多道人工耳蜗植入533例临床分析

Clinical review of cochlear implant in 533 cases

目的 分析人工耳蜗植入患者的手术适应证、手术方法和术后效果。方法 533例(534耳)重度和极重度聋患者接受人工耳蜗植入手术。其中语前聋495例,语后聋38例。植入时年龄:1～3岁167例,～5岁77例,-7岁73例,-14岁136例,～17岁28例,>17岁52例。内耳中耳畸形共76例,其中Mondini畸形26例、共同腔畸形10例、前庭水管扩大综合征20例。术前纯音听阈(听力级)为105.5 dB,听性脑干反应阈>95 dB,40 Hz相关电位(500 Hz)>101.7 dB。使用装置:Nucleus 22M 27耳,24M 308耳,24R Contour 131耳,24RST 21耳;Med El C40+44耳;Clarion CI 3耳。常规手术采用面隐窝进路方法。共同腔畸形病例采用经水平半规管进路。部分病例行术后声场测听和听觉言语评估。结果 Mondini畸形26例中有20例术中出现脑脊液井喷。电极平均植入深度:耳蜗正常病例中Nucleus 30环,Med El为31 mm。Mondini畸形病例中Nucleus 28环。共同腔畸形病例中Necleus 26环。语后聋患者的平均开放言语识别率为71％,17岁以下语前聋的问卷调查满意度为94.7％。结论 人工耳蜗是使重度和极重度聋患者恢复听觉功能的有效方法,术前评估,手术和术后康复都是治疗效果的关键。

Objective To summarize and analyze the etiology, surgical indications, operation methods and outcomes of cochlear implantation. Methods 533 cases (534 ears) with severe and profound hearing loss received cochlear implant, 489 were pre-lingual deafness and 38 cases were post-lingual deafness. Their ages at implant , 1-3 were 167, -5 were 77, -7 were 73,-14 were 136,-17 were 28, > 17 were 52. 76 cases ( 14. 3% ) were found the middle and inner ear malformations. That included Mondini 26 in cases, Common cavity in 10 cases and Large vestibule aqueduct syndrome in 20 cases. The average pure tone threshold were 105. 5 dB HL, ABR threshold were >95 dB nHL and 40 Hz threshold in 500 Hz were 101. 7 dB. The devices they used were Nucleus 22M in 27 ears, 24M in 308 ears, 24R Contour in 131 ears and 24R ST in 21 ears; Med El C40+ in 44 ears; Clarion CI in 3 ears. Facial recess approach was performed in normal cases, and in Common cavity cases horizontal semicircular canal approach was used. Preoperative hearing and speech evaluations were done in most cases. Results In 26 Mondini case, gusher were happened in 20 cases. The insertion depth in normal cases: Nucleus were 30 bands, Med El were 31 mm. In Mondini cases, Nucleus were 28 bands. In Common cavity cases, Nucleus were 26 bands. Of 533 cases, The average of open set sentences discrimination of post-lingual deadness was 70% , the satisfaction rate of questionnaire for pre-lingual deafness under 17 years old was 94. 7%. Conclusions Cochlear implant is a useful method to restore the hearing of the patients with severe and profound hearing loss. It is important for the outcomes with proper preoperative assessment, surgery and postoperative speech and hearing evaluations.