电诱发听神经复合动作电位与人工耳蜗植入

听神经复合动作电位反映了听觉通路第一级中枢耳蜗螺旋神经节的生理功能,人工耳蜗是将声信号转换为电信号刺激螺旋神经节来获得听力,电刺激听神经复合动作电位(electrically evoked auditory nerve compoundaction potentials,ECAP)可以反映耳蜗植入者初级听觉中枢的功能状态。本文综述ECAP的测试方法,影响因素以及临床意义,并讨论其在人工耳蜗植入术中术后的应用前景。     

人工耳蜗植入前电刺激听神经复合动作电位检测方法的建立和初步应用

目的 建立术中利用探测电极施行电刺激听神经复合动作电位(electrically evoked auditory nerve compound active potentials,ECAP)检测的方法,在植入人工耳蜗装置前评估患者耳蜗听神经功能状况.方法 选择20例人工耳蜗植入患者,其中耳蜗形态发育正常12例,5例双侧前庭导水管扩大,3例双侧耳蜗Mondini畸形.测试完成后全部使用Cochlear人工耳蜗.全麻后常规人工耳蜗手术进路,行标准耳蜗鼓阶开窗,将自制测试用多通道试验电极置入鼓阶,电极连接Cochlear公司体外言语处理器及自制电刺激发生器,连接电脑,采用Custom Sound EP 2.0软件,调整优化刺激参数进行神经反应遥测(neural responsetelemetry,NRT)初步了解听神经功能状态;刺激强度以5 CL为步长递减或递增至反应阈值给予电刺激脉冲,同时自动记录ECAP波形和阈值.植入人工耳蜗后常规进行NRT检测,记录ECAP波形和阈值;术后1个月患者开机后采集T、C值,将两种电极测试所得阈值和开机C值进行相关性研究,并进行数据统计分析.结果 试验电极ECAP引出率为90%,商业电极ECAP引出率为90%,平均阈值分别为(160.50±15.12)CL和(160.00±11.27)CL,两者经统计学检验没有显著性差异(P>0.05);和开机后C值(177.40±10.61)有明显相关性(R2=0.844,r=0.919).结论 成功建立了术中植入人工耳蜗装置前的ECAP检测方法,为内耳和/或听觉通路发育异常及无残余听力患者提供有效的听神经反应信息,对了解听觉系统发育程度及初步预测术后患者康复情况提供客观依据.     

电诱发复合动作电位测试在人工耳蜗中的应用进展

1ECAP测试概述电诱发复合动作电位(Electrically evoked compound action potentials,ECAP)最早用于研究动物听神经对电刺激信号的反应。随着人工耳蜗植入技术的发展,人们已可通过植入的电极进行电刺激,在体记录人类听神经的ECAP。目前,美国食品和药品监督管理局(FDA)认可的三种人工耳     

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。     

小儿耳蜗植入后电诱发复合动作电位的阈值及其临床应用

目的：研究应用神经反应遥测（neural response telemetry,NRT)技术，测试电诱发复合动作电位（electrically-evoked compound action potential,ECAP)阈值以指导小儿人工耳蜗映射调图的策略与时机。方法：应用NRT3．0软件对辐值增长函数进行线性拟合，确定ECAP阈值。比较6例儿童植入者在术后1、2、3个月ECAP阈值的变化，同时比较了7例儿童术中、术后ECAP阈值的差异。结果：ECAP幅值增长函数在接近阈值或进入饱和时不再呈线性。术后ECAP阈值保持稳定。各导电极的术中ECAP阈值比术后阈值平均高约15CL，二者有显著性相关（R2＝0．9154）。结论：应选取幅值增长函数的直线段部分进行拟合以确定ECAP阈值。术后应用ECAP阈值指导小儿映射调图时，测试一次ECAP阈值即可。术中ECAP阈值可用作开机时映射图的C值。     

儿童人工耳蜗植入术后电诱发复合动作电位分析

目的 应用神经反应遥测(NRT)技术,观察人工耳蜗植入后不同时间段的电诱发复合动作电位(ECAP)阈值变化,探讨其对人工耳蜗术后调机的指导意义。方法 对33例使用Nucleus CI24R(CA)型人工耳蜗植入的患儿,于术中及术后1、1.5、2、4、6个月进行ECAP 阈值测试,统计分析其变化规律。结果 33例165个电极的波形检出率为93.3%。电极1、7、11、17、22的术中ECAP阈值与术后30d开机时的ECAP阈值的差异有统计学意义。同一测试电极,随术后开机时间的增长,ECAP阈值呈逐渐增加的趋势。经单因素方差分析,术后不同测试时间ECAP阈值差异有统计学意义。结论 ECAP检出率高,术中可用于检测神经反应;术后可协助估算患者的行为反应T、C级,指导调机,尤其对儿童患者更为重要。     

神经反应遥测技术在人工耳蜗术后调试中的应用

目的通过对小儿人工耳蜗植入者术后言语处理器调试中运用NRT（神经反应遥侧）技术效果的分析．探讨NRT在人工耳蜗术后调试中的应用价值。方法选取10例术后主观调试配合欠佳的儿童．用Cochlear公司NRT3．0编程软件进行ECAP波形检测并测定ECAP阈值，利用测试结果判断主观阈值（T-值）和最大舒适阈（C-值），并得出言语处理器映射图（Map）。术后6个月行声场听阈测听。结果86．2％的电极引出ECAP波形，开机调试时反应阈值较小，以后逐渐升高，3～4个月左右闽值逐渐趋于稳定，而且靠近蜗底的阈值比蜗尖高。声场平均听阈为30～40dBSPL。经过言语康复训练，获得良好的效果。结论NRT技术可为术后快速准确地调试言语处理器提供客观依据．     

人工耳蜗术后电诱发镫骨肌反射、神经反应电位与舒适阈值对比观察

目的 研究人工耳蜗植入患者电诱发镫骨肌反射阈值（electrically evoked stapedius reflex thresholds,ESRT)、电诱发听神经复合动作电位（electrically evoked compound actionpotential,ECAP）阈值与主观最大舒适阈（most comfortable level,M值）的相关性。方法 纳入2018年—2020年在解放军总医院耳鼻咽喉头颈外科医学部接受人工耳蜗植入的研究对象,42例人工耳蜗植入患者的43耳,年龄11～58岁,男22例,女20例,人工耳蜗植入体品牌型号分别澳大利亚Cochlear公司CI512型16例,奥地利MED-EL公司SONATAti100型或Mi10xx型23例,美国Advance Bionics公司HiRes90K型4例。通过人工耳蜗调机软件映射编程模块选择M值测量,获得各个电极通道主观最大舒适阈值。使用丹麦国际听力公司Titan听力测试平台中ESRT模块测得相同通道的植入耳同侧和对侧ESRT,再利用人工耳蜗调机软件ECAP测试模块测试相同通道ECAP阈值,分析三者间的相关性。结...     

人工耳蜗植入者EABR与ECAP分析

目的探讨听觉电诱发电位对人工耳蜗植入者的电听觉传导功能客观评价的意义。方法对14例人工耳蜗植入者行电诱发听性脑干反应（electrically evoked audiotory brainstem responses,EABR）和电诱发听神经复合动作电位（electrically evoked compound action potential,ECAP）检查,根据第1、10、22号电极ECAP波形的检出与否将其分成A（1、10、22号电极ECAP均检出）、B（1、10、22号三个电极中有一个及以上ECAP未检出）两组,检测A组和B组患者的EABR阈值、波Ⅲ、Ⅴ潜伏期、Ⅲ-Ⅴ波间期并对其结果进行比较。结果刺激脉宽分别为25、50、75、100、125μs时,22号电极的EABR阈值B组高于A组,差异有显著统计学意义（P〈0.001）;刺激脉宽为50μs时：1号和10号电极的EABR阈值B组高于A组,差异有显著统计学意义（P〈0.001）。A、B两组患者22、10、1号电极EABR波Ⅲ、Ⅴ潜伏期和Ⅲ-Ⅴ波间期之间的差异无统计学意义（P〉0.05）。结论 ECAP波形较好者的EABR阈值较ECAP波形较差者的EABR阈值低。EABR波Ⅲ、Ⅴ潜伏期、Ⅲ-Ⅴ波间期与ECAP波形引出与否无明显相关性,ECAP灵敏性高而EABR稳定性好。     

人工耳蜗植入术前听神经完整性的评估

目的 探讨、评估人工耳蜗植入候选者术前听神经完整性的检查方法;在对侧耳人工耳蜗植入术前,客观检查耳蜗发育及病变状态的检查方法。方法 对12例人工耳蜗植入候选者进行检查,根据本小组建立的人工耳蜗植入术前耳蜗影像学检查方法、术前听神经完整性检查方法及评估标准、以及术后植入电极位置的早期检查方法,结合11例人工耳蜗植入术后听觉康复疗效进行分析。结果 11例患儿满足本小组制定的人工耳蜗植入遴选标准而接受了多导人工耳蜗植入,包括1例对侧耳(第2耳)人工耳蜗植入。一例患儿因评估结果为听神经发育障碍,未作人工耳蜗植入。所有人工耳蜗植入患儿术后听觉能力皆明显改善。结论 MRI头轴位及听神经轴位和颞骨CT薄层扫描、膜迷路表层实时三维重建及膜迷路实时重建等影像学方法,结合听力学及外耳道电刺激测听反应阈与不适阈差值的电生理方法来评估听神经的完整性,对术前预测人工耳蜗植入后患儿听觉康复的可能疗效,有非常重要的意义。术后早期反斯氏位X线摄片观察蜗内植入电极部位及植入电极形态,可作为人工耳蜗电极植入成功性直观、简捷的评估方法。     

Electrically evoked compound action potential (ECAP) in cochlear implant children: Changes in auditory nerve response in first year of cochlear implant use

AimRecording of the electrically evoked compound action potential (ECAP) of the auditory nerve in cochlear implant (CI) patients represents an option to assess changes in auditory nerve responses and the interaction between the electrode bundle and the neural tissue over time. The aim of the present work is to assess ECAP changes during the first year of cochlear implant for the purpose of predicting thresholds and adjustment of the patients’ programs over time.MethodData were collected from 25 children using Cochlear Nucleus 24 implants. ECAP thresholds were examined at the time of surgery, at initial stimulation, and 3, 6 and 12 months post-stimulation. Five electrodes located at basal, middle, and apical positions in the cochlea were tested at each time interval and ECAP thresholds were analyzed and compared.ResultsThere was a significant decrease in ECAP thresholds between the intraoperative measure and fitting time at all electrode sites. Mean ECAP thresholds measured at 3, 6 and 12 months post-stimulation remained similar to initial stimulation levels. Although there was no significant difference in ECAP thresholds recorded at fitting time and 12 months follow up session, there was significant increase in behavioral T and C levels from initial stimulation to the 12 months’ time point.ConclusionMost electrodes undergo non-significant change in ECAP thresholds over time, and therefore thresholds obtained on the day of initial stimulation can be used to estimate the patients’ map levels at any time. On the other hand, intraoperative thresholds demonstrated significant change relative to postoperative recording times, limiting the ability to use intraoperatively recorded ECAP thresholds to predict postoperative measurements.     

人工耳蜗植入患者电诱发镫骨肌反射检测

目的 寻找可靠的客观测定方法,在术中即时评价由植入体至听觉中枢传导通路的情况,并在术后协助人工耳蜗编程调试.方法 植入奥地利Combi 40＋型人工耳蜗系统的36位患者,使用CI.STUDIO＋2.0软件在术中进行电诱发镫骨肌反射（electrically evoked stapedius reflex,ESR）检测,分别选取第1、6、12电极作为观察蜗顶、蜗中、蜗底3个不同部位的研究电极,观察ESR检出率以及镫骨肌反射阈（electrically evoked stapediua reflex threshold,ESRT）与主观阈值（threshold,THR）、最大舒适级（maximum comfortable level,MCL）之间的关系.结果 ESR检出率为69.44%;各电极ESRT远远大于心理物理测试得到的主观阈值,接近最大舒适级,在THR和MCL动态范围的80%～90%左右,均值t检验ESRT与MCL无统计学差异（P〉0.05）.结论 ESR既可以用于术中判断植入体是否完好和听觉传导通路是否正常,预测手术效果,又可以在术后协助人工耳蜗编程调试,是一种方便、快捷的客观检查方法.     

Evaluation of NRT and behavioral measures for MAPping elderly cochlear implant users

We investigated the acceptability of electrophysiologically derived MAPs and the effect of these MAPs on speech perception in elderly adults using Nucleus 24 cochlear implants. Eight implant recipients aged 75 years or older trialed an electrophysiologically derived MAP and a behavioral MAP. The electrophysiologically derived MAP was based on the threshold and maximum comfort level for electrode 10 and evoked compound action potential thresholds measured on six electrodes using neural response telemetry (NRT). Word perception at 55 dB SPL and sentence perception in noise at 70 dB SPL were assessed after six weeks take-home experience and again after an additional two weeks of experience. During the final two weeks of take-home experience participants indicated their preferred MAP for different listening situations. The NRT derived MAP estimated behavioral T levels well, but underestimated behavioral C levels for apical electrodes in some subjects. Speech perception with NRT derived MAPs was comparable to speech perception with behaviorally measured MAPs. MAPs estimated from NRT data provided good speech perception outcomes for elderly implant recipients and were well tolerated.     

A comparison of intra- versus post-operatively acquired electrically evoked compound action potentials

The objective of this study was to compare the electrically evoked compound action potentials, intra- versus post-operatively, in cochlear implant patients. In a prospective study twenty-five consecutively implanted adult patients received a multichannel cochlear implant. In all patients, electrically evoked compound action potentials were recorded immediately after cochlear implantation and in a post-operative setting nine months later. The threshold of the electrically evoked compound action potential was determined in both settings. A high success rate (97.4%) was found in the intra-operative setting when recording the electrically evoked compound action potential threshold per patient. The success rate per patient was significantly lower (53.4%) in the post-operative setting. Correlations between the intra- versus the post-operative ECAP thresholds were statistically significant for all electrodes tested. The ECAP thresholds were not significantly different for the two settings. The intra-operative setting is preferable for acquisition of the ECAP threshold.     

Neural response telemetry with the nucleus CI24M cochlear implant

OBJECTIVES: To review our intraoperative and postoperative testing protocol for cochlear implant patients. This study describes the methodologies and applications of a new technique called neural response telemetry (NRT) for the Nucleus CI24M cochlear implant system. NRT uses radiofrequency telemetry technology to measure the action potentials of the auditory nerve. STUDY DESIGN: We have developed a specific protocol for intraoperative testing of the implant device before, during, and after implantation. This includes device integrity tests, visual detection of electrical stapedius muscle reflexes (VESR), and NRT. METHODS: Our methodologies use the commercial software (Windows-based Diagnostic and Programming System [WIN-DPS] and NRT) for the Nucleus CI24M. We describe the details of our protocol used on all of the patients (14 adults and 14 children) who received CI24M implants at Mayo Clinic (Rochester, MN). Our protocol correlates the NRT threshold with the behavioral responses for each patient on at least four electrodes. RESULTS: From August 1, 1998, to December 31,1998, we completed electrode integrity tests, NRT, and VESR testing intraoperatively on 12 patients with the Nucleus CI24M. We have measured normal implant function on all 28 of our CI24M patients with one exception. One of our children had a device failure after approximately 4 months as a result of head trauma. We have also obtained NRT results from an additional 10 patients postoperatively. CONCLUSIONS: The measurement of device and electrode array function is quite simple with the CI24M software. These measurements can be obtained intraoperatively as well as postoperatively. We conclude that VESR and NRT measurements can be very helpful in programming for patients with cochlear implants, especially children, because they provides us with target settings for the speech processor.     

神经反应遥测技术在人工耳蜗植入术中的监测应用

目的探讨在人工耳蜗植入术中能快速、准确地判断人工耳蜗装置的完好性和患者客观听觉反应的监测方法.方法在40例患儿人工耳蜗植入术中先测定电极阻抗,然后使用神经反应遥测技术(neuralresponsetelemetry,NRT)监测6个电极的电诱发听神经复合动作电位(electricallyevokedauditorynervecompoundactionpotentials,ECAP).结果患儿所有电极阻抗正常,ECAP的检出率分别为97.5%(39例/40例)和92.1%(221个电极/240个电极).其中33例内耳无畸形的患儿所有198个测试电极中有195个电极测出清晰的ECAP波形(98.5%).7例内耳Mondini畸形患者共42个测试电极中有26个电极测得ECAP波形(61.9%),两组之间差异有极显著性.靠近耳蜗底回(高频区)的电极比靠近蜗尖(低频区)的电极具有较高的ECAP反应阈值和较高的ECAP饱和阈值.结论NRT技术可以简便、快速和准确地判断患者的听神经反应,可望成为术中常规监测方法,内耳Mondini畸形是影响ECAP检出的重要因素.     

Nucleus24M型人工耳蜗植入后电极阻抗的变化

目的：研究人工耳蜗植入后电极阻抗的变化规律，以便确定术后进行映射调图的时间表。方法：对16例植入Nucleus CI24M型人工耳蜗患者，于术中及术后1、1．5、2、4、6个月进行电极阻抗测试，统计分析电极阻抗的变化规律。结果：患者电极阻抗在术中检测时最低，开机时最高，以后若干次随访时，阻抗逐渐下降，并在2～4个月左右趋于稳定。结论：电极阻抗的稳定提示耳蜗内生物组织的病理过程渐趋稳定；对心理物理测试配合良好的患者，术后只进行2～4个月左右的映射调图即可。