新型软带式骨导助听器疗效初步分析

发布时间：2018-08-26 14:43

【摘要】：目的:1评估6岁以下双侧传导性耳聋患儿佩戴Sophono牌新型软带骨导助听器后的听觉及言语改善效果;2分析6岁及其以上双侧传导性耳聋患者佩戴Sophono牌新型软带骨导助听器后的听力及言语改善情况;3了解6岁及其以上单侧极重度感音神经性耳聋患者佩戴Sophono牌新型软带骨导助听器后的听力改善情况。方法:收集2015年7月至2016年4月就诊于白求恩国际和平医院耳鼻咽喉头颈外科的耳聋患者,经筛选,符合入选标准27例,分为三组,对三组耳聋患者佩戴新型软带式骨导助听器后的听力言语改善情况做初步分析,并评估佩戴该型骨导助听器软带的临床应用效果。1入选标准:1)传导性或混合性耳聋患者:患者年龄≥1岁,纯音测听(pure-tone audiometry)或骨导听性脑干反应(auditory brainstem response,ABR)测试中的骨导阈值≤30 dB,气骨导差30 d B;2)单侧感音神经性耳聋(single side deafness,SSD):患者年龄≥6岁,患耳纯音测听提示感音神经性耳聋,气导PTA≥90 d B HL,健耳骨导PTA≤20 dB HL,患病时间最少在1年以上,除单耳极重度听力损失外,无眩晕、耳鸣等其他症状。2试验分组:1)6岁以下双侧传导性耳聋患儿组11例(年龄1~5岁,平均年龄2.64±1.03岁);2)6岁及其以上双侧传导性耳聋患者组12例(年龄9~24岁,平均年龄13.58±5.44岁);3)6岁以上单侧极重度感音神经性耳聋患者组4例(14~67岁,平均年龄39.75±21.79岁)。3听力学评估:1)6岁以下双侧传导性耳聋患儿组首先进行骨导ABR测试其裸耳骨导反应阈,其次通过声场下纯音测听测试其助听前、佩戴当日、佩戴2周及佩戴3个月后的纯音平均听阈(pure-tone average,PTA)测试,最后进行助听前及佩戴2周、佩戴3个月后听觉行为分级标准(categories of auditory performance,CAP)量表评估;2)6岁及其以上患者组在声场下进行助听前、佩戴当日、佩戴2周及佩戴3个月后的pta测试,并利用天使语训中文开放式言语评估系统进行言语识别阈(speechrecognitionthreshold,srt)测试。同时,记录所有患者佩戴后的不良反应及不良事件。结果:16岁传导性耳聋组,骨导abr反应阈均值为14.09±5.84dbnhl,佩戴sophono软带骨导助听器前声场下裸耳纯音测听pta均值为75.68±13.64dbhl,佩戴当日、佩戴2周及佩戴3个月后助听听阈分别下降至36.59±9.88、35.00±5.92、33.40±4.22dbhl。佩戴当日、2周及3个月后患者听力分别增益了39.09±10.64、40.68±12.85、42.27±12.99db。佩戴前声场测听pta均值与佩戴当日、佩戴2周及佩戴3个月后pta均值之间比较有统计学意义(p0.05),佩戴当日、佩戴2周及佩戴3个月后pta之间无统计学差异(p0.05)。佩戴sophono软带骨导助听器3个月后在0.25khz、0.5khz、1khz、2khz、4khz听阈分别降低了31.82±12.90、35.00±13.78、48.19±14.19、41.81±12.10、44.09±17.86db。助听前cap量表评分均值2.64±0.50分,佩戴2周及佩戴3个月后cap量表评分分别上升至5.36±0.50、5.36±0.50分。佩戴3个月平均提高了2.57分;2≥6岁传导性耳聋组,骨导听阈平均阈值均值7.00±6.67dbhl,助听前声场测听pta均值60.52±9.13dbhl,佩戴当日、佩戴2周及佩戴3个月后声场助听pta均值下降至26.35±5.55、29.38±4.69、31.35±9.83dbhl。助听当日、佩戴后2周、佩戴后3个月较助听前分别增益34.17±10.12、31.15±11.07、30.21±14.45db。助听前声场测听pta均值与佩戴当日、佩戴2周及佩戴3个月之间比较有统计学意义(p0.05),佩戴当日、佩戴2周及佩戴3个月助听后pta之间无统计学差异(p0.05)。助听3个月后0.25khz、0.5khz、1khz、2khz、4khz听阈分别降低了16.25±15.24、30.42±14.05、40.00±15.37、25.42±16.58、20.84±15.64db。助听前三个方向(0°、90°、270°)srt分别为67.30±4.46、68.66±5.08、69.16±4.53dbhl,佩戴当日三个方向srt分别为39.40±4.97、37.40±5.27、41.76±8.19dbhl,佩戴2周后三个方向srt分别为37.51±5.06、37.24±7.09、40.42±7.46dbhl及srt佩戴3个月后三个方向srt分别为38.32±4.92、38.72±6.34、42.65±5.68dbhl;3单侧极重度感音神经性耳聋组患耳裸耳气骨导阈值大多数不能引出,无法计算其PTA,对侧耳骨导听阈均值为9.37±6.80 d B HL,助听前掩蔽后声场测听PTA均值为55.00±12.08 dB HL,佩戴当日、佩戴2周及佩戴3个月后声场助听听阈下降至25.63±4.62、28.13±7.74、30.63±6.81 dB HL。佩戴当日、佩戴2周及3个月后较助听前分别增益29.38±14.31、26.88±11.61、24.38±11.84 dB。助听前0°、90°、270°方向言语识别阈分别为54.15±2.96、55.47±3.32、54.60±3.04 dB HL,佩戴当日三个方向SRT分别为38.02±2.11、31.08±2.65、38.54±2.81 dB HL,佩戴2周后三个方向言语识别阈分别为34.76±3.56、31.14±2.41、36.68±5.70 dB HL及佩戴3个月后三个方向言语识别阈分别为34.95±2.41、30.75±2.33、39.35±2.77dB HL;4各组患者均无助听器相关不良反应及不良事件。结论:1佩戴Sophono新型软带骨导助听器明显改善了6岁以下双侧传导性耳聋患儿听力及言语能力,早期佩戴可能会改善此类患儿的言语发育状况。2佩戴Sophono新型软带骨导助听器能有效的提升6岁及以上双侧传导性耳聋患者的听力及言语识别阈,可作为此类患者改善听力状况一种新的选择。3佩戴Sophono新型软带骨导助听器对于单侧极重度感音神经性耳聋患者有很好助听效果,能改善患者在安静情况下的听阈及方位感。
[Abstract]:Objective: 1. To evaluate the hearing and speech improvement of children with bilateral conductive deafness under 6 years old wearing Sophono brand new soft-band bone-guided hearing aid; 2. To analyze the hearing and speech improvement of children with bilateral conductive deafness over 6 years old wearing Sophono brand new soft-band bone-guided hearing aid; 3. Methods: From July 2015 to April 2016, 27 deaf patients in the Department of Otolaryngology, Head and Neck Surgery of Bethune International Peace Hospital were selected, and they were divided into three groups. The improvement of hearing and speech after hearing aids was analyzed and the clinical effect of wearing the bone-guided hearing aids was evaluated. 1 Selection criteria: 1) Bone in conductive or mixed deafness: age (> 1), pure-tone audiometry (pure-tone audiometry) or auditory brainstem response (ABR) test. Conduction threshold < 30 dB, air-bone conduction difference 30 dB; 2) unilateral sensorineural deafness (SSD): the patient's age (> 6 years), pure tone audiometry suggesting sensorineural deafness, air conduction PTA (> 90 dB HL), healthy ear bone conduction PTA (> 20 dB HL), the duration of the disease is at least 1 year, except for severe hearing loss in one ear, no dizziness, tinnitus and other. Symptoms: 1) 11 children under 6 years old with bilateral conductive deafness (aged 1-5 years, with an average age of 2.64 + 1.03 years); 2) 12 children aged 6 years or above with bilateral conductive deafness (aged 9-24 years, with an average age of 13.58 + 5.44 years); 3) 4 children over 6 years old with unilateral very severe sensorineural deafness (aged 14-67, with an average age of 39.75 + 21.7 years) 9-year-old) 3-year-old children with bilateral conductive deafness underwent bone conduction ABR test first, followed by pure-tone average (PTA) test before, on the day of, 2 weeks and 3 months after the hearing aid, and 2 weeks before and after the hearing aid. Three months after wearing, the auditory behavior rating scale (CAP) was assessed; 2) The patients aged 6 years and over were tested with PTA before, on the same day, 2 weeks and 3 months after wearing PTA under the sound field, and the speech recognition thresholds (SPEEC) were assessed with the Chinese Open Speech Assessment System of Angelic Speech Training. Results: In the 16-year-old conductive deafness group, the mean ABR threshold was 14.09 (+5.84) dbnhl, and the mean PTA was 75.68 (+13.64) dBHL in the bare ear before and after wearing the sophono soft-band bone-guided hearing aid. The auditory threshold decreased to 36.59 [9.88], 35.00 [5.92], 33.40 [4.22] dbhl. On the day of wearing, 2 weeks and 3 months after wearing, the patients'hearing gain was 39.09 [10.64], 40.68 [12.85], 42.27 [12.99] DB respectively. There was significant difference between the mean value of PTA measured before wearing and that on the day, 2 weeks and 3 months after wearing (p0.05). There was no significant difference between the two weeks and three months after wearing PTA (p0.05). after 3 months of wearing sophono soft band bone conduction hearing aid, the hearing thresholds of 0.25 khz, 0.5 khz, 1 khz, 2 khz, 4 kHz were decreased by 31.82 [12.90], 35.00 [13.78], 48.19 [14.19], 41.81 [12.10], 44.09 [17.86 db], respectively. the mean pre-hearing aid cap score was 2.64 [0.50], 2 weeks and 3 months after wearing sophono soft band bone conduction hearing aid. The AP scale score increased to 5.36 (+ 0.50) and 5.36 (+ 0.50) respectively. 4.69,31.35 [9.83] dbhl. on the day of hearing aid wearing, 2 weeks after wearing, 3 months after wearing, the gain was 34.17 [10.12], 31.15 [11.07], 30.21 [14.45] DB respectively. there was no significant difference between the mean value of PTA before hearing aid and the day of wearing, 2 weeks after wearing and 3 months after wearing (p0.05). 3 months after hearing aid, 0.25 khz, 0.5 khz, 0.5 khz, 1 khz, 1 khz, 2 khz, 1 khz, 2 khz, 4 kHz auditory threshvalue decreased by 16.25 [15.24, 30.42 [14.05, 40.00 [15.37, 45.00 [15.37, 25.42 [16.58, 25.42 [16.58, 20.84 [15.64] 64db], respectively. The first three directions (0 [, 90 [, 90 [, 270]) SRTs were 67.30 [(0.30 [4.46, 68.66 [6.66 [5.66 [5.08, 68.08, 69.66 40 SRT in three directions after wearing SRT for 2 weeks were 37.51 + 5.06, 37.24 + 7.09, 40.42 + 7.46 dBHL and 38.32 + 4.92, 38.72 + 6.34, 42.65 + 5.68 dBHL respectively, and most of the three directions in the unilateral extremely severe sensorineural deafness group were unable to calculate the pneumoosynamic conduction threshold of the bare ear and could not calculate the PTA. The mean audiometric thresholds were 9.37 (+ 6.80 dB HL), 55.00 (+ 12.08 dB HL) before and after masking. On the day of wearing, 2 weeks and 3 months after wearing, the audiometric thresholds decreased to 25.63 (+ 4.62), 28.13 (+ 7.74), 30.63 (+ 6.81) dB HL. Speech recognition thresholds in 0, 90, and 270 directions before hearing aid were 54.15, 55.47, 55.47, 3.32, 54.60, 3.04 dB HL, 38.02, 2.11, 31.08, 2.65, 38.54, 2.81 dB HL respectively. Speech recognition thresholds in three directions were 34.76, 3.56, 31.14, 2.41, 36.68, 5.70 dB and 3 months after wearing, respectively. Speech recognition thresholds in three directions were 34.95 [2.41], 30.75 [2.33] and 39.35 [2.77] dBHL, respectively; and there were no hearing aid-related adverse reactions and adverse events in all groups. Speech development in children. 2 The wearing of Sophono's new soft-band bone-guided hearing aid can effectively improve the hearing and speech recognition thresholds of patients with bilateral conductive deafness aged 6 years and over, and can be a new choice for improving hearing status in such patients. 3 The wearing of Sophono's new soft-band bone-guided hearing aid can improve the hearing of patients with unilateral extremely severe sensorineural hearing loss. It has a good hearing aid effect and can improve the hearing threshold and sense of orientation of patients in quiet condition.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R764.5

【参考文献】