人工耳蜗植入术对前庭功能影响的临床研究

发布时间：2018-07-04 14:27

本文选题：人工耳蜗植入 + 前庭功能检查　；参考：《福建医科大学》2010年硕士论文

【摘要】： 目的探讨人工耳蜗植入术对前庭功能的影响。患者与方法本研究入选对象为2001年至2009年于福建医科大学附属第一医院耳鼻咽喉科由同一术者行人工电子耳蜗植入术,术后6个月以上,并于2009年11月至2010年1月期间于我科随访,现年龄大于6岁的患者。排除1例非前庭因素自行放弃使用人工耳蜗者,共有12例患者参与本项研究。应用视频眼震电图仪常规进行自发眼震和双耳变温冷热试验,并结合前庭诱发肌源性电位检查进行前庭功能检测。以P13、N23波潜伏期与振幅,半规管轻瘫与方向,优势偏向值与方向,自发性眼震的强度与方向为评定指标。结果 12例患者中1人术前伴有眩晕术后眩晕消失,2人术前术后均有眩晕,主观眩晕症状出现率16.67%,VEMP异常率66.67%,双耳变温冷热试验异常率100%。患者行VEMP检查,双侧短纯音刺激P13波和N23波出现率为50%(6/12),诱发出波形的手术耳组P13潜伏期与非手术耳组相比,两者无明显差异(P0.05),手术耳组N23潜伏期与非手术耳组相比,两者无明显差异(P0.05),△P13-N23手术耳组与非手术耳组相比,两者无明显差异(t=0.009,P0.05);手术耳组振幅低于非手术耳组振幅,差值具有统计学意义(t=3.75, P0.05)。 12人中41.67%的患者(5/12)出现双侧半规管轻瘫,58.33%的患者(7/12)出现单侧迷路反应减弱,41.67%的患者(5/12)出现优势偏向。结论 1.人工耳蜗植入术后前庭功能检查异常不一定出现临床平衡障碍。 2.人工耳蜗植入术后主观性眩晕出现率低于前庭功能检查异常率可能与前庭代偿有关。 3.人工耳蜗植入术前伴有前庭功能障碍的患者术后容易出现主观性眩晕。 4.内耳畸形患者人工耳蜗植入术后前庭功能检查异常率高于内耳正常患者。 5.人工耳蜗植入术后可通过VEMP检查和双耳变温冷热试验检查来判断患者术后球囊和水平半规管的功能,人工耳蜗植入术对VEMP的传导并无影响,但可造成手术耳VEMP的振幅下降,可能与人工耳蜗植入术的手术刺激或长期的电极植入对球囊功能的影响有关;手术耳容易出现水平半规管功能减弱,对侧优势偏向,优势偏向的出现可能与位置性眼震和电极长期安置造成的前庭损伤有关。 6.前庭功能检查可广泛运用于人工耳蜗植入术前、术后的前庭评估。
[Abstract]:Objective to investigate the effect of cochlear implantation on vestibular function. Methods from 2001 to 2009, cochlear implant was performed in the Department of Otorhinolaryngology, the first affiliated Hospital of Fujian Medical University. From November 2009 to January 2010, we followed up the patients over 6 years old. A total of 12 patients took part in the study, excluding one case of non-vestibular factors voluntarily abandoning the use of cochlear implants. The spontaneous nystagmus and binaural temperature change cold and hot tests were carried out by video nystagmography, and vestibular function was detected with vestibular evoked myogenic potential (VEMP). The latent period and amplitude of P13 N23 wave, semicircular canal paresis and direction, dominant deviation value and direction, intensity and direction of spontaneous nystagmus were taken as the evaluation index. Results one patient with vertigo disappeared before operation and two patients had vertigo before and after operation. The occurrence rate of subjective vertigo symptom was 16.67 and the abnormal rate of VEMP was 66.67. The abnormal rate of bilateral ear warming test was 100. The frequency of P13 and N23 waves of bilateral short tone stimulation was 50% (6 / 12). There was no significant difference in P13 latency between the operation group and the non-operative ear group (P0.05). The N23 latency of the operation ear group was higher than that of the non-operative ear group. There was no significant difference between the two groups (P0.05), and there was no significant difference between the P13-N23 group and the non-operative group (t 0.009 P 0.05), the amplitude of the operated ear group was lower than that of the non-operative ear group, the amplitude of the operation ear group was lower than that of the non-operative ear group. The difference was statistically significant (t = 3.75, P0.05). 41.67% of the 12 patients (5 / 12) had bilateral semicircular canal paresis (58.33%) and 41.67% (5 / 12) had a dominant bias. Conclusion 1. Abnormal vestibular function after cochlear implantation does not necessarily lead to clinical imbalance. 2. The occurrence rate of subjective vertigo after cochlear implantation was lower than that of vestibular function examination. Patients with vestibular dysfunction before cochlear implantation are prone to subjective vertigo. 4. The abnormal rate of vestibular function in patients with inner ear malformation after cochlear implantation was higher than that in normal inner ear patients. After cochlear implantation, the function of balloon and horizontal semicircular canal after cochlear implantation can be judged by VEMP and binaural warming test. Cochlear implantation has no effect on the conduction of VEMP, but it can cause the amplitude of VEMP to decrease. It may be related to the effects of cochlear implantation or long-term electrode implantation on the saccular function, the horizontal semicircular canal function is weakened and the contralateral dominant bias is found in the operated ear. The occurrence of dominant bias may be related to the vestibular injury caused by positional nystagmus and long-term electrode placement. Vestibular function examination can be widely used in vestibular evaluation before and after cochlear implantation.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R764

【参考文献】