语前聋听神经病多道人工耳蜗植入效果初步观察

目的 探讨听神经病患者人工耳蜗植入后的电生理结果 变化并分析其听力言语康复效果.方法 对行人工耳蜗植入术的2例听神经病患儿进行术前听力学评估,术中、术后听觉诱发电位反应监测及开机后1年的随访,获得其开机后6个月与12个月时的听力言语康复效果,并与人工耳蜗使用时间相近的非听神经病耳蜗植入患儿的康复效果进行对比.结果 例1术中神经反应遥测henral response telemetry,NRT)及电刺激听性脑干诱发反应(electric auditory brainstem response,EABR)可引出波形,但重复性不好,EABR V波潜伏期延长.开机12个月时复查,2项电生理检查均引出可重复波形,EABR V波潜伏期在正常范围;听力言语康复效果显著提高,开机1年后有意义听觉整合量表得分优于对照组儿童;例2术中NRT未引出有意义波形,EABR可引出波形,但重复性不好;开机12个月复查,2项电生理检查均引出可重复波形,EABR V波潜伏期在正常范围;术后听力言语康复效果亦有所提高.结论 2例听神经病患者人工耳蜗植入后,术前听觉通路电活动的去同步化均得到一定程度的恢复,听力言语能力也有不同程度提高,说明人工耳蜗植入可以作为听神经病患者实现听力重建,重返主流社会的治疗和康复手段.

Outcome of cochlear implantation in prelingual pediatric auditory neuropathy

OBJECTIVE: To explore the electrophysiological results and rehabilitation outcome of two prelingually deafened pediatric cochlear implant patients with auditory neuropathy. METHODS: Preoperative audiological evaluation, intra-postoperative electrically evoked auditory brainstem response (EABR) and neural response telememetry (NRT) record for the two cases were conducted in Beijing Tongren Hospital. A one year follow-up was performed. Data collected before and at 6,12-month intervals after implantation were compared with that from control pediatric cochlear implant patients matched for the same duration of implant use as this two cases. RESULTS: The two children implanted had not had any postoperative medical or cochlear implant device complications. Intraoperative EABR and NRT were elicited in case 1 with unrepeatable waveforms. After 12 months of training, Case 1 had shown significant improvements in sound detection, speech perception abilities and communication skills, which was better than the control group, and the electrophysiological results became normal. Case 2 had also benefited from cochlear implantation, even though no recognizable NRT was found until he returned 12 month after the operation. CONDUSIONS: The desynchronization of auditory path had been changed after the electrical stimulation ongoing 12 months for children with auditory neuropathy. The two children had not had any complications postoperatively, and each child had shown improved listening and communication skills. Cochlear implantation could help patients with auditory neuropathy to improve their communication skill and go back to the main stream.