小儿人工耳蜗植入术后调试结果的变化特点

The Changes of Threshold and Comfortable Levels Associated with Mapping in Cochlear Implants Worn by Children

目的探讨人工耳蜗植入小儿开机一个月调试结果的变化特点,为其编程调试提供指导和依据。方法受试对象为使用澳大利亚Cochlear Nucleus 24型人工耳蜗系统的31例儿童。术后一个月起行系列的人工耳蜗编程调试,在调试中运用小儿行为测听法获得阈值(threshold level,TL)、舒适阈(comfortable level,CL)等参数,并将开机及开机后一个月所获得的数据进行比较分析。结果开机与开机一个月时相比,TL降低而CL升高,其中高频段电极通道的TL下降幅度较低频段电极通道更大,而低频段电极通道的CL增高幅度较高频段大(P<0.001)。各次调试获得的TL及CL结果均显示高频段通道的电流水平高而低频段通道的电流水平低(P<0.001)。开机时低频段动态范围(dynamic ranges,DR)最大,而开机一个月后高频段DR最大(P<0.001)。开机一个月后高、中、低3个频段电极通道的DR均较开机时大,其中高频段的DR改变较低频段更明显(P<0.001)。结论人工耳蜗植入小儿开机后的一个月期间,其编程调试结果变化显著,有必要对患儿进行多次调试。

Objective To investigate the changes of threshold and comfortable level associated with mapping in cochlear implants worn by children. Methods Thirty one children with multi--channel cochlear implants participated in this study. The threshold level（T--level）, comfortable level（C--level）and dynamic range （DR） in behavioral responses were recorded in the first mapping and one month afterwards, respectively. Results The average T- level in all the subjects decreased, especially for the electrodes of higher frequency while the average C--level increased in the electrodes of lower frequency, one month after the first mapping （P〈50. 001）. The average T--level or C-- level went up as the frequency band increased for the two mappings （P＇~0. 001）. The average DR decreased in the first mapping and increased one month later as the frequency band increased, respectively. The average DR for the electrodes of all the frequency band increased one month after the first mapping, especially for the higher frequency （P^0. 001）. Conclusion The changes of threshold and comfortable levels associated with mapping in cochlear im- plants worn by children were evident and one or more re--mappings should be required in the first month after the first mapping because this is a critical period for the children with cochlear implant to acquire better hearing.