语后聋患者多通道人工耳蜗植入后听觉效果分析

目的:探讨使用心理物理测试及听觉行为分级、言语可懂度分级对语后聋多通道人工耳蜗植入患者听觉言语康复效果进行评估的意义,比较语前聋和语后聋患者术后康复效果.方法:1997-03-2007-06共植入人工耳蜗353例,选择语后聋植入者31例,语前聋植入者59例参加研究.对语后聋和语前聋受试者的纯音听阈、听觉行为分级标准(CAP)和言语可懂度分级标准(SIR)进行评估分析,并比较相同植入电极的语后聋和语前聋患者开机0.5年后的电听觉阈值、最大舒适强度和动态范围有无差异,用统计学方法加以分析.结果:所有受试者声场测试语言频率平均听阈(啭音)为25～45 dB(nHL).植入同种电极(澳大利亚直电极、澳大利亚弯电极、奥地利Medel C40+)的语前聋和语后聋患者之间听觉阈值最大舒适强度和动态范围差异无统计学意义(P>0.05).语后聋患者的CAP和SIR得分高于语前聋患者.结论:CAP和SIR是一种对人工耳蜗植入者日常生活中听说能力的方便有效的评估方法.植入相同电极的语前聋和语后聋患者之间的纯音听阈、电听觉阈值、最大舒适强度、动态范围无明显差异,但语后聋患者听觉水平和言语可懂度效果好与语前聋患者.     

成人语前聋和语后聋人工耳蜗植入效果分析

目的分析成人人工耳蜗植入术后听觉及言语康复效果情况,探讨成人行人工耳蜗植入适应症的选择。方法对中国医科大学附属第一医院耳鼻咽喉科收治的18岁以上行人工耳蜗植入术患者52例进行测试,分为语前聋无干预组(9例)、语前聋佩戴助听器组(27例)、语后聋(16例)三组。采用声场助听听阈测试、电刺激听觉反应阈值(Threshold,THR)、最大舒适阈值(Maximum comfort level,MCL)评价其声音感知能力;采用普通话言语测听材料MSTMs中双音节词表评价其言语分辨能力。分别在开机6个月及24个月进行评估。结果开机6个月后三组声场助听阈值、THR、MCL均值无统计学差异。双音节识别率在开机6个月时语前聋无干预组8.78%、语前聋助听器组16.44%、语后聋组53.13%;在开机24个月时各组双音节识别率均上升,语前聋无干预组达18.22%、语前聋助听器组达52.89%、语后聋组达84.31%,语前聋助听器组提高明显。结论成人语前聋患者术后可获得与语后聋相近的听觉感知水平,长期使用人工耳蜗可加强言语识别能力,对术前有听觉言语基础的成人语前聋患者应积极行人工耳蜗植入术。     

语后聋人工耳蜗植入者的心理健康状况分析

目的探讨重度听力损失者借助人工耳蜗重获听力后的心理健康状况及其与听力正常人群的差异。方法采用症状自评量表(symptom checklist 90,SCL-90)和艾森克人格问卷(Eysenck personality questionnaire,EPQ)对18例语后聋人工耳蜗使用者(耳蜗组)的心理健康状态及人格特质进行评估,并与45例听力正常组(对照组)进行比较。结果①SCL-90评分结果显示:耳蜗组在人际关系、焦虑、敌对、恐怖、偏执、精神病性六个因子方面的得分均明显高于对照组(P<0.01);躯体化、强迫、抑郁三个因子的得分两组间差异无统计学意义(P>0.05)。②EPQ评定结果显示:耳蜗组在人格特质的内外倾、神经质、精神质三个维度评分与对照组相当,两组差异无统计学意义(P>0.05)。结论植入人工耳蜗有利于改善重度聋患者的心理健康状况,但人工耳蜗植入者在社会交往过程中仍存在人际关系敏感、焦虑、偏执等不良心理状态,提示在进行听觉言语康复的同时,还应关注其心理和社会交往状况,以帮助其改善生活质量、回归主流社会。     

语后聋患者人工耳蜗植入后短期内失匹配负波的表现

目的了解语后聋人工耳蜗植入者听觉中枢重塑过程中不同时期失匹配负波(mismatch negativity,MMN)的表现,探讨利用MMN评估其听觉中枢重塑的可能性。方法对6例语后聋人工耳蜗植入(CI)者(CI组)于开机时、开机后1、3及6个月分别行MMN检查,记录其MMN潜伏期及波幅,并与6例正常人(对照组)的MMN潜伏期及波幅相比较。结果 CI组3例(50%)患者在开机时引出MMN,6例(100%)开机后1、3、6个月均引出MMN,对照组6例(100%)正常人均引出MMN。CI组开机时、开机后1、3、6个月MMN的潜伏期分别为230.67±15.50、197±53.72、136.00±31.71、132.17±9.41ms;波幅分别为-2.53±3.09、-1.60±1.15、-1.83±0.96、-1.31±1.38mV;对照组MMN的潜伏期为142.0±23.10ms,波幅为-2.17±1.17mV。CI组开机时、开机后1个月MMN的潜伏期均较对照组延长,差异有统计学意义(P=0.001和P=0.044);开机后3、6个月MMN潜伏期与对照组比较差异无统计学意义(P=0.716和P=0.357)。CI患者在开机时、开机后1、3个月,MMN潜伏期逐渐缩短,差异有统计学意义(P<0.001),开机后3、6个月MMN潜伏期比较,差异无统计学意义(P=0.778)。开机时至开机后6个月,MMN波幅变化无明显规律。结论语后聋人工耳蜗植入者开机后3个月内其MMN潜伏期逐渐缩短,开机后3个月时其MMN波形分化达正常人水平,但波幅变化无明显规律。     

语后聋多通道人工耳蜗使用者的普通话言语识别

普通话是我国的规范语言，其语音学特点有别于西方语系，特别是声调。人工耳蜗植入作为治疗重度感音性聋的最重要手段，目前多为基于西方语系设计的国外产品，能否充分地体现汉语、特别是汉语普通话的语音学特点，一直备受关注。我国多通道人工耳蜗使用者、特别是更具代表性的语后聋使用者的普通话言语识别状况，目前仅报道5例。     

语后聋长期全聋耳的人工耳蜗植入

目的 探讨语后聋长期全聋耳的人工耳蜗植入术后效果.方法 双侧听力下降时间不同步、双侧耳聋程度不一致的语后聋患者4例,对重度聋时间较长(均>10年)、耳聋程度较重侧进行植入人工耳蜗,分别在开机后6个月、12个月,使用心理物理学测试(T/C值),术后声场内最佳助听条件下言语频率平均听阈(pure-tonethreshold average,PTA).安静及噪声环境巾的言语识别率(HINT句表),单音节词识别率(HOPE词表),汉语声调识别(MESP),听觉行为分级标准(CAP),成人生活质量调奁问卷等评价指标,评价其术后听觉言语康复效果.结果 4例受试者在开机半年至一年内均达到了较为理想的康复效果,PTA接近或达到正常水平;安静环境中的言语识别率平均达到90%以上,噪声环境中平均达到70%;植入者可以很好地识别汉语声调;人工耳蜗为植入者带来了较高的社会效益.患者对人工耳蜗的植入效果均表示满意.结论 4例受试者都选择重度聋时间较长侧作为人工耳蜗植入侧,开机后均在较短时间内获得了良好的听觉言语康复效果,充分发挥了人工耳蜗的功能和优势的同时.听力相对较好侧耳还町继续佩戴助听器,保留了患者双耳聆听和日后接收其它治疗的机会,最大限度地为患者创造了最佳聆听条件.     

大龄语前聋患者人工耳蜗植入术后的研究进展

大龄语前聋者,指习得语言能力前患重度或极重度耳聋并且人工耳蜗植入时年龄偏大的患者。大龄语前聋患者术后康复效果较适龄幼儿患者差,其术后的评估以及康复效果的影响因素是研究重点。所以,本文就大龄语前聋患者人工耳蜗植入术后康复的评估方法和相关影响因素等方面的研究进展加以综述。     

语前聋青少年人工耳蜗植入及康复体会

目的报道13例14岁以上青少年语前聋患者的人工耳蜗植入术的效果。方法手术采用面隐窝进路的常规术式,重点介绍语前聋患者人工耳蜗植入术前评估要点,术后言语分辨率的评价结果。结果13例患者术后经4～5次Mapping后,声场测听啭声听阈达到25～40dBnHL,平均30.4±4.8dBnHL。随访6个月到4年,借助唇读,术后2年闭式词表识别率平均达到79.11%;不借助唇读,闭式词表识别率平均达到61.67%。术后4年,借助唇读,开放式词表识别率平均达到80.67%;不借助唇读,开放式词表识别率平均达到66.83%。结论青少年语前聋患者具有理解力强、有文化基础等优势,只要入选者选择适当,尽管年龄过大,但人工耳蜗植入后仍能得到较好的言语分辨率,对提高生活质量、增加信息交流方式仍有很大帮助。对这类大龄的人工耳蜗植入者,术后语训方法可先借助唇读,掌握一定的听觉词汇后逐步减少唇读直至不借助唇读。     

伴脑瘫语前聋儿童的人工耳蜗植入

目的探讨伴脑瘫语前聋儿童人工耳蜗植入的疗效。方法回顾性分析1例5年前行人工耳蜗植入术的脑瘫患儿的临床资料及术后5年来的肢体运动状况,并以听觉行为分级标准(categories of auditory performance,CAP)和言语可懂度分级标准(speech intelligibility rating,SIR)评估并比较其手术前后听力言语能力。结果术后该患儿成功重建了听力,经过肢体康复训练,躯体运动障碍完全康复。术后5年声场测听为轻度听力下降,语言能力较听觉能力提高缓慢。CAP为5级,SIR为2级。普通话声调识别率约为43%,声母、韵母识别率分别约为50%、55%。结论对于伴有脑瘫的语前聋儿童经过术前全面评估和审慎观察后可以实施人工耳蜗植入手术,术后需要制定特殊的康复计划方能让患者从人工耳蜗植入术中受益,人工耳蜗植入可以作为脑瘫聋儿的康复手段之一。     

Non-use of cochlear implants by post-lingually deafened adults

Abstract

Objectives To document the occurrence of medical/surgical complications in the provision of cochlear implants to a cohort of post-lingually deafened adult patients; to compare cumulative mortality in the cohort with cumulative mortality predicted from an aged-matched control population; to relate the occurrence of medical/surgical complications to the patient's position in the case series; to identify risk factors for elective non-use of implants; and to examine the impact of complications, mortality and elective non-use on the cost of creating a successful user of a cochlear implant

Design Longitudinal prospective observational study.

Setting Nine hospitals in the UK, which received central funding between 1990 and 1994 to participate in a programme of adult implantation.

Participants All 313 post-lingually deafened adults who received multichannel cochlear implants in this programme.

Main outcome measures Status of patients in July 1998 (dead, an elective non-user or a user); duration of use prior to death or elective non-use; costs of creating and sustaining a successful user; ability to identify environmental sounds; self-reported benefit.

Results Cumulative mortality after 7.5 years was 6.3% (95% CI 2.5?10.1%) and was no different from cumulative mortality predicted from life expectancy in the general population. Cumulative elective non-use was stable at 6.3% (95% CI 3.6%?9.1%) between 4 and 7 years after implantation but rose to 11.0% (95% CI 1.7%?20.3%) at 7.5 years after implantation. Major medical/surgical complications were experienced by 25/313 patients (8.0%). The occurrence of such complications declined to ca. 1% over the first 50 cases in a hospital's case series. For patients who were users, self-reported benefit did not differ between patients who had experienced complications and those who had not. Older age at implantation, greater duration of deafness prior to implantation or an early position in a hospital's case series were not significant risk factors for elective non-use. Experiencing a major complication was a marginally significant risk factor (odds ratio = 3.2, 95% CI 1.0?10.6). Low auditory performance (odds ratio = 8.2, 95% CI 2.1?31.9) and low self-reported benefit (odds ratio = 19.6, 95% CI 4.6?84.4) were significant risk factors. Medical/surgical complications raised the cost of creating a successful user by less than 1%. Elective non-use raised the cost by between 5% and 10%.

Conclusions Medical/surgical complications were generally managed successfully without detriment to benefit; life expectancy in the general population can be used to predict the length of time for which patients have the potential to use cochlear implants; patients who experience little benefit are most at risk for elective non-use; given the high cost of cochlear implantation, benefit should be monitored to allow early rehabilitative intervention in cases of low benefit; patient cohorts such as the present one should continue to be followed up with a view to identifying pre-operative risk factors for elective non-use.     

Self-reported benefits from successive bilateral cochlear implantation in post-lingually deafened adults: randomised controlled trial

Adult users of unilateral Nucleus CI24 cochlear implants with the SPEAK processing strategy were randomised either to receive a second identical implant in the contralateral ear immediately, or to wait 12 months while they acted as controls for late-emerging benefits of the first implant. Twenty four subjects, twelve from each group, completed the study. Receipt of a second implant led to improvements in self-reported abilities in spatial hearing, quality of hearing, and hearing for speech, but to generally non-significant changes in measures of quality of life. Multivariate analyses showed that positive changes in quality of life were associated with improvements in hearing, but were offset by negative changes associated with worsening tinnitus. Even in a best-case scenario, in which no worsening of tinnitus was assumed to occur, the gain in quality of life was too small to achieve an acceptable cost-effectiveness ratio. The most promising strategies for improving the cost-effectiveness of bilateral implantation are to increase effectiveness through enhanced signal processing in binaural processors, and to reduce the cost of implant hardware.     

Preservation of residual hearing in children and post-lingually deafened adults after cochlear implantation: an initial study

OBJECTIVE: To investigate whether the residual hearing of severely hearing-impaired children and adults could be preserved using the soft surgery approach. PATIENTS AND METHODS: This project employed a prospective study design. All testing and surgery took place in the Institute of Physiology and Pathology of Hearing, Warsaw, Poland. Twenty-six patients (7 children and 19 post-lingually deafened adults) with residual hearing were assessed. Subjects were assessed using conventional pure-tone audiometry at least 1 month prior to surgery. Cochlear implant surgery with a Med-El Combi 40/40+ standard electrode array was conducted, using the soft surgery approach. Pure-tone audiometry thresholds were re-assessed at least 1 month after surgery. The researchers assessed change in auditory thresholds using pure-tone audiometry to determine preservation of residual hearing. RESULTS: Sixteen of 26 patients (62%) retained their residual hearing within 5 dB HL of pre-operative scores. Only 5 of 26 patients (19%) lost all measurable residual hearing after cochlear implantation. This suggests that surgeons are often able to preserve residual hearing during cochlear implant surgery using the soft surgery technique. CONCLUSIONS: Preservation of residual hearing is an important consideration in cochlear implantation in the light of changing selection criteria for cochlear implant candidates, and as younger children are receiving implants. This is important, as we do not know yet the long-term effects of inner ear damage due to traumatic insertions of electrodes. This finding suggests a good prognosis for future possibilities of re-implantation.     

Bilateral cochlear implantation in a patient with long-term deafness

PURPOSE OF THE STUDY: 1) To report the case of a 70-year-old patient with a history of auditory deprivation for 80% of his life and who received bilateral cochlear implants and 2) to discuss different aspects of the case, including duration of auditory deprivation, the decision for bilateral implantation, age at implantation, and the use of this treatment modality for tinnitus. CASE REPORT: A two-stages bilateral cochlear implantation was performed in a 70-year-old patient with long-term deafness without operative or post-operative problems with excellent functional result. DISCUSSION: Various studies have reported that in patients with long-term auditory deprivation, the results of cochlear implants are delayed and sometimes unsatisfactory when compared to patients with more recent post-lingual deafness. However they did not contraindicate the surgery. The positive results with the first implant (both for the tinnitus and the hearing loss) motivated the patient and medical team to proceed to bilateral implantation. CONCLUSION: Patients with longstanding auditory deprivation can achieve good functional results even though at a slower rate. The use of bilateral cochlear implants accelerates and optimizes the final outcome.     

Intelligibility of vowels produced by post-lingually deafened cochlear implant users.

The present study addresses the effect of cochlear implantation on the intelligibility of vowels produced by 20 post-lingually deafened Dutch subjects. All subjects received the Nucleus-22 cochlear implant (3 WSP and 17 MSP processors). Speech recordings were made pre-implantation and three and twelve months post-implantation with the implant switched on and off. Vowel intelligibility (monophthongs only) was determined using a panel of listeners. For all implanted subjects intelligibility was measured in a noisy background. For seven poorly speaking subjects it was also measured in a quiet background. After implantation with the Nucleus-22 device the results showed that vowel intelligibility, measured for all subjects in a noisy background, increased for most of them (about 15), while it increased for about half the number of poorly speaking subjects measured in a quiet background. Twelve months after implantation vowel intelligibility, measured for all subjects in noise, appeared to be based on first and second formant information. This was also found for the subgroup of seven subjects performing poorly pre-implantation when analysed separately. However, vowel intelligibility for this subgroup, when measured in a quiet background, was based also on vowel duration. The differences between the overall result in noise and the results of the subgroup in quiet should be attributed mainly to the noise and not to aspects of poor speech production in the subgroup. In addition, this study addresses the relationship between the intelligibility scores and objective measurements of vowel quality performed in a previous study. The results showed that the vowel intelligibility scores are mainly determined by the position of the second formant frequencies.     

Cochlear implants in post-lingually deafened patients

CONCLUSION: Post-lingually deafened patients had good speech intelligibility scores with cochlear implantation. The age at the operation, duration of deafness, and the number of electrodes outside the cochlea showed only weak correlation with the postoperative performance, which warrants cochlear implantation in elderly patients and patients with a long history of deafness and leaving dummy electrodes outside the cochlea. Patients with cochlear obstruction showed comparable performance to patients with an open cochlea. OBJECTIVE: To evaluate the background and performance of post-lingually deafened cochlear implantation recipients. PATIENTS AND METHODS: Preoperative and intraoperative factors were collected for 109 cochlear implant subjects. Speech intelligibility scores were obtained and the effects of preoperative and intraoperative factors on postoperative performance were evaluated. RESULTS: The average speech intelligibility score was 85.1% for vowels, 41.1% for consonant-vowel (CV) syllables, and 80.4% for phrases. The correlation coefficient between the age at the operation, the duration of deafness, and the number of electrodes outside the cochlea and the postoperative performance was between 0.03 and -0.27. Patients with cochlear obstruction and patients with open cochlea did not show significant differences in speech intelligibility tests. The onset of deafness (progressive vs sudden) did not have an effect on the speech intelligibility test.     

Bilateral cochlear implantation in a patient with bilateral temporal bone fractures

With the emphasis on bilateral hearing nowadays, bilateral cochlear implantation has been tried out for bilateral aural rehabilitation. Bilateral sensorineural hearing loss caused by head trauma can get help from cochlear implantation. We present the case of a 44-year-old man with bilateral otic capsule violating temporal bone fractures due to head trauma. The patient demonstrated much improved audiometric and psychoacoustic performance after bilateral cochlear implantation. We believe bilateral cochlear implantation in such patient can be a very effective tool for rehabilitation.     

Bilateral cochlear implantation

Cochlear implantation (CI) is the standard of care for the treatment of children and adults with bilateral severe-to-profound sensorineural hearing loss. Because the ultimate and continuous goal of CI teams is to improve patient performance, a potential method is bilateral CI. The potential benefits of bilateral CI include binaural summation, squelch, equivalent head shadow for each ear, improved hearing in noise, sound localization ability, and spatial release from masking. The potential disadvantages include additional or prolonged surgical procedure, unproven cost/benefit profile, and the elimination of the ability to use future technologies and/or medical therapies in the implanted ear.