微创人工耳蜗植入对残余听力保护的临床应用

目的 明确耳蜗畸形与耳蜗正常患者经人工耳蜗微创植入后其听力恢复及残余听力保护的情况。 方法 经术前颞骨CT、内耳水成像及听力学检查对患者进行分组纳入，分析38例行微创人工耳蜗植入的患者资料，耳蜗畸形16例，耳蜗正常22例，比较两组患者人工耳蜗植入后听觉行为分级（categories of auditory performance,CAP）及言语可懂度分级（speech intelligibility rating，SIR）评分以及残余听力保留情况，听力保留标准：125、250、500 Hz平均阈值较术前升高＜10 dBHL。 结果 人工耳蜗电极均能顺利植入，术中检测电极阻抗均正常，开机后两组对象人工耳蜗均工作正常，听觉反应良好。16例耳蜗畸形患者术后1个月低频残余听力保留率82%，完全保留率33%，部分保留率49%。22例耳蜗正常患者，低频残余听力保留率100%，完全保留率82%，部分保留率18%。随访6个月、1年听力保留率与1个月时无变化。耳蜗畸形患者术后CAP和SIR值分别为5.7±1.2、3.5±1.0；耳蜗正常患者术后CAP和SIR值分别为6.4±1.1、3.7±0.9，两者差异无统计学意义（P＞0.05）。 结论 耳蜗畸形患者术后不同时间的言语康复情况、对声音的反应能力与耳蜗正常患者术后无明显的差异。但耳蜗畸形由于结构的影响，耳蜗畸形组低频残余听力的保留率要有一定程度的下降。本研究耳蜗正常与耳蜗异常患者人工耳蜗植入后其术后疗效及残余听力的保留情况无显著差异，这一结果为临床诊治该类患者提供指导。

Clinical application of minimally invasive cochlear implantation for residual hearing protection

ObjectiveTo clarify the hearing recovery and residual hearing protection of patients with cochlear malformation and those with normal cochlea but requiring cochlear implantation after minimally invasive cochlear implantation.MethodsThe patients were grouped and included by pre-operative temporal bone CT, inner ear hydrography and audiology examination. The data of 38 patients undergoing minimally invasive cochlear implantation were analyzed, including 16 cases of cochlear malformation and 22 cases of normal cochlea. We compared the categories of auditory performance(CAP) and speech intelligibility rating(SIR) scores and residual hearing retention between two groups after cochlear implantation. The criteria for hearing retention were as follows: the mean thresholds of 125, 250 and 500 Hz were ＜10 dBHL higher than those before implantation.ResultsThe electrode of artificial cochlea was successfully implanted, and the electrode impedance was detected normally during the operation. After startup, the cochlear implant worked normally and well in both groups. In 16 cochlear implantation patients with cochlear malformation, the low-frequency residual hearing retention rate was 82%, complete hearing retention rate was 33%, and partial hearing retention rate was 49% at 1 year after cochlear implantation. In 22 patients with normal cochlea, low-frequency residual hearing retention rate was 100%, complete hearing retention rate was 82%, and partial hearing retention rate was 18%. There was no change in hearing retention rate between 6-months and 1-year follow-up compared with the data at 1 month. The postoperative CAP and SIR scores were 5.7±1.2 and 3.5±1.0 in patients with cochlear malformation respectively, and 6.4±1.1 and 3.7±0.9 in patients with normal cochlea respectively, and the difference was not statistically significant(P＞0.05).ConclusionThere is no significant difference in speech recovery and response ability to voice between patients with cochlear malformation and those with normal cochlea. However, the retention rate of low-frequency residual hearing in cochlear malformation group decreased to a certain extent due to the influence of the cochlear structure. In this study, there is no significant difference in postoperative efficacy and retention of residual hearing between patients with cochlear malformation and those with normal cochlea after minimally invasive cochlear implantation, which provides guidance for clinical diagnosis and treatment of such patients.