蜗轴骨化的人工耳蜗手术与术后神经电生理评价与主观检测

发布时间：2018-06-06 00:20

本文选题：耳蜗植入术 + 蜗轴骨化　；参考：《临床耳鼻咽喉头颈外科杂志》2014年16期

【摘要】：目的:探讨蜗轴骨化的人工耳蜗植入术和术后听觉神经电生理反应与听觉言语效果问题,为掌握人工耳蜗植入术的适应证提供参考。方法:在进行101例各种程度和类型的耳蜗骨化的人工耳蜗植入术中,涉及到耳蜗蜗轴骨化7例。耳蜗、蜗轴骨化的人工耳蜗植入术前均进行常规影像学检查。蜗轴骨化判断方法:按颞骨高分辨CT水平位和冠状位显示,正常耳蜗中央区的蜗轴结构呈中等密度,其CT值为400~630HU,骨化时蜗轴密度增高,CT值达900HU或以上,除外先天性等因素造成的蜗轴骨化或骨性闭锁等因素。进行术中和术后神经电生理与主观听觉言语检查。结果:7例耳蜗蜗轴骨化的人工耳蜗植入术中电极阻抗检查均正常。7例患者术后均进行EABR检查,1例术后无法引出可识别的EABR波形,其余6例均可以在中段或末端电极部位引出不典型的EABR波形。术后进行声场下的纯音检测:1例EABR无反应患者最大给声无反应;其余6例声场下纯音听力水平平均为75dB。术后听觉言语识别率:1例无听觉反应患者术后言语识别率为0,其余6例汉语普通话单韵母为100%、单声母为30%。结论:耳蜗完全骨化多数伴有蜗轴骨化,施行人工耳蜗植入的最佳方法是将多导电极环绕蜗轴旋转,其手术难度较大。蜗轴骨化的人工耳蜗植入术后听觉电生理反应呈现非典型表现,术后听觉言语效果很差,EABR无反应者存在无效的风险。
[Abstract]:Objective: to investigate the ossification of cochlear axis, the electrophysiological response of auditory nerve and the effect of auditory speech after cochlear ossification, so as to provide reference for the indication of cochlear implantation. Methods: in 101 cases of cochlear ossification, 7 cases involved cochlear axial ossification. Cochlea and cochlear axis ossification were performed before cochlear implantation. Methods: according to high resolution CT horizontal and coronal position of temporal bone, the structure of cochlear axis of normal cochlea showed moderate density, its CT value was 400 ~ 630HU. during ossification, the CT value of cochlear axial density increased to 900HU or above. Except congenital factors such as cochlear axis ossification or osseous atresia. Nerve electrophysiology and subjective auditory speech were examined during and after operation. Results in 7 cases of cochlear axial ossification of cochlea, the electrode impedance was normal in 7 cases of cochlear ossification. All patients underwent EABR after operation and 1 case could not derive the recognizable wave of EABR after operation. In the other 6 cases, atypical EABR waveforms could be obtained at the middle or end electrode sites. After operation, pure tone examination was performed in 1 case of EABR and the average hearing level of 6 cases was 75 dB. The rate of speech recognition was 0 in one patient without auditory response, 100 in the other 6 cases, and 30 in the consonant. Conclusion: cochlear ossification is usually accompanied by cochlear axial ossification. The best method for cochlear implant is to rotate the multi-conducting electrode around the cochlear axis. After cochlear ossification cochlear implantation, the auditory electrophysiological response was atypical, and the auditory speech effect was poor after operation. There was a risk of no response to EABR after cochlear ossification.
【作者单位】：首都医科大学附属北京友谊医院耳鼻咽喉科;
【基金】：卫生公益性行业基金(No:201202001)
【分类号】：R764.5

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