共同腔畸形患儿蜗神经对电刺激的反应及耳蜗术后效果研究

The Responsiveness of the Cochlear Nerve to Electrical Stimuli in Children with Common Cavity Deformity and the Outcomes with Cochlear Implantation

目的研究共同腔畸形(common cavity deformity,CCD)患儿蜗神经对电刺激反应的特点,及耳蜗术后听觉言语发展情况。方法收集2016年6月~2018年12月在我院行人工耳蜗植入的CCD患儿6例,7耳。同时选取6例耳蜗发育正常的人工耳蜗植入患儿作为对照。使用Custom Sound EPTM软件记录两组患者电极周围电刺激复合动作电位(electrically evoked compound action potential,eCAP),并计算eCAP的引出率。分别记录电极远端、中端及近端处一个电极的eCAP增益曲线,并记录该电极eCAP诱发阈值(T值)及eCAP增益曲线的坡度(slope)。评估术后6 m、12 m、18 m及24 m耳蜗助听听阈、CAP及SIR评分及术后言语识别率结果。采用SPSS 20.0软件分析CCD组及对照组eCAP诱发T值、eCAP增益曲线的坡度及耳蜗术后效果。结果对照组患儿各电极均可记录到eCAP波(100%),CCD组eCAP的引出率为74.78%。CCD组近端、中端及远端eCAP诱发T值明显高于对照组(P<0.05);CCD组近端、中端及远端eCAP增益曲线的坡度明显小于对照组(P<0.05)。术后6 m、12 m、18 m及24 m,CCD组耳蜗助听听阈高于对照组,且在开机6 m及12 m时差异有统计学意义(P<0.05)。术后6 m、12 m、18 m及24 m,CCD组CAP评分及SIR评分低于对照组,且在开机12 m时差异有统计学意义(P<0.05)。结论 CCD患儿蜗神经对电刺激的反应比耳蜗发育正常患儿差,且CCD患儿蜗神经的功能个体间差异较大。人工耳蜗对CCD患儿有效,但耳蜗术后听觉及言语发展缓慢且较耳蜗发育正常患儿差。

Objective To investigate the responsiveness of the cochlear nerve to electrical stimuli in implanted children with common cavity deformity(CCD),and compare their cochlear implantation outcomes with children of normal cochleas.Methods The study participants included 6 children with CCD who underwent cochlear implantation in our hospital from June 2016 to December 2018.The control group included 6 children with normal cochlear.The electrically-evoked compound action potential(eCAP)was obtained for each intra-cochlear CI electrode using Custom Sound EP sofeware(version4.3).The eCAP amplitude growth functions were recorded at three electrodes along the electrode array.The aided hearing threshold,CAP score and SIR score were measured at 6 m,12 m,18 m and 24 m post-operation.The eCAP threshold,slope of the eCAP amplitude function and the outcomes of cochlear implantion were compared between the groups using the SPSS 20 software.Results The eCAP was recorded at all CI electrodes in control group(100%).In the study participants,the eCAP was recorded at some but not all CI electrodes(74.78%).In the CCD group,the eCAP thresholds were higher and the slopes of eCAP amplitude growth function were smaller than those measured in the control group(P<0.05).The hearing thresholds with cochlear implantation were higher in the CCD group than those in the control group post-operation,and there were significant differences at the 6 m and 12 m.The CAP and SIR scores were lower in the CCD group than those in the control group.Conclusion Children with CCD showed reduced cochlear nerve responsiveness to electrical stimuli.The cochlear nerve function in patients with CCD varied a lot.Children with CCD can benefit from implantation,but their results are poorer than children with normal cochleas.