前庭水管扩大患者人工耳蜗植入术后效果研究  

Efficacy of Cochlear Implantation in Patients with Enlarged Vestibular Aqueduct

作　　者：仵倩 胡健 赵晓云 刘贝贝 陈迟[1] 边盼盼[1] 徐百成[1] 郭玉芬[1] WU Qian;HU Jian;ZHAO Xiaoyun;LIU Beibei;CHEN Chi;BIAN Panpan;XU Baicheng;GUO Yufen(Department of Otolaryngology Head and Neck Surgery,Second Affiliated Hospital of Lanzhou University,Lanzhou 730030)

机构地区：[1]兰州大学第二医院耳鼻咽喉头颈外科,兰州730030

出　　处：《中华耳科学杂志》2020年第6期1007-1012,共6页Chinese Journal of Otology

摘　　要：目的通过分析前庭水管扩大(Enlarged vestibular aqueduct,EVA)患者行人工耳蜗植入(Cochlear implantation,CI)的听觉言语康复效果,并与内耳形态正常组CI患者进行对比,评估EVA患者接受CI治疗的有效性,探讨内耳形态学对术后听觉言语康复效果的影响。方法选择诊断为EVA并行CI患者71例,另筛选临床资料相匹配的71例内耳形态正常CI患者作为对照组,所有患者术后三年进行听力言语评估,包括声场助听听阈,听觉能力分级(Categories of auditory performace,CAP)及言语可懂度分级(Speech intelligibility rating,SIR)问卷评估,通过"心爱飞扬"言语测试软件进行言语识别能力评估。另外测量前庭水管(Vestibular aqueduct,VA)中点直径,CT阅片确诊不完全分隔Ⅱ型(Incomplete partition of the cochlea,IP-Ⅱ),研究内耳形态异常对术后听觉言语康复效果的影响。结果EVA组与内耳形态正常组患者和单纯EVA与EVA伴IP-Ⅱ畸形患者术后三年听觉言语康复效果无统计学差异。EVA组VA中点直径平均值为2.70±0.79 mm,VA中点直径大于3.0mm组与VA中点直径扩大小于3.0 mm组,两组患者CI术后言语识别能力具有统计学差异。结论EVA患者通过CI可获得与内耳形态正常者相当的听觉言语康复效果;EVA是否伴IP-Ⅱ畸形与术后听觉言语康复效果无相关性;VA中点直径扩大超过3.0 mm,EVA患者CI术后听觉言语康复效果较差。Objective To report hearing and speech recognition outcomes after cochlear implantation in children with enlarged vestibular aqueduct(EVA), in comparison to children with normal inner ear anatomy. Method A total of 142 children with congenital severe to profound hearing loss participated in this study, including 71 with EVA and 71 clinically matched children showing normal inner ear anatomy. Pure tone thresholds in sound field, categories of auditory performance(CAP) and speech intelligibility rating(SIR) were used to evaluate development of auditory skills, and a computer aided Chinese speech audiometry platform was used to test sentence recognition abilities in quiet and noise at three years after cochlear implantation. The vestibular aqueduct(VA) midpoint was measured and incomplete partition of cochlea Ⅱ(IP-Ⅱ) was diagnosed on CT scans, which were also used to analyze the correlation between inner ear malformation and hearing speech rehabilitation after surgery. Results Pure tone thresholds in sound field, CAP, SIR and speech recognition ability were not significantly different between the EVA patients and those with normal inner ear anatomy ate three years after surgery, nor between patients with EVA alone and those with IP-Ⅱ deformity. The mean VA midpoint was 2.70 ± 0.79 mm. Speech recognition ability showed a statistically significant difference between patients with VA midpoint greater than 3 mm and those with VA midpoint less than 3 mm. Conclusion Auditory skills after cochlear implantation were similar in children in EVA as compared to children with normal inner ear anatomy, regardless if EVA is associated with IP-Ⅱ deformity. Diameter at the midpoint of VA of more than 3.0 mm is associated with poor auditory speech rehabilitation after CI.

关 键 词：人工耳蜗植入 前庭水管扩大 IP-Ⅱ畸形 听觉言语康复效果 

分 类 号：R764[医药卫生—耳鼻咽喉科]