Mondini畸形电子耳蜗植入电极选择与术后效果分析

Comparison of hearing rehabilitation for patients with Mondini malformation after cochlear implantation with different electrodes

目的:探讨Mondini畸形患者采用弯电极进行电子耳蜗植入的手术方法,比较直、弯电极电子耳蜗植入的术后效果。方法:收集进行电子耳蜗手术的Mondini畸形患者,选择植入弯电极的患者9例,另根据植入年龄、康复条件等选择9例直电极植入患者进行配对分组。分析两组Mondini畸形患者术前听力学特征、术中手术特点、术后神经反应遥测(NRT)结果及开机调试结果,随访术后听觉行为分级标准(CAP)和言语可懂度分级标准(SIR)评分,对比分析采用不同电极患者的测试参数及术后康复效果。结果:Mondini畸形患者术前听力均为极重度神经性聋,4例术中出现脑脊液"井喷";直电极组2例出现面肌抽搐,其余无术后面瘫、面肌抽搐、脑脊液漏、脑膜炎等并发症;所有Mondini畸形患者术后均获得听觉,术中电极植入后测试NRT,弯电极组NRT引出率为77.78%,高于直电极组引出率(55.56%)。开机6个月收集编程调试的阈值(T-levels)、最大舒适强度(Clevels)和动态范围,其中平均T值:弯电极组(145.11±10.88)CL,直电极组(168.44±22.45)CL,P<0.05;平均C值:弯电极组(182.67±14.65)CL,直电极组(213.00±19.27)CL,P<0.05;动态范围:弯电极组(37.56±6.75)CL,直电极组(44.56±18.06)CL,P>0.05。随访6个月~4年,CAP平均得分弯电极组为7.28±0.62,直电极组7.22±0.79,P>0.05;SIR平均得分弯电极组为4.17±0.56,直电极组4.00±0.71,P>0.05。结论:Mondini畸形患者可以根据需要采用弯电极电子耳蜗植入,术后听力言语康复与直电极无显著性差异,优点是刺激电量较小,NRT引出率高,并发症发生率低。

Objective：To investigate the feasibility of cochlear implantation with contour electrode in patients with Mondini malformation and analysis of hearing rehabilitation after operation.Method：Collection of 9cases of straight electrode cochlear implantation patients with Mondini malformation,according to the age of deafness and the condition of rehabilitation,9patients with curved electrode implanted were matched and grouped.Retrospectively analysis of audiology characteristics,surgical technique,postoperative NRT results and map results,and evaluating the hearing and speech rehabilitation ability by CAP and SIR scores.The test parameters and rehabilitation effect of two groups＇ patients were compared according to different implant electrode.Result：Eighteen cases of patients with Mondini malformation are severe sensory neural hearing loss according to preoperative hearing test,6cases without residual hearing.By preoperative EABR test,all patients were implanted with different types of electrode.There were 4cases of ＂gush＂ in operation,2cases of facial spasm in straight electrode group,no complications postoperative cerebrospinal fluid leakage,no facial paralysis,no meningitis and other surgical complication after operation.Detecting NRT,the inducing rate of NRT was 77.78%in contour electrode group and 55.56%in straight electrode group;6month after operation,the average T value was（145.11±10.88）CL in contour electrode group and（168.44±22.45）CL in straight electrode group,P〈0.05;the average C value was（182.67±14.65）CL in contour electrode group and（213.00±19.27）CL in straight electrode group,P〈0.05.Dynamic range：（37.56±6.75）CL in contour electrode group and（44.56±18.06）CL in straight electrode group,P〉0.05.Postoperative follow-ups were performed from 6months to 4years,the average score of CAP was 7.28±0.62 in contour electrode group and 7.22±0.79 in straight electrode group,P〉0.05;the average score of SIR was4.17±0.56 in contour electrode group and 4.00±0.71 in straight electrode group,P〉0.05.Conclusion：Contour electrode can be chosen for bilateral serious hearing loss patients with Mondini malformation assisted by EABR,there is no significant difference compared with straight electrode in postoperative hearing and speech rehabilitationability.The advantages are that the stimulation quantity is small,the NRT extraction rate is high,and the complication rate is low.