大前庭水管综合症患者的人工耳蜗植入

发布时间：2018-06-05 23:02

本文选题：前庭水管 + 畸形　；参考：《安徽医科大学》2011年硕士论文

【摘要】：目的大前庭水管综合症患者的听力发展到稳定的重-极重度感音神经性耳聋后,药物及配戴助听器无法补偿听力。近年来,随着人工耳蜗植入技术的迅速发展,已成为治疗大前庭水管综合症患者的手段,本文通过分析18例LAVS患者的临床资料及随访结果,探讨LAVS患者行人工耳蜗植入术的安全性和有效性。方法分析2005年6月至2010年6月我院112例人工耳蜗植入患者的临床资料,术前除声阻抗、脑干电位、多频稳态、耳生发射等常规听力学检查外,重点通过HRCT和MRI的影像学检查,搜集了18例大前庭水管综合症患者行人工耳蜗植入的临床资料。从术前如何明确诊断、是否并发内耳畸形、如何预测术中是否出现“井喷”等现象;术中主要观察有无发生“井喷”、耳蜗植入是否顺利等及相关的处理办法;术后评估:⑴观察术后有无并发症,并进行电话随访;⑵随机抽取并设立18例内耳结构正常的人工耳蜗植入患儿为对照组,术后半年,用自由声场纯音测听测两组的听力水平、用孙喜斌研制《聋儿康复听觉言语评估词表》来测患者的言语识别率,对并两组的结果进行统计学分析,看两组有无差别,进而得出结论。结果 1手术结果 18例大前庭水管综合症患者均顺利完成手术,术中15例电极全植入、3例不完全植入,其中5例出现轻度“井喷”、1例严重“井喷”;术后随访0. 5～6.5年,无脑脊液漏、颅内感染、面瘫等并发症,仅有1例术后四月出现植入体前移,经加压包扎,抗炎后固定。 2术后听力言语评估结果半年后LAV组声场纯音听力水平在25～46dBSPL之间,平均为34.5dBSPL,18例内耳结构正常组在23～48dBSPL,平均为31.6dBSPL;LAV组言语识别率67%～88%,平均为78.3%,18例内耳正常组言语识别率在69%～92%,平均为81.6%,通过SPASS13.0软件,对两组数据进行t检验,P均0.05,两组差别无统计学意义。 3电话随访结果今年1月份进行末次电话随访时,有14例已进入普通小学、幼儿园上学,4例仍在言语康复学校训练,均可和家人正常交流,家属满意度优。结论大前庭水管综合症患者的人工耳蜗植入较内耳结构正常者风险大,但经严格的术前听力和影像学评估、术中积极处理及术后的正规康复训练后,手术是安全、有效的。
[Abstract]:Objective after the patients with large vestibular aqueduct syndrome developed to severe and severe sensorineural hearing loss, drugs and hearing aids could not compensate for hearing loss. In recent years, with the rapid development of cochlear implant technology, it has become a method to treat patients with large vestibular aqueduct syndrome. The clinical data and follow-up results of 18 patients with LAVS were analyzed. To investigate the safety and efficacy of cochlear implantation in patients with LAVS. Methods the clinical data of 112 patients with cochlear implants from June 2005 to June 2010 were analyzed. In addition to acoustic impedance, brainstem potential, multi-frequency steady-state, otogenic emission and other routine audiological examinations, the imaging examinations of HRCT and MRI were carried out. Clinical data of cochlear implantation in 18 patients with large vestibular aqueduct syndrome were collected. How to make sure the diagnosis before operation, whether the deformity of inner ear is complicated, how to predict whether there is "blowout" during operation, how to observe whether there is "blowout" or not, whether the cochlear implantation is smooth or not, and how to deal with it. After operation, 1 was evaluated for postoperative complications, and 18 children with normal inner ear structure were selected randomly and 18 children with normal inner ear structure were selected as control group. The hearing level of the two groups was measured by free sound field pure tone audiometry half a year after operation. The speech recognition rate of deaf children was measured by using Sun Xibin's speech Evaluation list for hearing Rehabilitation of Deaf Children. The results of the two groups were statistically analyzed to see if there were any differences between the two groups and to draw a conclusion. Result 1 result of operation All the 18 patients with large vestibular aqueduct syndrome successfully completed the operation, and 15 cases were implanted with full electrode in 3 cases, among which 5 cases had mild "blowout" and 1 case was severe "blowout". From 5 to 6.5 years, there was no cerebrospinal fluid leakage, intracranial infection, facial paralysis and other complications. 2the results of hearing and speech evaluation after operation Half a year later, the sound field pure tone hearing level of LAV group was between 25~46dBSPL, with an average of 34.5 dBSPLs and 18 cases of normal inner ear structure group. The average score was 31.6 dBSPLL, and the average was 31.6dBSPLLAV group. The average speech recognition rate of LAV group was 78.3dSPLLAV. The speech recognition rate of 18 cases of inner ear normal group was 6992, the average was 81.60.Through SPASS13.0 software, The two groups of data were tested by t test (P < 0.05), and there was no significant difference between the two groups. 3 telephone follow-up results By the last telephone follow-up in January this year, 14 cases had entered ordinary primary school, 4 cases in kindergarten were still training in speech rehabilitation school, they could communicate with their families normally, and the satisfaction of the families was excellent. Conclusion the risk of cochlear implantation in patients with large vestibular aqueduct syndrome is higher than that in patients with normal inner ear structure, but it is safe and effective after strict preoperative hearing and imaging evaluation, active treatment during operation and regular rehabilitation training after operation.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R764

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