人工耳蜗植入患者电诱发镫骨肌反射的阈值及其临床意义

Electrically evoked stapedius reflex threshold and its clinical contribution of cochlear implantations

目的通过对人工耳蜗植入患者术后调试中进行主观心理物理测试和术中及术后电诱发镫骨肌反射阈值(electrically evoked stapedius reflex threshold,ESRT)的检测,探讨应用客观方法进行术后调试的临床应用价值,为人工耳蜗术后程序的调试提供客观依据。方法对2003年8月至2006年4月行 Medel 多道人工耳蜗系统 Combi 40+型人工耳蜗植入的28例患者检测电诱发镫骨肌反射阈和开机调试中主观心理物理测试的最大舒适阈,比较两者之间的关系。结果对10例患者进行术中电诱发镫骨肌反射的检测,引出率为78.3%(94/120)。进行术后电诱发镫骨肌反射的检测,引出率为82.5%(99/120),3例大前前庭导水管综合征患者的引出率为47.2%(17/36)。28例患者按每个电极的术后最大舒适阈(maximum comfortable level,MCL)与 ESRT 进行比较:①术后 MCL 平均值大于 ESRT 为247个电极(80.5%);②术后 MCL 值等于 ESRT 有14个电极(4.6%);③术后 MCL平均值小于 ESRT 有46个电极(15.0%)。术后 ESRT 平均值为(677.1±109.8)cu,MCL 平均值为(732.3±114.8)cu,ESRT 小于 MCL(t=11.37,P<0.05)。结论人工耳蜗植入术中观察到电诱发镫骨肌反射可以确切提示植入设备完好,由植入体至听觉中枢传导通路正常;电诱发镫骨肌反射阈值对术后开机调试有指导意义。

Objective To investigate and measure the electrically evoked stapedius reflex threshold （ESRT） and the maximum comfortable level （MCL） ,the feasibility of using objective index of the fitting of speech processor was evaluated. Methods The relationship of ESRT and MCL was conducted by measuring the ESRT and MCL of 28 Medel Combi 40 ＋ cochlear implant users from August 2003 to April 2006. Results The incidence of ESRT of 10 patient during operation was 78.3% （94/120）, and the incidence 3 months after the operation was 82. 5% （99/120）. The incidence of ESRT in 3 patients with Large vestibular aqueduct syndrome was 47.2% （17/36）. The ESRT and MCL of each electrode of those 28 patients after operation were compared, the result was shown as following： （ 1 ）247 electrodes＇MCL were greater than ESRT ;（2） 14 electrodes＇ MCL were equal to ESRT; （3） 46 electrodes＇ MCL were smaller than ESRT. The average of ESRT after operation was（677.1± 109. 8） cu ,the average of MCL was （732. 3 ± 114. 8） cu. ESRT was smaller than MCL（ t = 11.37, P 〈 0. 05 ）. Conclusions The cochlear implantations must be in normal working condition when ESR was positive. ESRT is a useful method to map the fitting of speech processor.