伴耳鸣患者人工耳蜗植入术中电刺激听觉脑干诱发电位特点及术后疗效分析  

Analysis of intraoperative EABR characteristics and postoperative efficacy of cochlear implant in patients with tinnitus

作　　者：郭晓会 王斌[2] 曹克利[2] 高志强[2] 魏朝刚[3] GUO Xiaohui;WANG Bin;CAO Keli;GAO Zhiqiang;WEI Chaogang(Senior Department of Ophthalmology,the Third Medical Center of PLA General Hospital,Beijing,100853,China;Department of Otolaryngology,the Peking Union Medical College Hospital;Department of Otolaryngology Head and Neck Surgery,Peking University First Hospital)

机构地区：[1]解放军总医院第三医学中心眼科医学部,北京100853 [2]中国医学科学院北京协和医院耳鼻喉科 [3]北京大学第一医院耳鼻咽喉头颈外科

出　　处：《临床耳鼻咽喉头颈外科杂志》2022年第6期423-428,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：北京市科委首都临床特色应用研究基金(No:Z171100001017218)。

摘　　要：目的:探讨伴耳鸣耳聋患者术中电刺激听觉脑干诱发电位(EABR)的特点,分析人工耳蜗植入术(CI)对耳鸣的抑制效果及与听觉诱发电位相关性。方法:选择2014—2015年行CI的成人神经性聋伴耳鸣患者28例(耳鸣组),另选择相同耳聋时间的不伴耳鸣患者10例(对照组),回顾性分析两组患者术前听力学、影像学及耳鸣病史等资料,术中采用EABR检测各级听觉中枢功能,分析其电生理特点;术后随访开机调试结果,采用耳鸣残疾评估量表(THI)评估患者术前和术后耳鸣变化情况,将EABR结果和THI评分进行相关性分析。结果:38例患者术中电极全部植入耳蜗内,术后无面瘫、脑脊液漏、脑膜炎等手术并发症,术后均获得不同程度的电听性反应;术中EABR结果经最小显著性t检验:Ⅲ波波幅、Ⅴ波波幅及Ⅴ波潜伏期在耳鸣组与对照组的差异有统计学意义(P<0.05);耳鸣组Ⅲ波波幅大于Ⅴ波波幅(P<0.05);两组患者开机12个月调机平均C值(162.78±24.57)CL和术中EABR平均阈值(158.62±10.31)CL,经直线相关分析呈明显相关(r=0.903,P<0.01);28例耳鸣患者CI术前、术后1 d、术后1年三个时间点THI总分分别为65.00±14.93,55.00±15.93,36.00±21.02,经方差分析术后1年得分差异有统计学意义(P<0.05),术后1 d较术前差异无统计学意义(P>0.05);术中EABR波形Ⅲ波波幅和术后1年THI变化直线相关分析有显著相关性(r=0.873,P<0.05)。结论:伴耳鸣的耳聋患者术中EABR与不伴耳鸣患者有明显差异,人工耳蜗电刺激对神经性耳鸣有较好的抑制作用,术中EABR为研究人工耳蜗抑制耳鸣提供了一种客观的评估方法。Objective:To investigate the characteristics of intraoperative electrically stimulated auditory brainstem responses(EABR)in patients with neural deafness and tinnitus,and to analyze the inhibitory effect of cochlear implantation on tinnitus and its correlation with auditory evoked potential.Methods:Twenty-eight adult patients with neuronal deafness accompanied by tinnitus who underwent cochlear implant surgery in the Peking Union Medical College Hospital from 2014 to 2015 were selected,and 10 age-matched patients without tinnitus with the same age were selected as the control group.Preoperative audiology,imaging and tinnitus history of the patients were retrospectively analyzed.During the operation,EABR were used to detect the auditory central functions at all levels,and the electrophysiological characteristics of the two groups were analyzed.The tinnitus handicap inventory(THI)was used to evaluate the severity of tinnitus before and after surgery,and the correlation between EABR results and THI score was analyzed.Results:There were no postoperative complications such as facial paralysis,cerebrospinal fluid leakage,meningitis,etc.,and electroacoustic reactions were observed in all 38 patients.The results of intraoperative EABR showed that there were significant differences inⅢwave amplitude,Ⅴwave amplitude andⅤwave latency between tinnitus group and control group(P<0.05).The mean C value of(162.78±24.57)CL and the mean intraoperative EABR threshold of(158.62±10.31)CL were collected in the two groups 12 months after starting the machine,and there was a significant correlation according to linear correlation analysis(r=0.903,P<0.01).The total THI scores of 28 tinnitus patients were 65.00±14.93,55.00±15.93 and 36.00±21.02 at three time points before,1 day after and 1 year after cochlear implantation,respectively.The scores of 1 year after cochlear implantation were significantly different by ANOVA(P<0.05),but there was no statistically significant difference 1 day after operation(P>0.05).There was signifi

关 键 词：耳鸣 耳蜗植入术 电刺激听觉脑干诱发电位 

分 类 号：R764.45[医药卫生—耳鼻咽喉科]