人工耳蜗术后耳鸣疗效及耳鸣改变模式分析  

Effect of cochlear implantation on tinnitus and the prognosis mode analysis

作　　者：王智超[1] 黄琦[2] 陈兵 程华茂 李蕴[4] 谢敏[1] 谢文[1] 黄美萍[4] 戴春富 吴皓[4] 孔维佳[1] WANG Zhichao;HUANG Qi;CHEN Bing;CHENG Huamao;LI Yun;XIE Min;XIE Wen;HUANG Meiping;DAI Chunfu;WU Hao;KONG Weijia(Department of Otolaryngology,Wuhan Union Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan,430022,China;Department of Otolaryngology Head and Neck Surgery,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine;Department of Otolarygology,Eye&ENT Hospital of Fudan University;Department of Otolaryngology Head and Neck Surgery,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine)

机构地区：[1]华中科技大学同济医学院附属协和医院耳鼻咽喉科,武汉430022 [2]上海交通大学医学院附属新华医院耳鼻咽喉头颈外科 [3]复旦大学附属眼耳鼻喉科医院耳鼻咽喉科 [4]上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科

出　　处：《临床耳鼻咽喉头颈外科杂志》2020年第11期966-971,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:观察人工耳蜗对成人耳鸣的疗效,并探讨单侧人工耳蜗植入后耳鸣改变模式下患者的听言能力提升情况及对耳鸣改变模式相关影响因素分析。方法:对70例使用LCI-20PI国产人工耳蜗(含LSP-20A声音处理器)的语后聋患者分别于术前及术后开机和第3、6、9个月进行有无耳鸣症状的简单问卷,并按耳鸣的进展模式分为6个组。A组(-to-):表示耳鸣始终无,即植入前无耳鸣,植入后持续无耳鸣;B组(+to-):表示耳鸣从有到无,即植入前有耳鸣,植入后耳鸣消失;C组(-to+):表示耳鸣从无到有,即植入前无耳鸣,植入后出现耳鸣;D组(+to-to+):表示耳鸣从有到无到有,即植入前有耳鸣,观察过程中耳鸣消失,最后耳鸣再次出现;E组(-to+to-):表示耳鸣从无到有到无,即植入前无耳鸣,观察过程中有耳鸣出现,后耳鸣消失;F组(+to+):表示耳鸣持续有,即耳蜗植入前后耳鸣持续存在。对各组听阈的改善、平均言语分辨率(SDR)、年龄、听力损失病程及助听器的佩戴时间进行分析。结果:耳鸣治疗的有效率为80%,开机9个月后新发耳鸣率为9%。A组(-to-)年龄为(20.79±11.364)岁,B组(+to-)为(32.69±10.606)岁,C组(-to+)为(40.25±2.217)岁,D组(+to-to+)为(28.00±0)岁,E组(-to+to-)为(52.50±6.364)岁,F组(+to+)为(30.33±11.015)岁,组间比较差异有统计学意义(P<0.05)。听力损失病程与助听器佩戴时间组间比较差异均无统计学意义(P>0.05)。F组(+to+)SDR提升最大,组间比较差异无统计学意义(P>0.05)。E组(-to+to-)听阈值为(22.50±3.535)dB HL,改善最少,F组(+to+)为(56.04±10.649)dB HL,改善最多,2组比较差异有统计学意义(P<0.05)。结论:人工耳蜗对耳鸣治疗有效率为80%。耳鸣持续组的患者听力言语恢复均更好,提示可能与残存听神经数量及功能有关。患者的年龄对术后耳鸣出现的影响可能较大,需要在术前宣教及术后康复中予以关注。Objective:To describe the effects of the possible related factors in unilateral cochlear implantation(CI)on tinnitus,and analysis the hearing and speech ability in different tinnitus prognosis mode.Method:The 70 post-lingual deafness CI patients(27.73±14.032 years old)in the clinical trial for LCI-20 PI cochlear implant and LSP-20 A sound processor project by a fast questionnaire about the tinnitus positive or negative respectively before the CI,3 rd,6 th,9 th and 12 th months after the first mapping.6 modes about tinnitus development were record:Type A(-to-),no tinnitus before the CI and continued negative until the last follow-up;Type B(+to-),have tinnitus before CI and disappeared after the mapping;Type C(-to+),no tinnitus before but appeared after the surgery;Type D(+to-to+),have tinnitus before the CI and disappeared during the continue follow-up,but finally the tinnitus show up again at last;Type E(-to+to-),no tinnitus before and suffered from tinnitus after the CI surgery,but the noise disappeared at last;Type F(+to+),have the tinnitus in all the duration.Then we briefly analyzed the factors like age,gender,the duration of hearing loss,and the duration of hearing aids usage.Compare the characteristics in all the modes of tinnitus prognosis.Result:In this research CI treatment effect rate on tinnitus is 80%.The mean age of Type A(tinnitus from-to-)group is(20.79±11.364)years old;Type B(tinnitus from+to-)group is(32.69±10.606)years old;Type C(tinnitus from-to+)group is(40.25±2.217)years old;Type D(tinnitus from+to-to+)group is(28.00±0)years old;Type E(tinnitus from-to+to-)group is(52.50±6.364)years old;Type F(tinnitus from+to+)group is(30.33±11.015)years old.And P<0.05 between the groups,while the severe-deaf-duration intergroup differences(P>0.05).The mean speech discrimination rates are all elevate after 12 months and no statistical significance between the groups.But the E group has a lowst elevation in mean pure tone threshold(22.50±3.535)dB HL,when the F group has the best promotion(56.04±10.64

关 键 词：耳蜗植入术 听觉丧失 感音神经性 语后聋 言语分辨率 耳鸣 

分 类 号：R764.45[医药卫生—耳鼻咽喉科]