儿童人工电子耳蜗植入术的护理体会

<正>人工耳蜗植入术(cochlear implantation,CI)即在耳蜗内埋植电极以刺激听神经,是为耳聋患者重建听觉的治疗策略之一,是感音神经性耳聋患者获得听觉的新技术[1]。为保证CI的成功,除了适应证选择得当和精湛的手术技术外,手术前后的护理同样重要。我院近年来收治双耳极重度感音神经性耳     

耳聋的鉴别诊断

耳聋是听觉系统障碍所致的听力减低。轻者为重听,重者为耳聋。因两者之间无明显分界故概称为聋。根据发病的时间分为先天性聋和后天性聋;根据病变部位可分传音性聋、感音神经性聋和混合性聋;根据病变性质可分器质性聋和功能性聋。一、先天性聋出生后即有听力障碍者称为先天性聋。分传音性聋和感音神经性聋,前者因外耳及中耳病变所引起;后者因耳蜗、听神经和听中枢病变所     

重度感音神经性耳聋行人工耳蜗植入术13例围术期护理

对13例重度感音神经性耳聋患儿行人工耳蜗植入术,并给予精心围术期护理,本组无一例患儿出现面瘫、感染、大出血及植入体移位等并发症.认为人工耳蜗可帮助患有重度感音神经性耳聋患儿恢复或获得听力,提高其语言交流能力.     

人工耳蜗植入术的手术配合

当听觉系统中的传音、感音部、听神经和其各级中枢发生病变,听功能出现障碍,即发生不同程度的听力下降,称为耳聋。耳聋分类不同,治疗方法也不尽相同,其中人工耳蜗植入是帮助双侧重度、极重度感音神经性耳聋患者康复听觉的有效手段之一。2009年2月至2012年12月,本院耳鼻咽喉科为78例患者实施人工耳蜗植入术,现将手术配合报告如下。     

MRI对儿童感音神经性耳聋人工耳蜗植入术前的诊断价值

目的探讨磁共振成像在儿童感音神经性耳聋(SNHL)人工耳蜗植入术前的诊断价值及临床应用。方法回顾性分析80例临床诊断为SNHL拟行人工耳蜗植入的患儿MRI图像,结合内耳畸形的最新分类标准进行影像学分类诊断。结果 80例(160耳)发现中内耳畸形152耳,其中耳蜗畸形38耳,前庭畸形33耳,半规管畸形41耳,内耳道畸形40耳,前庭导水管扩大37耳,蜗神经畸形46耳。结论 MRI能对儿童感音神经性耳聋人工耳蜗植入术前提供丰富详细的解剖学信息,并进行分类诊断,对指导手术、评估预后等都具有重要的临床意义。     

儿童期分泌性中耳炎与语言发育迟缓的临床分析

目的探讨儿童期分泌性中耳炎所致感音神经性耳聋对语言、认知和交流能力的影响，及对分泌性中耳炎感音神经性耳聋患儿早期确诊、早期治疗、早期进行听力语言康复的重要性。方法根据26例语言发育迟缓的分泌性中耳炎患儿就诊情况及听力调查资料，分析高频听力损失和语言频率的关系以及对语言、认知和交流能力的影响。结果分泌性中耳炎所致感音神经性耳聋患儿对语言、认知和交流能力有影响，只有当高频听力损失达到一定程度，并波及到语频时，才会引起语言发育迟缓。早期发现分泌性中耳炎感音神经性耳聋儿童，早期确诊，早期进行听力语言康复非常必要，可以大大地减少因感音神经性耳聋所致的语言障碍。结论儿童期分泌性中耳炎所致的感音神经性耳聋可以引起患儿语言发育迟缓。对分泌性中耳炎患儿早期诊断、早期治疗可避免残余听力障碍对语言、认知和交流能力的影响。我们将病程超过3个月以上的儿童期分泌性中耳炎作为感音神经性耳聋的高危儿童，在儿童保健系统开展听力筛查，及早发现感音神经性耳聋儿童，可将此类儿童的早期诊断的确诊率、早期配戴助听器和早期开展听觉语言康复的年龄提前。     

改良鼻饲法在脑卒中后意识障碍患者中的应用

对13例重度感音神经性耳聋患儿行人工耳蜗植入术,并给予精心围术期护理,本组无一例患儿出现面瘫、感染、大出血及植入体移位等并发症。认为人工耳蜗可帮助患有重度感音神经性耳聋患儿恢复或获得听力,提高其语言交流能力。     

人工耳蜗植入患者的健康教育

人工耳蜗是一种电子装置,它能代替病变受损的听觉器官,把声音转换成编码的电信号传人内耳耳蜗,刺激残存的听神经纤维,由大脑产生听觉。帮助双耳重度或深度感音神经性耳聋的患者(听力损失90分贝以上)获得或重获听觉,从无声世界回到有声世界。2002年11月27日至2003年9月22日,我科引进澳大利亚的24导人工耳蜗,成功地为10例耳聋患者进行了植入术,现将护理体会总结如下：     

豚鼠脂肪间充质干细胞植入耳聋模型修复听力的作用

背景：脂肪间充质干细胞是否是治疗因毛细胞退化、缺失所造成的感音神经性聋的福音呢？目的：探讨豚鼠脂肪间充质干细胞经耳蜗鼓阶途径植入感音神经性耳聋动物模型后对听力的修复作用。方法：庆大霉素腹腔注射建立豚鼠感音神经性耳聋动物模型,耳蜗鼓阶途径植入豚鼠脂肪间充质干细胞,分别于植入后1,3周检测听性脑干反应,观察植入脂肪间充质干细胞后耳聋动物听力的变化;并追踪EDU标记的豚鼠脂肪间充质干细胞在耳蜗内的迁移及分布情况。结果与结论：在植入后1周及3周进行听性脑干反应检测,听力较移植前逐渐好转。植入细胞后1周,细胞大多分布在外淋巴液中,部分迁移至耳蜗柯蒂器贴附于基底膜上,植入细胞后3周,细胞不仅迁移并贴附在Corti器基底膜发挥作用,而且部分迁移到蜗神经,植入时间越长,存活细胞越少。结果表明豚鼠脂肪间充质干细胞通过耳蜗鼓阶途径微孔植入,可以定向迁移并存活最终达到提高听力的目的。     

耳聋的临床诊断与治疗

耳聋是听觉传导路发生器质性或功能性病变致不同程度听力损害(hearing impairment)的总称,程度较轻的亦称重听,显著影响社交能力者称为聋,因听觉障碍难以用语言进行正常人际沟通者称为聋哑或聋人.按耳聋发生部位与性质,一般将耳聋分为传导性聋、感音神经性聋和混合性聋.感音神经性聋按病变部位可再分为中枢性聋、神经性聋和感音性聋,但中枢性聋罕见,单纯的神经性聋少见,感音性聋最为常见.一般情况下.临床仍将三者合称感音神经性聋[1].因此,耳聋可能是原发疾病,也可能是某些疾病的症状.临床实践中,由于患者或患儿家长讲述不清、医师认识不足或疾病处于不同发展阶段等因素,易导致误诊误治,甚至引起医疗事故.为提高耳聋临床诊治水平,本文根据笔者长期临床经验和科研成果,结合复习近年文献,就耳聋的I临床诊断与治疗相关问题提出个人看法,供同道们参考与讨论.     

语前聋儿多导人工耳蜗植入6例随访观察

目的 探讨多导人工耳蜗植入对重度感音性语前聋儿童的治疗效果. 方法 对 6例极重度感音性语前聋儿童植入由澳大利亚 Cochlear公司生产的 Nuclus24型多导人工耳蜗.术后 1个月开机. 结果 6例语前聋儿童在接受人工耳蜗植入后均获得听力,听阈平均提高到 33.33 dBHL;双音节词言语辨别率( SDS)术后 6个月听平均 28.33% ,听加唇读平均 61.6%;术后 12个月( SDS)听平均 51%,听加唇读平均 73.8%,比术前有明显改善. 结论 多导人工耳蜗植入对恢复极重度感音神经性语前聋儿童的听觉是有效的,植入年龄越小效果越好.     

Sensorineural hearing loss associated with Byler disease.

Progressive familial intrahepatic cholestasis, sometimes described as Byler disease, is a lethal liver disease and its inheritance is autosomal recessive. There is a previous report on the occasional association between this disease and sensorineural hearing loss without any audiological findings. We report here two siblings, an 18-year-old female and a 16-year-old male, suffering from Byler disease and hearing loss. Pure tone, Bekesy and speech audiometries and auditory brain stem response examination were performed. Audiometric data showed hearing characteristics of cochlear origin, high-frequency loss and progressiveness. This sensorineural hearing loss possibly results from a genetic mutation. The mechanism of cochlear disorder in patients with Byler disease is unknown, however, a novel gene responsible for deafness might be found to be related to Byler disease.     

Challenges for stem cells to functionally repair the damaged auditory nerve

Introduction: In the auditory system, a specialized subset of sensory neurons are responsible for correctly relaying precise pitch and temporal cues to the brain. In individuals with severe-to-profound sensorineural hearing impairment these sensory auditory neurons can be directly stimulated by a cochlear implant, which restores sound input to the brainstem after the loss of hair cells. This neural prosthesis therefore depends on a residual population of functional neurons in order to function effectively.

Areas covered: In severe cases of sensorineural hearing loss where the numbers of auditory neurons are significantly depleted, the benefits derived from a cochlear implant may be minimal. One way in which to restore function to the auditory nerve is to replace these lost neurons using differentiated stem cells, thus re-establishing the neural circuit required for cochlear implant function. Such a therapy relies on producing an appropriate population of electrophysiologically functional neurons from stem cells, and on these cells integrating and reconnecting in an appropriate manner in the deaf cochlea.

Expert opinion: Here we review progress in the field to date, including some of the key functional features that stem cell-derived neurons would need to possess and how these might be enhanced using electrical stimulation from a cochlear implant.     

Regeneration of the auditory pathway

In order to investigate the possibility of the treatment of sensorineural hearing disturbance, experiments were performed using animals. First, the central cochlear pathway in the brain stem to pons was transected in adult rats. Tissue from embryos was transplanted to the lesion site. In 20% of the rats examined, the axons regrew beyond the transected site and regenerated into the denervated side and terminated at the normal targets. The hearing function of animals was also recovered. Those findings contradict the widely held view that the adult mammalian central auditory system cannot be restored following damage. Then, adult rat hippocampus-derived neural stem cells(NSC) were grafted into newborn rat cochlea. Within two to four weeks of grafting to the cochlea, some NSC survived in the cochlear cavity. Some of them had adopted the morphologies and positions of hair cells. This suggests that NSC can adapt to the environment of the cochlea and gives hope for treatment of the damaged cochlea and sensorineural hearing loss.     

听神经瘤手术之耳科观

听神经瘤是桥脑小脑角区最常见的良性肿瘤,常见症状包括单侧感音性听力下降、耳鸣、眩晕等。手术切除是听神经瘤的主要治疗方式,常用入路包括以耳科为主的经迷路入路、经耳囊入路、扩大经迷路入路、改良经耳囊入路和颅中窝入路,以神经外科为主的枕下乙状窦后入路等。一般建议听力良好的小肿瘤选择颅中窝入路;肿瘤较大、希望保留听力者采用枕下乙状窦后入路;不考虑保留听力且为中、小型听神经瘤者,可采用经迷路入路或经耳囊入路。随着显微外科技术的发展以及术中神经监测设备的广泛应用,中、小型听神经瘤手术的面/听神经功能保留率已有显著提高,未来更多的听神经瘤患者有望在保留面/听神经功能的基础上获得治愈。     

Sensorineural Hearing Loss in Sickle Cell Disease: Case Reports

Sickle cell disease (SCD) is characterized by intermittent episodes of vascular occlusion and end-organ damage. It is believed that auditory impairment is associated because of sickling and slugging of blood in the cochlea. A prevalence of sensorineural hearing loss among patients with SCD has been reported. We present 2 patients with SCD with sudden sensorineural hearing loss. The goal is to detect hearing loss early and improve developmental and language outcomes. Understanding the need to screen for hearing loss in children with SCD will enable providers to maximize the quality of life of patients and improve school performance.     

Integration of acoustic and electrical hearing

For some individuals with severe high-frequency hearing loss, hearing aids cannot provide a satisfactory improvement in speech recognition. However, these same patients often have too much residual hearing to qualify as candidates for a cochlear implant. Here we describe results with the Iowa/Nucleus Hybrid cochlear implant, which is designed to preserve the patient's residual low-frequency hearing while at the same time supplementing their high-frequency hearing through electrical stimulation. The advantages of this approach are presented, including improved speech recognition in competing backgrounds as compared with traditional cochlear implants. The results with the Iowa/Nucleus Hybrid device demonstrate the ability of the auditory system to integrate acoustic and electrical stimulation, even under conditions of severe distortions to the normal cochlear place-frequency mapping.     

Unilateral sudden sensorineural hearing loss with vertigo as a first symptom of bilateral internal auditory canal metastases: a case report

There have been relatively few reports of bilateral internal auditory canal metastases of asymptomatic primary pulmonary adenocarcinoma presenting as unilateral sudden sensorineural hearing loss and vertigo. We report a case of a 60-year-old male patient who complained of sudden hearing loss in the right ear and vertigo. Upon a physical examination, no definite neurological signs or nystagmus were observed. Pure-tone audiometry showed deafness in the right ear at all frequencies and high-frequency sensorineural hearing loss in the left ear. The video head impulse test suggested bilateral vestibulopathy. Magnetic resonance imaging of the brain (with gadolinium contrast) revealed bilateral internal auditory canal enhancement and a variable-sized nodular and peripheral-enhancing lesion in the cerebrum and the right cerebellum. A computed tomographic and bronchoscopic biopsy identified asymptomatic primary pulmonary adenocarcinoma in the left upper lobe of the lungs. This is a rare report of bilateral internal auditory canal metastases in an asymptomatic patient with primary pulmonary adenocarcinoma who initially presented with symptoms of unilateral sudden sensorineural hearing loss with vertigo.     

糖尿病对听力及耳蜗形态学结构影响的相关因素

背景：糖尿病是多种病因引起以高血糖为特征的代谢紊乱内分泌性疾病,由于患者长期高血糖状态可引起微血管病变,导致患者听力下降、耳鸣。糖尿病与听力损伤的关系密切,糖尿病听力损伤的发病机制可能与糖尿病引起的微血管病变和代谢紊乱有关。目的：从耳蜗微循环、细胞稳态、遗传及衰老等方面了解糖尿病听力损伤的原因,来揭示目前尚未完全明确的糖尿病听力损伤机制,为临床治疗方案的选择和预后的判断提供根据。方法：糖尿病与听力损伤的关系密切,糖尿病听力损伤的发病机制可能与糖尿病引起的微血管病变和代谢紊乱有关。从耳蜗微循环、细胞稳态、遗传及衰老等方面了解糖尿病听力损伤的原因,来揭示目前尚未完全明确的糖尿病听力损伤机制。结果与结论：糖尿病患者听力损伤属于糖尿病微血管病变,耳蜗微循环在听觉生理中起着十分重要的作用,内耳许多疾病与微循环障碍有关,耳蜗微循环障碍引起耳蜗缺血和缺血后再灌注损伤是导致听力损伤的重要原因。