人工耳蜗术中圆窗膜与圆窗龛电诱发听性脑干反应比较分析

Round window membrane vs niche electrical stimulation EABR in cochlear implantation

目的探讨人工耳蜗植入术中不同刺激位置对电诱发听觉脑干反应(EABR)波形的影响。方法选取CT,MRI影像耳蜗形态正常的双侧感音神经性耳聋患30例,均为单侧植入。植入术中先后电刺激术耳圆窗龛与圆窗膜,比较分析刺激强度在1.0-3.0mA之间时2种不同位置处EABR阈值以及Ⅲ波、Ⅴ波引出率、潜伏期和波间期的差别。结果①EABR阈值在圆窗龛刺激中为1.745±0.09692 m A,圆窗膜刺激中为1.275±0.1160 m A(P<0.05)。②EABRⅢ波检出率圆窗龛刺激为66.667%,圆窗膜刺激为93.333%(P<0.05)。③Ⅲ波潜伏期圆窗龛刺激为2.215±0.04600ms,圆窗膜刺激为2.180±0.03566ms。④EABRⅤ波圆窗龛刺激检出率为50%,圆窗膜刺激检出率为93.333%(P<0.05)。⑤EABRⅤ波潜伏期圆窗龛刺激为4.059±0.08122ms,圆窗膜刺激为3.951±0.06329 ms。⑥EABRⅢ-Ⅴ间期圆窗龛刺激为1.880±0.06285 ms,圆窗膜刺激为1.807±0.04218 ms。结论圆窗膜刺激EABR波形稳定,可重复性强,受肌电反应干扰小,引出率高,以较小的刺激强度能取得较好的波形,对听觉传导通路的评估更为准确。

Objective To investigate the effects of different stimulation positions of electro-evoked auditory brainstem response during cochlear implantation. Methods The differences of EABR stimulation threshold, wave III, wave V extraction rate, latency and wave interval between the two stimulation modes of stimulation intensity between 1.0-3.0 mA and round window membrane were compared and analyzed. Result ① The EABR threshold was 1.745 ±0.097 m A in niche stimulation and 1.275 ±0.116 m A in round window membrane stimulation. ②The EABR wave III detection rate niche stimulation was 66.667%, and the round window membrane stimulation was 93.333%.③TThe wave III latency niche stimulation was 2.215±0.046 ms and the round window membrane stimulation was 2.180±0.036 ms. ④T The detection rate of EABR wave V niche stimuli was 50%, and the round window membrane stimulation was 93.333%. ⑤The EABR wave V latency niche stimulation was 4.059±0.081 ms, and the round window membrane stimulation was3.951±0.063 ms. ⑥The EABR III-V intervalniche stimulation was 1.880±0.063 ms, and the round window membrane stimulation was1.807±0.042 ms. Conclusion The waveform of round window membrane stimulates the EABR is stable, reproducible, less interfered by the myoelectric reaction, and has a low false negative rate. It is more accurate in the evaluation of the auditory conduction pathway.