28例人工耳蜗植入术前鼓岬电刺激检测听觉通路及术后评估

Evaluating auditory pathway by promontory stimulation test and postoperative hearing rehabilitation(28 cases)

目的:探讨鼓岬电刺激对成人无残余听力人工耳蜗植入患者术前听觉通路检测的价值及预估术后听觉康复效果。方法:选取行鼓岬电刺激的成人语后聋患者28例,均为双侧极重度神经性耳聋,纯音测听及助听听阈测试双耳无残余听力。门诊局部麻醉下行鼓岬电刺激,测试双耳50、100、200 Hz脉冲方波的电听觉阈(T值)、最大舒适阈(M值)及频率辨别力,其中22例患者可以测到电听觉,植入人工耳蜗装置,术后1个月开机,术后12个月测试NRT,测试安静环境下闭合项双字词言语识别率,进行统计学分析。结果:22例可测到电反应,鼓岬电刺激100、200 Hz平均T值分别为(14.21±12.86)μA和(20.37±19.19)μA,M值分别为(33.88±21.79)μA和(47.92±28.93)μA,动态范围分别为(21.18±14.15)μA和(27.55±20.40)μA。14例可以辨别频率差异,选择可以测得电听觉反应的患耳进行人工耳蜗手术,术后22例患者开机成功,开机后12个月助听听阈为(25.87±2.35)～(41.27±4.55)dB,安静环境平均言语识别率为(74.37±15.19)%,统计学分析患者术后言语识别率和鼓岬电刺激的100Hz、200Hz的动态范围以及100Hz的T值和200Hz的T、M值有显著相关性(P<0.05),和频率辨别能力显著相关(P<0.05)。结论:鼓岬电刺激可以用来检测患者电听性反应,在人工耳蜗植入术前评估听觉通路,筛选手术适应证,并初步预估术后听觉康复效果。

Objective:To evaluate auditory pathway in patients by promontory stimulation test(PST)before artificial cochlear implantation(CI),and to analyze the relationship between postoperative hearing rehabilitation and PST.Method:Selecting 28 cases of adult subjects without residual hearing who accepted promontory stimulation test,different etiology led to bilateral severe sensor neural deafness.PST was examined by measuring the electric auditory threshold(T value)and maximum comfort threshold(M value)of 50,100 and 200 Hz pulse square waves,and by measuring frequency discrimination.Cochlear implantation was performed in 22 patients detected electrical hearing.NRT and speech perception of disyllabic words were tested 12 months later.The data was analyzed by statistically.Result:Twenty-two patients could be detected,the average T value of PST of 100 and200 Hz:(14.21±12.86)μA,(20.37±19.19)μA,M value:(33.88 ±21.79)μA,(47.92 ±28.93)μA,the dynamic range:(21.18±14.15)μA,(27.55±20.40)μA.14 patients can distinguish the frequency difference.22 patients accepted hearing 1 month after surgery.The average hearing threshold at 12 months is(25.87±2.35)dB to(41.27±4.55)dB.The average speech perception rate at 12 months is(74.37±15.19)%in quiet environment,and it was significantly difference(P<0.05)between two groups in frequency discrimination ability.Postoperative speech perception outcome correlated with the dynamic range of the PST at 100 and 200 Hz,and the T value of 100 Hz and the T and M values of 200 Hz,there were statistically significant difference(P<0.05).Conclusion:PST can be used to evaluate the auditory pathway in difficult cases before cochlear implantation,and to predict functional outcome after cochlear implant surgery.