电诱发听性脑干反应在人工耳蜗植入中的应用

Application of EABR in cochlear implantation

目的分析人工耳蜗植入患者耳蜗植入前电诱发听性脑干反应(electrical auditory brainstem response,EABR)的测试结果并初步探讨其意义。方法对14例不同病因、不同年龄的人工耳蜗植入患者耳蜗植入前进行测试,采用EMG外置电刺激器连接面神经探针作为刺激电极,采用Neuro Soft公司生产的Neruo-Audio听觉诱发电位仪及调试软件进行EABR测试,测量并分析EABR波形,各波潜伏期和波间期,Ⅴ波波幅、阈值。结果EABR的Ⅱ、Ⅲ、Ⅳ、Ⅴ波与声诱发ABR相似,Ⅲ、Ⅴ波的潜伏期较声诱发ABR缩短,但Ⅲ~Ⅴ波间期与声诱发ABR相同。14例耳聋患者均记录到EABR的Ⅲ波/Ⅴ波,引出率为100%。4例极重度感音神经性聋未合并其他异常患者术中2.5、2.0 mA刺激Ⅲ、Ⅴ波典型,潜伏期和波间期均正常,术中神经反应遥测技术(neural response telemetru,NRT)引出,提示其听神经脑干传导通路无异常,预后效果良好。其他部分患者存在潜伏期延长或波形分化不良或刺激阈值较高等表现,提示可能由于不同因素所导致听觉传导通路异常。结论EABR是通过电刺激耳蜗来了解听觉系统对电刺激的生理反应,最接近人工耳蜗的工作状态,可以对患者听力康复的效果提供更准确的预测;特别是对于一些特殊患者,具有评估人工耳蜗植入效果的优势。而对各种特殊类型耳聋的人工耳蜗植入术前检测、术后评估数据仍需深入探索。

Objective To evaluate the outcomes and significance of electrical auditory brainstem response(EABR)before cochlear implantation(CI).Methods Preoperative EABR was performed in 14 patients underwent CI with different etiology and age.The facial nerve probe connecting with the EMG external electrical stimulator as electrical stimulator,EABR was performed by using the Neruo-Audio auditory evoked potentiometer of Neuro Soft company to record EABR waveforms and measure the latencies of all waves and their intervals as well as the amplitude and threshold of V-wave.Results The waveforms of Ⅱ、Ⅲ、Ⅳ、Ⅴ by EABR were similar with those by acoustic evoked auditory brainstem responses(AABR),while the latencies of Ⅲ,Ⅴ wave by EABR were shorter than those by AABR with the sameⅢ-Ⅴ interval.Meaningful EABR waves were recorded in all 14 patients.4 patients without other abnormalities showed welldifferentiated EABRⅢ,Ⅳ waves,normalⅢ-Ⅴ intervals and V-wave amplitudes,well-recognized NRT wave forms,which indicated normal auditory pathway and good prognosis.The presence of prolonged latency or poorly-differentiated waveform or elevated threshold suggested abnormality of auditory pathway.Conclusions EABR is an objective nerve electrophysiological testing method that accurately predicts the effect of hearing rehabilitation,which is closest to the working state of cochlear.It has great advantage of predicting the surgical outcome of cochlear implantation,especially for some special cases.The research on EABR before CI needs to be further explored.