人工耳蜗植入术后听觉言语效果的影响因素

Effect of cochlear implantation on hearing and speech rehabilitation

目的探讨影响人工耳蜗植入术后听觉言语恢复效果的相关因素。方法对24例双耳重度或极重度感音神经性耳聋患者，术前进行智力、听力学、影像学检查，配带助听器评估，并严格掌握手术适应证，经乳突-面隐窝进路行人工耳蜗植入术，记载术中情况，术终测电极电阻，术后1个月开机调试，语前聋者进行听觉语言培训，术后追踪随访疗效满意度和言语可懂度，对所得临床资料进行分析。结果 23例耳蜗植入手术一次成功，1例电极移位二次手术成功，术后暂时性面瘫2例、眩晕1例，两周X线颞骨拍片证实耳蜗电极位于耳蜗内，1个月开机调试，全部病例获取听力。3例语后聋患者听觉言语恢复，其他语前聋患者均行半年以上的听觉语言培训，随访4—6年，半开放式言语识别率〉80％，全部患者及家属达到术前的期望值。结论人工耳蜗是治疗重度极重度感音神经性耳聋及全聋的有效方法，术后效果主要与人工耳蜗植入时的年龄、术前听力与言语基础、听神经及其传导功能、智力、植入电极在规定的部位、术后调机与康复的有效性等关系密切。

Objective To investigate factors affecting hearing and speech rehabilitation following cochlear implantation. Methods Twenty-foar case.s of bilateral severe or profound sensorineural deafness had intelligence, audiology, aural image and hearingaids estimated before multi-channel cochlear implantation through the facial nerve recess approach. Postoperative electrode resistance was recorded and mapping was carried out one month after the operations. Pre-lingual patients received audition and speech or language skill rehabilitation trainings. Results Twenty-three patients were successfully operated on and one with electrode placement was operated on twice. During the follow-up, two patients had short-term facial paralysis and one had a short period of vertigo. An X-my film of the temporal bones two weeks later proved that all electrodes were properly located in the cochlear. Mapping performed one month after the surgery showed that heating was completely recovered in 24 cases. Three post-lingual deaf patients were able to hear and speak. Other per-lingual deaf patients received audition and speech or language skill rehabilitation trainings. During a follow-up of 4-6 years, the language understanding rate was 80% and the appropriate expectation was sailstied. Conclusion Cochlear implantation is a routine treatment for bilateral severe or profound sensorineural deafness. Its thempeutic effectiveness is correlated with many factors including indication, age, hearing-aids before the operations, remnant audition, course of operation, electrode position, audition and speech or language skill rehabilitation trainings and appropriate expectations.