蜗神经孔狭窄和闭锁的诊断与人工耳蜗植入术后效果

发布时间：2018-06-15 10:36

本文选题：蜗神经孔狭窄 + 骨性闭锁　；参考：《临床耳鼻咽喉头颈外科杂志》2014年15期

【摘要】：目的:探讨在人工耳蜗植入术患者中,先天性蜗神经孔狭窄与骨性闭锁的CT形态特征与人工耳蜗植入术后患者听神经的电生理反应和听觉言语识别效果,为探索人工耳蜗植入手术适应证提供参考。方法:对3 700例双耳极重度感音神经性聋患者进行蜗神经孔狭窄和骨性闭锁判断方法的制定,用术前颞骨高分辨CT和MRI筛查双侧蜗神经管狭窄和骨性闭锁患者,并进行人工耳蜗植入手术。对术后的听觉神经电反应遥测、术后的EABR检测、人工耳蜗的声场下纯音听力检测、听觉言语识别率的检测结果进行分析,总结蜗神经孔狭窄和骨性闭锁的感音性聋患者的人工耳蜗植入术后的电生理检测结果和听觉言语识别效果。结果:①按蜗神经孔狭窄和骨性闭锁的判断方法对3 700例人工耳蜗植入手术患者进行术前的影像学筛查:蜗神经孔狭窄和闭锁共27例,发生率为0.73%,其中蜗神经孔骨性闭锁6例。②27例人工耳蜗植入术患者术中电极阻抗检测均正常,听神经电反应遥测(NET、ART、NRI)检测,除6例奥地利COMBI 40+无该检测以外,其余21例中14例引出非典型的听神经反应波形,7例引不出波形。③术后3个月进行EABR检测为:27例均引出非典型EABR波形。④术后3个月进行主观听力检查。声场下纯音听力检测:27例500、1 000、2 000Hz平均为75dB HL;术后16例3岁以上患者进行言语识别率的检测:单韵母的言语识别率为65%,单声母的言语识别率10%。结论:①蜗神经孔狭窄和骨性闭锁可以在人工耳蜗植入术前通过颞骨高分辨CT筛查明确诊断。②蜗神经孔狭窄和骨性闭锁的人工耳蜗植入术后言语识别效果很差,大多数仅对汉语韵母有识别,是否具备人工耳蜗植入的适应证,还需进一步的临床效果的随访验证。
[Abstract]:Objective: to investigate the CT features of congenital cochlear foramen stenosis and osseous atresia in cochlear implants and the electrophysiological response of auditory nerve and the effect of auditory speech recognition after cochlear implantation. To explore the indication of cochlear implantation. Methods: 3 700 patients with extremely severe auricular sensorineural deafness were examined for stenosis of cochlear foramen and osseous atresia. Preoperative high resolution CT and MRI were used to screen bilateral cochlear canal stenosis and osseous atresia. Cochlear implantation was performed. The results of telemetering of auditory nerve response, detection of EABR after operation, pure tone audiometry in the sound field of cochlear implant, and auditory speech recognition rate were analyzed. To summarize the results of electrophysiological examination and auditory speech recognition of cochlear foramen stenosis and osseous atresia in patients with sensorineural deafness after cochlear implantation. Results according to the method of judging the stenosis of cochlear foramen and osseous atresia, 3700 cases of cochlear implant were screened before operation: 27 cases of stenosis and atresia of cochlear foramen, 27 cases of cochlear foramen stenosis and atresia, The incidence rate was 0.73. Among them, 6 patients with osseous atresia of the foramen cochlea and 227 patients with cochlear implants underwent cochlear implantation. In the other 21 cases, 14 cases got atypical acoustic nerve response waveform, 7 cases did not draw out the waveform. 3 months after operation, EABR was detected in 27 cases. All the 27 cases got atypical EABR waveform. 4 months after operation, subjective hearing examination was performed. The speech recognition rate of 16 patients over 3 years of age after operation was: the speech recognition rate of single vowel was 65 and the speech recognition rate of mono-consonant was 10. Conclusion the stenosis of foramen cochlea and osseous atresia can be clearly diagnosed by high-resolution CT screening of temporal bone before cochlear implantation. 2 the speech recognition effect of cochlear implant after cochlear foramen stenosis and osseous atresia is very poor. Most of the Chinese vowels are only recognized and the indications of cochlear implants need to be further followed up.
【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】：R764.9

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