人工耳蜗植入电极长度的选择与疗效评估  

Selection of cochlear electrode array implantation lengths and outcomes in patients with bilateral sensorineural hearing loss

作　　者：牛晓敏 平陆 高儒真[1] 夏鑫 范欣淼 陈钰[3] 樊悦[1] 陈晓巍[1] Niu Xiaomin;Ping Lu;Gao Ruzhen;Xia Xin;Fan Xinmiao;Chen Yu;Fan Yue;Chen Xiaowei(Department of Otolaryngology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Clinical Academy,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院北京协和医院耳鼻喉科,北京100730 [2]中国医学科学院,北京协和医学院临床学院,北京100730 [3]中国医学科学院北京协和医学院北京协和医院放射科,北京100730

出　　处：《中华医学杂志》2021年第2期108-114,共7页National Medical Journal of China

基　　金：国家重点研发计划项目(2020YFC2005200,2020YFC2005201,2016YFC0901500)。

摘　　要：目的综合评价对于双侧感音神经性耳聋患者,单侧植入全覆盖与标准长度电极对听阈、言语识别、生活质量的提升效果是否存在差异。方法选取2018年4月至2019年8月在北京协和医院耳鼻喉科诊断为双侧重度-极重度感音神经性耳聋患者26例,男12例,女14例,年龄19~71(43±16)岁。术前行颞骨高分辨率CT,应用OTOPLAN软件进行评估,以经圆窗膜入路的微创手术单侧植入全覆盖电极11耳(全覆盖组),标准电极15耳(标准电极组),于术后开机时、3~5个月、6~11个月及术后1年以上分别对比两组患者声场下助听听阈,安静及噪声下言语识别与Nijmegen人工耳蜗植入量表(NICQ)评分。结果全覆盖组与标准电极组患者术后开机时听阈分别为(46.5±3.4)dB与(48.5±2.2)dB,差异无统计学意义(P=0.074),术后听阈及言语识别水平均较术前提高(均P<0.05);1年后听阈分别为(32.1±1.2)dB与(32.5±0.9)dB,差异无统计学意义(P=0.355);除术后1年以上随访时单、双音节词与术后3~5个月的句子识别率外,全覆盖组65 dB声压级(SPL)单、双音节词及句子识别率在各次随访中均优于标准电极组(均P<0.05);术后1年以上噪音条件(信噪比=10 dB)下,全覆盖组单、双音节词与句子识别率均高于标准电极组(均P<0.05);NICQ量表各维度术后均提升,其中自信心维度两组提升值差异有统计学意义(P<0.05),其余各维度提升值两组比较差异均无统计学意义(均P>0.05)。结论在双侧重度-极重度感音神经性耳聋患者中单侧植入基于OTOPLAN选择的全覆盖与标准电极均能带来明显的听力及生活质量改善,全覆盖电极植入可能会提升患者术后的言语识别获益。Objective To perform a comprehensive comparison on the therapeutic effects of unilateral 31.5 mm and 28 mm cochlear implantation(CI)on the post-operative hearing rehabilitation outcomes,including hearing threshold,speech recognition and quality of life,in patients with bilateral sensorineural hearing loss.Methods A total of 26 patients[12 males,14 females,aged 19-71(43±16)years]diagnosed with bilateral severe-to-profound sensorineural hearing loss at Peking Union Medical College Hospital from April 2018 to August 2019 were included.Patients underwent temporal bone high resolution CT(HRCT),based on which the electrode lengths were calculated using OTOPLAN.Eleven and fifteen ears were implanted with MED-EL Flex 31.5 mm and Flex 28 mm electrode arrays respectively,via round window approach under minimally invasive surgery.The patients were followed up regularly for up to 2 years.At each follow-up,aided hearing threshold,speech recognition in quiet and noise,and Nijmegen Cochlear Implantation Questionnaire(NICQ)scores were evaluated and compared.Results Post-operative hearing thresholds were(46.5±3.4)dB and(48.5±2.2)dB in patients implanted with MED-EL Flex 31.5 mm and Flex 28 mm electrode arrays,respectively,with no statistically significant difference(P=0.074).Both hearing thresholds and speech recognition demonstrated significant post-operative improvement compared with pre-operative results.Hearing thresholds after 1-year post-operation were(32.1±1.2)dB and(32.5±0.9)dB,respectively(P=0.355).Patients implanted with Flex 31.5 mm electrode scored significantly higher at speech recognition under 65 dB sound pressure level(SPL)at most of the follow-ups(All P<0.05).Speech recognition in noise(S/N=10 dB)was also improved in patients implanted with Flex 31.5 mm electrode.All sub-divisions of the NICQ demonstrated significant post-operative improvement,and no significant difference between the 2 groups was observed apart from the"self-confidence"sub-division.Conclusions Selection of MED-EL Flex 31.5 mm and 28 mm impl

关 键 词：听觉丧失 感音神经性 耳蜗植入术 听力学 电极长度 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]