听神经病儿童人工耳蜗植入效果评估  

Evaluation of the outcomes of cochlear implant in children with auditory neuropathy

作　　者：任寸寸 林颖[1] 樊小勤 梁鹏飞 张鑫雨 高泽军 查定军 Ren Cuncun;Lin Ying;Fan Xiaoqin;Liang Pengfei;Zhang Xinyu;Gao Zejun;Zha Dingjun(Department of Otorhinolaryngology Head and Neck Surgery,Xijing Hospital,Air Force Military Medical University,Xi′an 710032,China)

机构地区：[1]中国人民解放军空军军医大学西京医院耳鼻咽喉头颈外科,西安710032

出　　处：《中华耳鼻咽喉头颈外科杂志》2024年第5期432-438,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金面上项目(81870732,82171161);陕西省一般项目(2022SF-534);陕西省创新团队(2023-CX-TD-70)。

摘　　要：目的:探讨先天性听神经病(auditory neuropathy,AN)儿童人工耳蜗(cochlear implant,CI)植入术后的听觉言语能力,并分析基因检测在AN患者CI术后效果预测中的作用。方法:研究对象为2002—2021年在西京医院经听力学检查诊断为AN并行CI手术的14例患儿,其中男9例、女5例,植入年龄(3.1±1.7)岁(均数±标准差,下同),分析其术前听力学特征及耳聋基因检测结果。另选52例行CI手术的普通感音神经性听力损失(sensorineural hearing loss,SNHL)患儿作为对照组,其中男30例,女22例,植入年龄(2.2±0.9)岁,其年龄、性别等人口统计学因素与AN组相匹配。使用改良版听觉能力分级(Category Auditory Performance,CAP-Ⅱ)和言语可懂度分级(Speech Intelligibility Rate,SIR)评价两组患者术后听觉言语能力的发展情况,采用心爱飞扬言语测听系统测试单双音节词和语句的言语识别率。使用Matlab 2022软件对数据进行分析和处理。结果:14例AN患儿耳聋基因检测显示6例为OTOF基因变异,2例(姐弟二人)经全外显子组测序证实为TNN基因变异,其余6例未发现明确致病性基因变异。所有患者术中电极均顺利植入耳蜗,术后未出现相关并发症。术后所有AN患儿的听觉和言语能力均有提高,但仅64%(9/14)的AN患儿CI术后听觉能力得分与对照组SNHL患儿相当(包括2例TNN基因变异的患儿),36%(5/14)的AN患儿听觉及言语能力得分明显低于对照组SNHL患儿。2例TNN基因变异患儿的言语识别率平均为86.5%,2例OTOF基因变异患儿的言语识别率平均为83.2%。结论:AN患儿CI术后可获得不同程度的听觉和言语能力改善,但个体差异较大,部分患儿可达到与普通SNHL患儿相当的效果,但仍有部分患儿效果较差。TNN致病基因变异导致的AN患儿CI术后效果与普通SNHL儿童的效果相当,基因检测对预测AN患儿CI术后效果有一定参考价值。Objective To investigate the auditory and speech abilities of children with congenital auditory neuropathy(AN)after cochlear implant(CI),and to analyze the role of genetic testing in predicting the postoperative outcomes of CI in AN patients.Methods Fourteen children diagnosed with AN by audiological battery test and underwent CI surgery in Xijing Hospital of the Air Force Medical University from 2002 to 2021 were included in this study(9 males and 5 females),with an implantation age of(3.1±1.7)years(mean±standard deviation,the same as follows).The preoperative audiological results and deafness gene results were analyzed.Another 52 children with ordinary sensorineural hearing loss(SNHL)were selected as the control group(30 males and 22 females),with an implantation age of(2.2±0.9)years.The demographic factors such as age and gender were matched with those of the AN group.The modified Category Auditory Performance(CAP-Ⅱ)and Speech Intelligence Rate(SIR)were used to evaluate the development of postoperative auditory and speech abilities in two groups.The Mandarin Speech Test System was used to test the speech recognition rate of monosyllabic and disyllabic words and sentences.Matlab 2022 software was used to analyze the data.Results The results of gene in 14 children with AN showed that 6 cases had OTOF gene mutations,2 cases(siblings)were confirmed to have TNN gene mutations through whole exome sequencing,and the remaining 6 cases were not find any clear pathogenic gene mutations.All subjects underwent CI surgery with electrodes implanted into the cochlea smoothly,and there were no postoperative complications.After surgery,all AN children had improved auditory and speech abilities,but only 64%(9/14)of AN children with CI had auditory ability scores comparable to the control group of SNHL children(including 2 children with TNN gene mutations),and 36%(5/14)of AN children had lower scores than the control group of SNHL children.The average speech recognition rate of two children with TNN gene mutations was 86.5%

关 键 词：听神经病 听觉丧失 感音神经性 耳蜗植入术 突变 测听法 言语 

分 类 号：R764[医药卫生—耳鼻咽喉科]