（91．9％）,高危新生儿882例（8．1％）。初筛通过7450例（68．7％）,未通过3395例（31．3％）。拒绝筛查1793例,占14．2％（1793／12638）,其中正常新生儿833例（46．5％）,高危新生儿960例（53．5％）。未通过初筛应进行复筛的新生儿3395例,实际复筛2536例（74．7％）,未能复筛859例（25．3％）。复筛或初筛未通过应接受听力诊断120例,实际接受听力诊断79例（65．8％）,52例确诊听力损失的患儿中6例（7．6％）为双侧极重度听力损失,9例（11．4％）为重度听力损失（双耳7例,单耳2例）,11例（13．9％）为中度听力损失（双耳5例,单耳6例）,26例（32．9％）为轻度听力损失（双耳11例,单耳15例）;27例（34．2％）听力正常。本组先天性听力损失（包括单耳和双耳）的总发生率为0．5％（52／10845）,双侧听力损失的发生率为0．3％（29／10845）。正常新生儿听力损失发生率0．2％（22／9963）;高危新生儿听力损失发生率为3．4％（30／882）。13例双侧重度、极重度听力损失患儿中8例（61．5％）配戴了助听器,1例（7．7％）接受了人工耳蜗植入。结论：在农村地区开展新生儿听力筛查是必要的也是可行的。解决失访率高和转诊率低、提高高危新生儿筛查率仍是目前亟待解决的问题。     

Cochlear implantation in children with large vestibular aqueduct syndrome

OBJECTIVE: This study describes the effectiveness of a multielectrode cochlear implant prosthesis (Cochlear; Cochlear Pty., Lane Cove, Australia) for providing hearing to children with deafness caused by large vestibular aqueduct syndrome (LVAS). STUDY DESIGN: The study design was a retrospective study. SETTING: All the children attended The Children's Cochlear Implant Center (NSW), which is a specialist center that provides audiologic testing, speech therapy, habilitation, and medical assistance for children with cochlear implants. PATIENTS: Ten children were studied who had profound hearing loss and radiologic evidence of a vestibular aqueduct larger than 2 mm in width in its intraosseous portion. INTERVENTION: The children received a multielectrode (Cochlear) cochlear implant prosthesis, and the associated programming of the device and habitation were performed postoperatively. No significant problems were encountered at any of the surgeries, although there was an initial gush of perilymph when the otic capsule was opened in 7 ears. MAIN OUTCOME MEASURES: Postoperative audiologic performance at six monthly intervals and school performance were assessed. RESULTS: The postoperative auditory performance was improved in all children. At 6 months, their average BKB score had increased from 31% to 79%; average word score, from 8% to 43%; and average phoneme score, from 38% to 70%. The older children were able to continue their education in their usual setting with less reliance on hearing support staff. CONCLUSION: Children with a deteriorating hearing loss caused by LVAS can derive considerable benefit from a cochlear implant.     

Paediatric cochlear implantation: the views of parents

The purpose of this study was to understand the parental perspective on paediatric cochlear implantation over time. Face-to-face semi-structured interviews were conducted with 216 families of children who were implanted at the Nottingham Paediatric Cochlear Implant Programme between 1989 and 2002, and who were attending an appointment during the study period (July 2001 August 2002). The qualitative data revealed that time played an important role in family experiences of paediatric cochlear implantation. Expectations were continually revised throughout the process, as a result of new knowledge and new technological developments. The results show that outcomes are highly individualistic although parents had a shared hope of the implant enabling the child to function in a "hearing world"; that the biggest area of contention is in respect of their child's education; and that parents talked openly about constraints imposed on them by implantation. The vast majority of parents did not regret their decision to proceed with implantation.     

Paediatric cochlear implantation: the views of parents

The purpose of this study was to understand the parental perspective on paediatric cochlear implantation over time. Face-to-face semi-structured interviews were conducted with 216 families of children who were implanted at the Nottingham Paediatric Cochlear Implant Programme between 1989 and 2002, and who were attending an appointment during the study period (July 2001–August 2002). The qualitative data revealed that time played an important role in family experiences of paediatric cochlear implantation. Expectations were continually revised throughout the process, as a result of new knowledge and new technological developments. The results show that outcomes are highly individualistic although parents had a shared hope of the implant enabling the child to function in a “hearing world”; that the biggest area of contention is in respect of their child's education; and that parents talked openly about constraints imposed on them by implantation. The vast majority of parents did not regret their decision to proceed with implantation.     

Comparison of learning preferences of Turkish children who had been applied cochlear implantation in Turkey and Germany according to theory of multiple intelligence

AimThe aim of the study is to determinate the using dominant multiple intelligence types and compare the learning preferences of Turkish cochlear implanted children aged four to ten in Turkey and Germany according to Theory of multiple intelligence.Material and methodThe study has been conducted on a total of 80 children and four groups in Freiburg/Germany and Ankara/Turkey. The applications have been done in University of Freiburg, Cochlear Implant Center in Germany, and University of Hacettepe, ENT Department, Audiology and Speech Pathology Section in Turkey. In this study, the data have been collected by means of General Information Form and Cochlear Implant Information Form applied to parents. To determine the dominant multiple intelligence types of children, the TIMI (Teele Inventory of Multiple Intelligences) which was developed by Sue Teele have been used.ResultsThe study results exposed that there was not a statistically significant difference on dominant intelligence areas and averages of scores of multiple intelligence types in control groups (p > 0.05). Although, the dominant intelligence areas were different (except for first dominant intelligence) in cochlear implanted children in Turkey and Germany, there was not a statistically significant difference on averages of scores of dominant multiple intelligence types.ConclusionEvery hearing impaired child who started training, should be evaluated in terms of multiple intelligence areas and identified strengths and weaknesses. Multiple intelligence activities should be used in their educational programs.     

UK and Ireland experience of cochlear implants in children with Down Syndrome

Objectives

Down Syndrome (DS) is associated with a high incidence of hearing loss. The majority of hearing loss is conductive, but between 4 and 20% is sensorineural, which in the main is mild or moderate and is managed with conventional behind-the-ear hearing aids. Cochlear implantation is an elective invasive procedure, performed to provide some form of hearing rehabilitation in individuals with severe to profound sensorineural hearing loss, and initially candidacy criteria were strict—excluding patients with additional disabilities. With good results and expanding experience, more candidates with additional disabilities are now being implanted. A survey of UK and Ireland Cochlear Implant Programmes sought to identify the number of individuals with DS who have been implanted with a cochlear implant (CI) and to provide relevant information on outcomes of implantation in these individuals.

Methods

E-mail survey of all programmes within the British Cochlear Implant Group (BCIG). Postal questionnaire to programmes identified to have implanted a child with Down Syndrome, with data collection on pre-operative assessment, surgical and post-operative outcomes. Case series review.

Results

Three of 23 BCIG programmes have implanted a child with Down Syndrome. Four children have received implants. No intraoperative or post-operative surgical complications were encountered. All children had middle ear disease, but no problems with implantation were associated with their middle ear condition. All children remain implant users, 12 months to 4 years post-implantation.

Conclusion

Cochlear implantation is an option for a child with Down Syndrome and associated severe to profound sensorineural hearing loss. Clinicians caring for these children and their families should consider referral for assessment by a Cochlear Implant Programme.     

Parents and their cochlear implanted child: questionnaire development to assess parental views and experiences

OBJECTIVES: To test the reliability of a validated closed-format questionnaire assessing parental views following cochlear implantation of their child. DESIGN: Parents were surveyed using a closed-format questionnaire developed in earlier work. The same parents were surveyed 1 month later and responses compared. Test-retest reliability was thereby assessed. SETTING: Tertiary referral Pediatric Cochlear Implant Centre in the UK. SUBJECTS AND METHODS: The parents of 20 children who had been born deaf or were deafened by age 3 years and who had been implanted for at least 2 years were drawn at random from patient lists. Parents were surveyed using a closed-format questionnaire whose validity had been previously assessed and re-surveyed 1 month later. Responses over time were compared. RESULTS: For the majority of items in the questionnaire, the replication of the item would lead to the same response on at least 95% of occasions. The text of the closed-format questionnaire is reproduced in full. CONCLUSION: This validated closed-format questionnaire appears to be unique in respect of cochlear implantation, being based explicitly on issues thought important by the parents. The high test-retest reliability indicates that it is capable of eliciting parental views in a meaningful manner. This information that is not currently available by other means can then be used as part of an overall assessment of outcomes, to inform efforts aimed at quality improvement as well as demonstrating accountability to purchasers and policymakers. Moreover, a wider use of this instrument can result in valid comparisons of outcomes among different cochlear implant centres.     

未通过听力筛查的新生儿诊断测听结果分析

目的通过分析未通过听力筛查的新生儿诊断测听结果,全面了解这些幼儿的听力状况,以便更好地采取应对措施。方法对102例未通过新生儿听力筛查的幼儿进行畸变产物耳声发射（DPOAE）和听性脑干反应（ABR）测试,并参考声导抗测试结果进行听力学诊断。结果双耳听力正常33例（33。7％）;双耳听力异常47例（48％）,其中轻中度听力损失26例（26．5％）、重度以上听力损失21例（21．4％）;单耳听力正常18例（18．4％）。4例只进行了DPOAE测试者未记入最后统计数据。结论在未通过新生儿听力筛查的幼儿中,听力损失表现出一定程度的多样性,部分幼儿的听力有一定的波动。在临床工作中。应根据不同的听力损失情况做出相应处理。     

What factors influence patient and parent choice of cochlear implant model for children?

Abstract

Objectives

The West of England Cochlear Implant Programme purchases two makes of cochlear implant (CI) for paediatric use (MED-EL and Cochlear). If the CI team has no preference, the decision regarding which implant to use is made by the patient and family. Families are provided with information about the devices and allowed time to handle dummy implants and ask questions.

The aim of this study is to establish how patients make this choice and which factors are considered most important in the decision-making process.

Method

Patients who received a CI within the past 4 years were sent a postal survey, with reminders issued when patients attended for checkups. Patients were asked to rate certain factors from 0 to 10 depending on their importance in the decision-making process.

Results

Sixty-four patients replied (response rate 74%). In most cases (83%), the parents and/or children were involved in the decision regarding the choice of implant. Eighty-nine percent of patients received information about the choices of CI from the CI team. Patients also accessed information directly from the manufacturer, from other CI users, and from websites.

The most important factor in choosing CI model was robustness and reliability (mean score 9.6), followed by comfort (9.4), size/shape (9.2), and control system/ease of use (8.9). All patients were happy with the choices they made.

Discussion

In this study, most patients undergoing cochlear implantation were offered a choice of model. Robustness, reliability, comfort, and size/shape of CI are considered the most important factors in this decision.     

Paediatric cochlear implantation: how reliable is computed tomography in assessing cochlear patency?

This study investigates the accuracy of pre-operavive high resolution computed tomographic (CT) scans in predicting the patency of the cochlea in children undergoing cochlear implantation. The first 26 children on the Nottingham Paediatric Cochlear Implant programme were reviewed. CT scans were performed utilizing 1 mm contiguous sections and these were then assessed by a neuroradiologist. In patients who had normal inner ears on CT a high degree of accuracy in predicting a patent cochlear was achieved (87%). However, in 15% of cases the degree of ossification was significantly under-estimated causing major difficulties at the time of surgery. Although high resolution CT offers great clarity and fine detail, it has its limitations. Further information may be provided by magnetic resonance imaging.