Bhlhe40 protects cochlear hair cell-like HEI-OC1 cells against H_(2)O_(2) ‑triggered oxidative injury

Background:Cochlear hair cell injury is a common pathological feature of hearing loss.The basic helix-loop-helix family,member e40(Bhlhe40),a gene belonging to the basic helix-loop-helix(bHLH)family,exhibits strong transcriptional repression activity.Methods:Oxidative damage,in House Ear Institute-Organ of Corti 1(HEI-OC1)cells,was caused using hydrogen peroxide(H2O2).The Ad-Bhlhe40 particles were constructed to overexpress Bhlhe40 in HEI-OC1 cells.Various assays including cell counting kit-8(CCK-8),terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling assay(TUNEL),flow cytometry,immunofluorescence,and corresponding commercial kits were employed to investigate the impacts of Bhlhe40 on cell viability,apoptosis,oxidative stress levels,mitochondrial membrane potential and cellular senescence.Additionally,a dual-luciferase reporter assay was performed to confirm the targeting of the histone deacetylases 2(Hdac2)by Bhlhe40.Results:The results revealed that Bhlhe40 was downregulated in H_(2)O_(2)-treated HEI-OC1 cells,but its overexpression improved cell viability and mitigated H_(2)O_(2)-induced oxidative injury in HEI-OC1 cells with increase of superoxide dismutase(SOD),catalase(CAT)and glutathione peroxidase(GPx)activities and decrease of reactive oxygen species(ROS)levels.Besides,overexpression of Bhlhe40 suppressed H_(2)O_(2)-triggered cell senescence,as evidenced by the fact that the upregulation of P53,P21,and P16 in HEI-OC1 cells treated with H2O2 were all alleviated by Bhlhe40 overexpression.And we further verified that overexpression of Bhlhe40 could inhibit the expression of Hdac2,which may be related to the repression of Hdac2 transcription.Conclusion:This study suggests that Bhlhe40 plays a protective role against senescence and oxidative damage in cochlear hair cells exposed to H2O2.

Analysis of the Influence of Sound Source Position and Electrode Placement on the Stimulation Pattern of the Cochlear Implant under Noise Conditions: Optimization of Auditory Perceptual Effects

Background: Cochlear implants (CI) are widely used to restore hearing in people with severe to profound hearing loss. However, optimizing CI performance, especially in difficult listening environments with background noise, remains a major challenge. Understanding the influence of factors such as sound source position and electrode placement on CI stimulation patterns is critical to improving auditory perception. Methods: In this study, an analysis was conducted to investigate the influence of sound source position and electrode placement on CI stimulation patterns under noisy conditions. For this purpose, a special measurement setup with a CI speech processor-microphone test box was used to simulate realistic listening scenarios and measure CI performance. Results: The results show that the effectiveness of CI noise reduction systems is influenced by factors such as the position of the sound source and electrode placement. In particular, the beamforming ultra zoom mode showed significantly better noise reduction than the omnidirectional mode, especially under real listening conditions. Furthermore, differences in electrode responses indicate individual variability in the CI user experience, highlighting the importance of personalized fitting algorithms. Conclusions: The results demonstrate the importance of considering environmental factors and individual differences when optimizing CI performance. Future research efforts should focus on the development of personalized fitting algorithms and the exploration of innovative strategies, such as the integration of artificial intelligence, to improve CI functionality in different listening environments. This study contributes to our understanding of CI stimulation patterns and lays the foundation for improving auditory perception in CI users.

Long-term complications of the transmeatal approach (Open Transcanal) in cochlear implants: A follow-up study

Objective: Multiple alternative approaches of cochlear implant surgery have been described, such as the suprameatal approach, transcanal approach, transmeatal approach and middle cranial fossa approach.Transmeatal(open trnascanal) approach has not been adapted since first described in the clinical field.we aimed to assess the long-term complications of the transmeatal approach in a series of 131 patients at our center between 2004 and 2008.Methods: This study was a retrospective case series of all patients who underwent cochlear implants with the transmeatal(open transcanal) approach from May 2004 to December 2008 at King Faisal Specialist and Research Hospital(Riyadh, Saudi Arabia), which were conducted by the same surgeon.Results: Complications were observed often with various combinations-recurrent otitis externa, posterior tympanic membrane perforation, electrode extrusion, cholesteatoma, and chronic mastoiditis. The overall long-term complication rate was 16%(21/131). The gap between the implantation and the diagnosis of a complication ranged from <1 year to 11 years. Major complications were as follows:cholesteatoma in 5(3.8%) patients, extrusion of the electrode in 5(3.8%) patients, and tympanic membrane perforation or deep retractions in 5(3.8%) patients. Minor complications were as follows: recurrent mastoiditis with/without concomitant temporary facial nerve palsy in 4(3%) patients, recurrent otitis externa infections in 7(5%) patients, and weakness of the posterior canal wall in 1 patient.Conclusion: The transmeatal approach posed an high rate of complications on long-term follow-up such as cholestetoma formation, extrusion of electrode or perielectrode reaction formation to tympanic membrane and external auditory canal.

The role of cochlear implantation in alleviating Tumarkin drop attacks of Meniere's disease;a case report

Ménière’s disease(MD)patients may suffer episodes of sudden falls,named Tu markin drop attacks(DAs).This fall occurs abruptly and without warning or loss of consciousness.DAs usually aggravate the clinical picture of MD and are challenging to manage.The present report describes a case treated by cochlear implantation(CI)due to concomitant deafness and offers some clinical considerations for this condition.A male patient aged 48 years with a 10-year history of definite bilateral MD had profound SNHL on the right and severe SNHL on the left side.He suffered from intermittent attacks of vertigo,ear fullness,and tinnitus and,in the last year,had developed DAs and experienced 14 episodes in the previous six months.The preoperative category of acoustic performance was 3.The Dizziness Handicap Inventory(DHI)questionnaire showed a total score of 46,which indicated a moderate degree of disability.A CI was planned for the right side.The patient did not report any further DAs episode for two years since then.The postoperative category of acoustic performance became 11,and the postoperative DHI questionnaire showed a decrease in the total score(from 46 to 19),which indicated a mild disability.Unilateral CI effectively alleviated the DAs associated with bilateral MD.Our report proposes a new modality for managing vertiginous symptoms in cases of MD with hearing loss without the need for more aggressive surgical interventions with the need for clinical trials to confirm our results.

Comparing accuracy of cochlear measurements on magnetic resonance imaging and computed tomography:A step towards radiation-free cochlear implantation

Objective:Computed Tomography(CT)and Magnetic Resonance Imaging(MRI)are commonly employed in pre-operative evaluation for cochlear implant surgery.However,with a decrease in the age of implantation,even minor radiation exposure can cause detrimental effects on children over their lifetime.The current study compares different cochlear measurements from CT and MRI scans and evaluates the feasibility of using only an MRI scan for radiological evaluation before cochlear implantation.Methods:A longitudinal observational study was conducted on 94 ears/47 children,employing CT and MRI scans.The CT and MRI scan measurements include,A value,B value,Cochlear duct length(CDL),twoturn cochlear length,alpha and beta angles to look for cochlear orientation.Cochlear nerve diameter was measured using MRI.The values were compared.Results:The mean difference between measurements from CT and MRI scans for A value,B value,CDL,and two-turn cochlear length values was 0.567±0.413 mm,0.406±0.368 mm,2.365±1.675 mm,and 2.063±1.477 mm respectively without any significant difference.The alpha and beta angle measures were comparable,with no statistically significant difference.Conclusion:The study suggests that MRI scans can be the only radiological investigation needed with no radiation risk and reduces the cost of cochlear implant program in the paediatric population.There is no significant difference between the measurements obtained from CT and MRI scans.However,observed discrepancies in cochlear measurements across different populations require regionally or race-specific standardized values to ensure accurate diagnosis and precision in cochlear implant surgery.This aspect must be addressed to ensure positive outcomes for patients.

Stages of Emotional Experience of Parents of Children with Cochlear Implantation (CI)

Rehabilitation is a set of measures aimed at compensating or fully restoring the functions of the patient impaired by the disease. In the rehabilitation of children with a cochlear implant, a comprehensive, systematic approach is essential in the work of doctors, teachers, sign language teachers, psychologists, and families. Rehabilitation and social adaptation of children with a cochlear implant depend not only on specialists but also on the ability of parents to help the child organize educational activities in an optimistic mood and the ability to provide emotional support. This means that the role of parents in the way to successful rehabilitation is high, and therefore this topic is especially relevant today. .

Revealing the contribution of basilar membrane's biological activity to the mechanism of the cochlear phonosensitive amplification

Explaining the mechanism of the cochlear active phonosensitive amplification has been a major problem in medicine.The basilar membrane(BM)is the key infrastructure.In 1960,Nobel Laureate von B′ek′esy first discovered BM's traveling wave motion.Since that time,BM's models only have considered the traveling wave but not the biological activity.Therefore,a new model considering changes of BM's stiffness in space and time is established based on the immersed boundary method to describe its biological activity.It not only reproduces the results of traveling wave motion but also explains the mechanization on the generation of traveling wave.An important discovery is that changes of BM's stiffness in space and time will cause the unstable global resonance,which will induce amplification of sounds in cochlea.An important inference is that biological activity shall be included in the application of mechanical principles to the analysis of life,which is the essential difference between biomechanics and general mechanics.

Preliminary Results of Cochlear Implantation in Underdeveloped Countries: The Experience of Cameroon

Introduction: Deafness, is the most common neurosensory deficit in humans. The origins can be diverse: congenital or acquired and sometimes of an etiology that is difficult to specify. The main risk is social exclusion. The advent of cochlear implants is a solution of choice for severe to profound sensorineural hearing loss. This innovative therapeutic modality is new to Cameroon, so we proposed to evaluate the preliminary results of cochlear implantation at the General Hospitals of Yaoundé and Douala, by addressing the epidemiological, clinical and paraclinical, surgical, and prosthetic aspects. Methodology: We conducted a descriptive and prospective cross-sectional study over a period of two years and eight months, from January 2019 to 31 August 2021. The study sites were: the general hospitals of Yaounde and Douala, as well as the private practices of speech therapists in the said cities. We collected socio-demographic, clinical, paraclinical variables and data on surgical, prosthetic and speech therapy management which were processed. Results: We recruited 15 cochlear implant patients, one adult and 14 children. The sex ratio was 1.14 in favour of girls, the average age of the child population was 4.9 years and one subject was 57 years old. These children were mostly in school (85.7%) and mostly (86.7%) living in urban areas. The average period of sound deprivation was 3.9 years. The deafness of the children was 100% prelingual and the acquired cause was evoked in front of the risk factors (prematurity, low birth weight, neonatal asphyxia, jaundice, meningitis, neuromalaria) for 57.7% of them. The adult deafness was postlingual and post-traumatic. The associated clinical conditions found in 4 (26.8%) of the patients were an ocular refraction disorder, a chronic otitis media sequelae, cerebral palsy and minor head trauma injuries. There was no syndromic or malformative picture. The deafness was bilateral in all cases, asymmetric in 22.2% of cases and severe to profound sensorineural. The threshold of the deafness was deep in 78.6% of cases, with a more marked involvement on the right. Imaging studies (MRI and CT scans of the cranium, brain and rock) carried out in our series showed abnormalities in 4 (26.7%) of the children, but none of these abnormalities were an absolute contraindication to implantation. The surgical management was done with oticon® Neuro ZTI implants. Implantations were unilateral and mostly right, with one case of stenosis of the round window recess observed. The postoperative course was simple for 92.8% of patients. One case of superinfection of the surgical wound. The activations were performed within four to five weeks after surgery and the implant was functional in fourteen patients and dysfunction was observed in one patient. Conclusion: The cochlear implant is an effective solution in the fight against severe to profound sensorineural deafness. The diffusion of this therapeutic tool in our environment is still hampered by the youth of the teams, the lack of equipment and the insufficient financial means.

Barriers to Early Pediatric Cochlear Implantation in Kenya

Background: Cochlear implantation is the best management option for children with profound hearing loss and has received no benefit from hearing aids. Early implantation for these children is associated with good speech and language outcomes. Objectives: To determine the barriers to early pediatric cochlear implantation. Methodology: A qualitative cross-sectional study was conducted at Hearing Implants Centre in Nairobi Kenya from August 2022 to February 2023. The target population was 40 children who had undergone cochlear implantation under the auspices of Cochlear Implant Group of Kenya but data was only collected from 30 of them. The remaining were ruled out because 3 were unreachable over the phone, 5 refused to participate and 2 did not meet the inclusion criteria. Results: Patient file reviews and parental telephone interviews were conducted to collect information and analyzed using Microsoft excel and presented using graphs, tables and pie charts. The analysis of the gender showed 46.67% were male and 53.33% were female. Analysis on newborn screening showed that none had it done. The mode age of hearing loss suspicion was between the ages of 2 - 3 years. The hearing loss suspicion done was done by the mothers at 20 children the reminder being 3 by the father, 1 by a family friend, 4 by the school-teacher and 2 by the child’s grandmother. A total of 17 participants noted a delayed in speech and language, 9 noted that the child did not respond to loud sounds, 4 noted that the children did not turn when called. Once hearing loss was identified, 73% saw the ENT, 17% saw a pediatrician, 7% went to see an Audiologist, and 3% saw a speech therapist. The mode age at diagnosis was 1.5 years. The mode age at implantation was 5 years. The mode time from diagnosis was 2 years. Conclusions: This study sought to investigate the barriers to pediatric cochlear implantation in Kenya. From the results it was determined that factors such as lack of newborn screening, high cost of cochlear implantation, lack of awareness have led to late cochlear implantation.

不同开机年龄人工耳蜗植入儿童术后早期语前听能康复效果的研究

目的 探讨不同开机年龄人工耳蜗(CI)植入儿童术后早期语前听能(EPLAD)康复效果,并与健听儿童进行横向比较。方法 选取2015-2022年四川大学华西医院完成CI术后开机的1~4岁听障儿童共141例,按开机年龄分为1~2岁组(n=50)、2~3岁组(n=50)、3~4岁组(n=41)。采用婴幼儿有意义听觉整合量表(ITMAIS)和有意义听觉整合量表(MAIS)进行评估,构建广义估计方程(GEE)模型,分析受试者在开机前和开机后1、3、6、12个月时的EPLAD,并与健听儿童进行比较。结果 141例1~4岁CI植入儿童在开机后各个随访时间点的ITMAIS/MAIS得分均有提高,各个随访时间点量表得分两两比较差异有统计学意义(P<0.05);基于3组不同开机年龄组的ITMAIS/MAIS得分,组间比较差异无统计学意义(P>0.05);3组CI植入患儿在开机12个月内与健听儿童12个月内的得分水平相当。结论 1~4岁CI植入患儿在开机后12个月内,其听能发展水平随着术后康复时间的延长而逐渐提高,EPLAD康复效果与健听儿童一致。不同开机年龄对CI植入患儿术后开机12个月内的ITMAIS/MAIS得分无明显影响。

仅有部分底回的耳蜗发育不全畸形

目的根据影像学特征探讨一种有别于目前Sennaroglu分类标准的特殊耳蜗畸形种类及其临床表现。方法分析11例(13耳)特殊耳蜗畸形患者的颞骨高分辨率CT(HRCT)、3D-核磁(3D-MRI)表现和听力学结果,归纳此类耳蜗畸形的特点。结果此类耳蜗畸形的影像学表现为仅有部分耳蜗底回自前庭腹侧发出,无转弯或仅有部分内侧转弯,无上底回、中回及顶回(耳蜗不足0.5圈),无蜗轴及阶间隔;在HRCT轴位图像上均未见到耳蜗与内听道(IAC)产生连接。MRI均显示蜗神经发育不良(CND),听力学均表现为全聋;大多伴有发育异常的前庭(12/13)和畸形的半规管(12/13),对侧耳蜗也多伴有严重畸形(10/13)。根据影像学特点,此类耳蜗畸形仅有部分底回发育,属于耳蜗发育不全(CH),本研究将其命名为耳蜗发育不全X型(CH-X)。结论仅有部分底回(不足0.5圈)的耳蜗发育不全(CH-X)是一类严重的内耳畸形,约占内耳畸形的2%左右,患耳表现为全聋,由于畸形的耳蜗无明显的蜗孔和蜗神经,人工耳蜗植入可能获益较小。

老年性聋患者人工耳蜗植入效果分析

目的 探究老年性聋患者人工耳蜗植入术后听觉言语康复效果及生活质量的变化。方法 对31例行人工耳蜗植入的老年性聋患者进行听力学、言语功能及生活质量评估并比较差异。听力学评估采用助听听阈,言语能力评估采用词表识别率,评估时间为术前、开机后6个月及开机后12个月。生活质量评估采用Nijmegen人工耳蜗植入量表(NCIQ),评估时间为术前及开机后12个月。结果 共纳入31例患者,31例患者术前、开机后6个月及开机后12个月助听听阈分别为(62.55±3.69)、(46.58±5.14)、(38.68±4.26)dBHL,差异具有统计学意义(P<0.05)。术前、开机后6个月及开机后12个月单音节词识别率分别为(9.55±5.81)%、(54.77±8.90)%、(68.52±7.21)%,差异具有统计学意义(P<0.05);术前、开机后6个月及开机后12个月双音节词识别率分别为(19.87±9.72)%、(64.00±6.53)%、(74.26±6.79)%,差异具有统计学意义(P<0.05);术前、开机后6个月及开机后12个月短句识别率分别为(28.00±10.58)%、(68.52±7.78)%、(77.61±8.59)%,差异具有统计学意义(P<0.05)。术前及开机12个月NCIQ总量表得分分别为(35.90±5.80)、(65.16±8.18)分,差异具有统计学意义(P<0.05)。结论 人工耳蜗植入可以改善老年性聋患者的听觉言语能力及生活质量,对于重度以上听力损失且助听器效果不佳的老年性聋患者可以选择人工耳蜗植入。

成人双侧序贯植入人工耳蜗调机病例报告

目的通过人工耳蜗调机改善序贯植入双侧人工耳蜗患者的听觉感受,实现双侧听觉的对称和匹配,改善人工耳蜗言语分辨能力。方法利用人工耳蜗调机硬件、软件测量患者双侧人工耳蜗所需各电刺激参数,根据双侧人工耳蜗响度、音色等设置两侧的平衡及对称匹配;通过声场助听听阈测试、言语测听和主观量表评估量化人工耳蜗疗效;辅导患者使用听觉辅助无线调频系统改善在噪声环境下的信噪比,评估不同信噪比噪声下语句测试改善效果。结果(1)双侧对称匹配调机后,双侧助听听阈为20~30 dHL,左侧言语识别率分别为单音节词得分46.7%,双音节词得分63%,安静下语句得分74%,+10 dB信噪比噪声下语句得分32%。右侧言语识别率分别为单音节词得分66%,双音节词得分60%,安静下语句得分45%,+10 dB信噪比噪声下语句得分45%。双侧人工耳蜗使用1年调机后言语识别率分别为单音节词得分76%,双音节词得分75%,安静下语句得分96%,+10 dB信噪比噪声下语句得分34%。(2)使用无线调频系统辅助下人工耳蜗言语测试语句识别率分别为+10 dB信噪比52%,+5 dB信噪比64%,0 dB信噪比30%,-5 dB信噪比34%,-10 dB信噪比18%。结论对重度以上听障患者,序贯双侧植入效果优于单侧植入;人工耳蜗术后调机影响人工耳蜗的效果;人工耳蜗患者在复杂情况下言语分辨困难时应使用辅助设备。

耳蜗基膜响应随强度灵敏度衰减的畸变

听力衰退的一个直接表现是听觉强度感知灵敏度下降,听觉阈限提高。为探索与此相伴影响语音感知清晰度的耳蜗听觉信息表达的其他变化,改善助听器听力康复效果,本研究通过动物实验观察了耳蜗基膜振动在强度响应灵敏度下降时的其他响应特征变化。结果显示,随着耳蜗振动幅度响应灵敏度的下降,耳蜗基膜振动幅度随激励声压的增长从非线性渐趋于线性;基膜振动的频率成分中组合频率成分幅度逐渐减小,直至消失;基膜调谐曲线逐渐钝化,调谐频率逐渐向高频偏移。

人工耳蜗植入对成人语后聋患者植入侧耳鸣的影响

目的 探究成人语后聋患者人工耳蜗植入术后植入侧耳鸣的变化,并分析其影响因素。方法 2017年1月~2021年12月于郑州大学第一附属医院耳科进行单侧人工耳蜗植入的47例成人语后聋伴耳鸣患者,分别于术前和术后开机6个月进行耳鸣问卷评估,评估材料为耳鸣障碍量表(tinnitus handicap inventory,THI)和视觉模拟量表(visual analogue scale,VAS),比较人工耳蜗植入术后患者耳鸣的变化,并分析其可能的影响因素。结果 47例患者人工耳蜗植入术前、术后开机6个月时THI评分别为36.94±13.337、14.48±12.726分,VAS评分分别为5.13±1.676、2.34±1.903分,术后评分均较术前降低,差异均有统计学意义(P<0.05);其中18例患者耳鸣完全消失,13例患者耳鸣减轻,14例患者耳鸣无变化,2例患者耳鸣加重,总体耳鸣有效率为66.0%(31/47);术前耳鸣病程与耳鸣严重程度对术后耳鸣预后有影响(P<0.05),术前耳鸣病程≤5年、中度及以上耳鸣组耳鸣有效率分别高于耳鸣病程>5年(P<0.05)、轻微及轻度耳鸣组(P<0.001)。结论 人工耳蜗植入对成年语后聋患者植入侧耳鸣具有抑制作用;术前耳鸣病程短、耳鸣程度重的患者术后耳鸣改善的可能性更大。

人工耳蜗植入年龄对患儿听觉言语变化规律的影响

目的 探究双耳重度感音神经聋(sensorineural hearing loss,SNHL)患儿人工耳蜗植入(cochlear implantation,CI)后听觉言语变化规律及影响因素。方法 前瞻性选取2018年1月至2021年6月于河南科技大学第二附属医院耳鼻咽喉科行单侧CI治疗的患儿216例,符合纳入、排除标准203例,人工耳蜗开机后漏诊32例,最终纳入171例。R软件spline函数拟合术后24个月听觉能力轨迹;多变量线性混合回归模型动态分析影响听能发育的协变量;Cox模型明确年龄与听能发育的关联性;E值法行敏感性检验;Spearman秩相关分析年龄与语言交流相关性。结果 CI植入后患儿语前听能恢复轨迹为Y=16.14+10.89X-0.54X2+0.01X3(0≤X≤24)。CI植入前协变量为听阈、语言模仿能力和术前佩戴助听器,CI植入后6~12月协变量为语言模仿能力和术后佩戴助听器,CI植入后24月协变量为术后佩戴助听器和语训时长。经Cox模型调整后,植入年龄与听能发育程度存在显著负关联效应(HR=2.07,95%CI:1.81~2.30)。在CI植入后3~24月,患儿轮流交流能力、主动交流能力、视觉交流能力和听觉注意力逐步提高,并与年龄呈负相关性。结论 CI植入年龄越早SNHL患儿术后听觉言语发育越好,早发现早治疗是提高患儿术后听力恢复、语言发展的重要措施。

儿童人工耳蜗植入术后听觉言语康复情况的影响因素

目的 分析儿童人工耳蜗植入术后听觉言语康复情况的影响因素。方法 回顾性收集2015年1月至2020年1月南阳市中心医院收治的120例人工耳蜗植入术后耳聋儿童临床资料,术后均随访24个月,比较所有儿童开机前及术后1、3、6、9、12、24个月听觉行为分级、语言可懂度分级、婴幼儿有意义听觉整合量表评分,以多重线性回归分析耳聋儿童人工耳蜗植入术后24个月听觉言语康复情况的影响因素。结果 开机前及术后1、3、6、9、12、24个月,耳聋儿童人工耳蜗植入术后听觉行为分级、语言可懂度分级、婴幼儿有意义听觉整合量表评分均呈逐渐升高趋势,不同时间点比较,差异有统计学意义(P<0.05)。多重线性回归分析结果显示,术前有残余听力且佩戴助听器、植入时年龄≤3岁、人工耳蜗植入术电极类型为弯电极、监护人受教育程度为中及以上、康复模式为康复机构联合家庭、基因突变类型为GJB2、监护人为父母均为影响耳聋儿童人工耳蜗植入术后24个月听觉行为分级评分、婴幼儿有意义听觉整合量表评分的保护因素(P<0.05);术前有残余听力且佩戴助听器、植入时年龄≤3岁、人工耳蜗植入术电极类型为弯电极、康复模式为康复机构联合家庭、基因突变类型为GJB2、监护人受教育程度为高中及以上均为影响耳聋儿童人工耳蜗植入术后24个月语言可懂度分级评分的保护因素(P<0.05)。结论 影响耳聋儿童人工耳蜗植入术后24个月婴幼儿听觉言语康复的相关因素包括植入时年龄、术前有残余听力且佩戴助听器情况、人工耳蜗植入术电极类型情况、监护人情况、康复模式、基因突变类型,临床可针对以上因素对耳聋儿童进行干预,促进其听觉言语康复。

锥形束CT评价人工耳蜗植入的电极深度和位置

目的分析人工耳蜗植入后电极植入深度、位置与耳蜗大小、盘旋方式的关系,探讨植入后电极深度的影响因素和电极移位的原因。方法选取植入CI24RE(CA)弯电极30例和SONATA ti100 Standard直电极人工耳蜗装置41例,利用锥形束CT测量术后电极植入长度、植入深度角、电极在耳蜗内的位置,分析上述指标与术前CT评估的耳蜗大小、倾斜角度的关系。结果①术后电极植入深度角和长度均存在较大的个体差异。直电极组平均植入深度角为702±53度,平均植入长度为30.02±1.29 mm;弯电极组平均植入深度角为441±45度,平均植入长度为18.4±1.0 mm,两组间差异有统计学意义(P<0.001)。②电极植入深度角与耳蜗底回的长径和宽径均呈负相关:直电极组r=-0.768(P<0.001)、r=-0.678(P<0.001),弯电极组r=-0.467(P=0.008)、r=-0.471(P=0.008)。电极植入长度与植入深度角呈正相关:直电极组r=0.578(P<0.001),弯电极组r=0.748(P<0.001)。③术后电极移位6例,均为弯电极且位于耳蜗180度位置。弯电极组中电极移位者与未移位者耳蜗底回倾斜角以及第一回和第二回之间的夹角差异有统计学意义(10.28度vs 8.75度,P=0.006;15.23度vs 14.00度,P=0.033)。结论人工耳蜗植入术后电极植入长度和深度角存在较大的个体差异,与耳蜗大小密切相关;耳蜗盘旋方式不同是引起电极移位的原因之一。

内耳三维真实重建反转恢复成像与突发性聋预后

目的分析突发性聋(突聋)患者的内耳三维真实重建反转恢复(three dimensional real inversion recovery,3D Real IR)成像表现,探讨内耳不同信号强度与突聋预后的关系。方法选取2022年9月25日—2023年4月10日郑州大学第五附属医院耳鼻咽喉科住院治疗及门诊治疗的单侧突聋患者60例,按照听力曲线将患者分为低频下降型4例、高频下降型1例、平坦下降型34例和全聋型21例。由于平坦下降型和全聋型治疗方法一致,将平坦下降型和全聋型的55例患者按治疗有效与否分为无效组25例和有效组30例;按治疗前听力分级,分为轻度听力损失组11例、中度听力损失组7例、重度听力损失组16例和极重度听力损失组21例;根据听力下降与否分为患耳组55耳和健耳组55耳。比较患耳和健耳的耳蜗信号强度,并测量延髓信号强度,分别计算耳蜗/延髓(cochlea/medulla ratio,CM)比值,分析耳蜗信号强度与治疗结果之间关系。结果无效组CM比值明显高于治疗有效组,差异有统计学意义(P<0.001);患耳组与健耳组CM比值比较,差异有统计学意义(P<0.05)。轻度、中度、重度和极重度听力损失组患耳CM比值比较(2.57±3.02 vs 1.77±0.87 vs 2.04±1.98 vs 2.51±2.33),差异无统计学意义(F=0.304,P=0.823)。结论内耳3D Real IR可显示突聋患者血-迷路屏障通透性的改变,CM比值可以更精确了解突聋患者内耳受损的程度,CM比值大小与听力损失程度并不一致,可以单独作为一种判断突聋预后的因素。突聋患者CM比值高于1.58提示可能预后不良。

不同致聋基因突变的人工耳蜗植入术后患儿皮层诱发电位的研究

目的观察不同致聋基因突变的人工耳蜗植入患儿皮层诱发电位(CAEP)的差异。方法分析郑州大学第一附属医院耳科32例行单侧人工耳蜗植入术(植入型号为澳大利亚CI512)的无残存听力,且SLC26A4基因、GJB2基因或TMPRSS3基因突变患儿的临床资料,分为A、B、C组。于术后1个月/ba1/和/ba4/声刺激下分别行CAEP检测,记录/ba1/和/ba4/声刺激下P1波引出率、潜伏期、振幅。结果/ba1/和/ba4/声刺激下,A、B组引出率差异无统计学意义(P>0.05);A、B组引出率均高于C组,差异有统计学意义(P<0.05)。/ba1/和/ba4/声刺激下,A、B组潜伏期差异无统计学意义(P>0.05);A、B组潜伏期短于C组,差异有统计学意义(P<0.05)。/ba1/和/ba4/声刺激下,A、B、C组振幅比较,差异无统计学意义(P>0.05)。结论SLC26A4基因、GJB2基因突变的CAEP的P1波引出率高于TMPRSS3基因突变,且LC26A4基因、GJB2基因突变的CAEP的P1波潜伏期短于TMPRSS3基因突变。