人工耳蜗植入术在聋哑症合并中耳炎、大前庭水管综合征，及脑白质发育不良的临床应用

发布时间：2018-06-06 11:41

本文选题：人工耳蜗植入 + 重度感音神经性耳聋　；参考：《中南大学》2010年硕士论文

【摘要】： 目的通过对湘雅医院接受人工耳蜗植入患者临床资料的回顾性分析,探讨人工耳蜗植入术在聋哑症合并中耳炎、大前庭水管综合征,及脑白质发育不良的临床应用。数据与方法对湘雅医院2002年1月至2010年3月接受人工耳蜗植入的124例患者进行回顾性分析,CT发现慢性分泌性中耳炎9例,大前庭水管综合征(LVAS)6例；MRI发现脑白质发育不良5例；其中男11例,女9例,年龄1岁-8岁。在104例单纯聋哑症患者中抽取20例,做为对照,评估有合并症患者的术后康复效果；其中男13例,女7例,年龄1岁-9岁。术前行临床医学、影像学、听力学、助听器效果、语言能力等各方面评估。40例患者均经乳突后鼓室面神经隐窝入路行工期人工耳蜗植入,均采用澳大利亚Cochlear公司CI24型人工耳蜗装置,术中行阻抗测试及神经反应遥测(NRT)。术后三天行耳蜗拍片,术后一个月开机调试。术后随访一年电极阻抗、言语识别率等康复指标。结果此40例患者均为语前聋；术前脑干诱发电位(ABR)、多频稳态诱发电位(ASSR)、畸变产物耳声发射(DPOAE)证实40例患者均为极重度感音神经性聋。40例患者全部成功完成I期人工耳蜗植入术,耳蜗造孔及电极插入顺利,术中测试电极阻抗及NRT均良好。9例聋哑症合并慢性分泌性中耳炎患者,术中可见乳突小房及鼓室粘膜增厚,其内可见淡黄色胶冻样分泌物。6例LVAS患者,术中均发生镫井喷,电极插入顺利,用软组织封闭后井喷停止。5例脑白质发育不良患者,术中无特殊发现。所有病例未发生并发症；术后三天行耳蜗拍片,均显示电极在耳蜗内；术后一个月开机调试,均有听觉反应。术后随访未发现耳部炎性并发症及其它并发症；患者康复良好,有合并症的耳蜗植入者的电极阻抗值及言语识别率,与单纯聋哑症患者无统计学差异。结论聋哑症合并慢性分泌性中耳炎及大前庭水管综合症并不是人工耳蜗植入的禁忌证,但慢性分泌性中耳炎患者围术期应加强观察和预防感染；大前庭水管综合症患者术中遇“镫井喷”,恰当处理不影响电极植入。短期来看,脑白质发育不良并未影响聋哑症患者人工耳蜗植入术后康复效果,但其长期是否影响患者的智力、语言发育,应视脑白质发育不良本身的病变而定。
[Abstract]:Objective to analyze retrospectively the clinical data of cochlear implants in Xiangya Hospital, and to explore the application of cochlear implantation in deaf-mutism complicated with otitis media and vestibular aqueduct syndrome. Data and methods 124 patients received cochlear implant in Xiangya Hospital from January 2002 to March 2010 were analyzed retrospectively and 9 cases of chronic secretory otitis media were found by CT. Six patients with large vestibular aqueduct syndrome (LVASS) were diagnosed by MRI in 5 patients, including 11 males and 9 females aged 1-8 years. Twenty of 104 patients with simple deaf-mutism were selected as control group to evaluate the postoperative rehabilitation effect of patients with complications, including 13 males and 7 females, aged 1-9 years. Preoperative evaluation of clinical medicine, imaging, audiology, hearing aid, speech ability and other aspects. 40 patients underwent cochlear implantation through the posterior tympanic recess. All patients were treated with cochlear CI24 cochlear implant in Australia. Impedance test and nerve response telemetry were performed during the operation. Cochlear film was taken 3 days after operation, and the machine was debugged one month after operation. One year after operation, the electrode impedance, speech recognition rate and other rehabilitation indexes were followed up. Results all the 40 patients were prelingual deafness. Preoperative brainstem evoked potential (ABR), multi-frequency steady-state evoked potential (ASSR), distortion product otoacoustic emission (DPOAE) confirmed that all 40 patients with extremely severe sensorineural deafness underwent stage I cochlear implantation successfully, cochlear foramen and electrode insertion were successful. The electrode impedance and NRT were good in 9 cases of deaf-mutism complicated with chronic secretory otitis media. The mucosal thickening of mastoid chamber and tympanic chamber was observed during the operation. There were 6 cases of LVAS with light yellow gelatinous secretions. The stirrup blowout occurred during the operation. The electrode was inserted smoothly and the blowout stopped in 5 patients with leukoplasia after soft tissue sealing. No special findings were found during the operation. There were no complications in all cases. Cochlea film was taken 3 days after operation and the electrode was found in the cochlea. No postoperative inflammatory and other complications were found, and the electrode impedance and speech recognition rate of cochlear implants with complicated cochlear implantation were well recovered. Conclusion chronic secretory otitis media and large vestibular aqueduct syndrome are not contraindication for cochlear implantation. However, the patients with chronic secretory otitis media should strengthen observation and prevention of infection during perioperative period, and the patients with large vestibular aqueduct syndrome should be treated properly with stirrup blowout during operation, and the electrode implantation should not be affected by proper treatment. In the short term, leukoplasia does not affect the rehabilitation effect of cochlear implantation in deaf and mute patients, but whether it affects the patient's intelligence and language development in the long run should depend on the lesion of leukoplasia itself.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R764

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