蜗神经孔狭窄和闭锁的诊断与人工耳蜗植入术后效果  

Diagnosis of cochlear nerve foramen stenosis and atresia of the cochlear implantation

作　　者：张道行[1] 

机构地区：[1]首都医科大学附属北京友谊医院耳鼻咽喉科,北京100050

出　　处：《临床耳鼻咽喉头颈外科杂志》2014年第15期1101-1104,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：卫生公益性行业基金(No:201202001)

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。Objective：To summarize methods on diagnosis of congenital cochlear nerve canal（CNC）stenosis or atresia and to report results of post-operation such as auditory electrophysiological test and speech test.Method：Based on temporal bone HRCT and internal acoustic canal MRI,27bilateral congenital CNC stenosis/bony atresia cases were distinguished from 3 700CI cases.Unilateral cochlear implantations were conducted above 27cases.Post-operation tests such as auditory nerve response telemetry,EABR test,hearing threshold in sound field and speech recognition test were applied in the cases above.Result：Incidence of CNC stenosis/bony atresia was observed at 0.73%（27in 3700CI cases）.Impedance values were in the normal range accounting for 27cases.Introoperative auditory nerve response telemetry were conducted accounting for 21cases while 6cases which were implanted with Combi40＋ were not available for this test.Atypical ART response wave was observed for 14cases,while no response for 7cases.EABR test was completed in 27cases within post-operation during 3months and atypical EABR was identified in all cases.Hearing threshold in sound field was confirmed at 75dB which was the average value of 500Hz,1000Hz,and 2000Hz in all 27cases.Speech recognition test result reached to both 65%（21cases,simple finals test）and fewer than 10%（21cases,simple initials test）.Conclusion：By temporal bone HRCT pre-operation,CNC stenosis/bony atresia can be diagnosed.According to both relatively poor auditory and speech test results,further research and discussion are requisite to identify CI indication among the cases above.

关 键 词：蜗神经孔狭窄 骨性闭锁 耳蜗植入术 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]