人工耳蜗植入后对侧耳是否联合使用助听器声调识别的对比研究

目的 探讨人工耳蜗植入后对侧耳联合使用助听器对声调识别的影响;同时探讨人工耳蜗开机时间、康复训练时间、听障儿童的学习能力等因素对声调识别的影响。 方法 选择3~7岁的人工耳蜗植入儿童27例,采用《言语听觉反应评估》(EARS)中的“封闭式声调测试”作为测试材料,分别单独使用人工耳蜗(CI)和在人工耳蜗对侧耳联合使用助听器(CIHA)在安静和噪声两种环境下进行声调识别的测试,使用SPSS 17.0对测试结果进行统计学分析。 结果 无论在安静环境还是噪声环境下,CIHA的声调测试成绩均优于CI,此优势在噪声环境下更明显;人工耳蜗开机时间、康复训练时间较长者声调测试成绩均优于较短者;听障儿童的希-内学习能力测试结果学习能力DIQ≥100与DIQ<100者声调测试成绩差异无统计学意义。 结论 建议听障儿童人工耳蜗植入后对侧耳联合使用助听器,但助听器需要优化和调整。     

助听器与人工耳蜗的联合使用

人工耳蜗植入技术的适用范围已经从全聋患者扩宽到有残余听力的重度聋者，成为重度以及极重度聋患者恢复听力的重要康复手段。对于术后对侧耳仍具有残余听力的患者或者由于人工耳蜗植入电极的限制，使得植入耳的低频残余听力不能得到利用的患者，其残余频率段的言语识别率可能在随后的几年里呈进行性下降，     

人工耳蜗植入者对侧耳佩戴助听器的效果评价

目的　探讨人工耳蜗植入者对侧耳佩戴助听器的意义和作用。方法　对 6例年龄 7～ 18岁的语前聋患者于术后开机半年时在不同助听方式下 (人工耳蜗 +助听器和单独使用人工耳蜗 )进行声场 (啭音 )测听、言语功能评估和问卷调查 ,将结果进行统计分析。结果　人工耳蜗 +助听器较单独使用人工耳蜗声场 (啭音 )测试的各频率听阈低 (P <0 .0 1)。词汇识别测试显示两者均有良好的聆听效果 (P >0 .0 5 )。问卷调查显示患者普遍接受人工耳蜗 +助听器的方式 ,感觉舒适、方向性立体感强 ,交流更佳。结论　使用人工耳蜗者对侧耳佩戴助听器有助于更好地聆听。     

人工耳蜗植入术前助听器试戴的意义

对拟行人工耳蜗植入手术的双侧极重度耳聋患者进行助听器试戴和语言训练，并定期作言语识别记分（ＳＤＳ）。结果：３例患者戴助听器ＳＤＳ较未戴助听器时无明显提高，分值改变＜４０％，选择人工耳蜗植入且术后听觉效果好；另５例戴助听器后可进行一般交谈，以助听器为听力康复的最佳选择。对人工耳蜗植入术前助听器试戴的意义进行了讨论。     

儿童人工耳蜗植入后康复安置及其效果分析

目的分析儿童人工耳蜗植入后康复安置效果，为继续做好捐赠项目受赠聋儿术后集中安置工作及进一步提升术后康复效果提供经验。方法本研究采用教育行动研究法，按照捐赠项目受赠聋儿术后安置要求，将200名聋儿安置在18个具备资质的聋儿康复机构，定期跟踪．指导。在安置期满后，整理．对比材料相对完整的受赠聋儿康复评估数据和家长对康复效果的满意度调查结果，分析儿童人工耳蜗植入后康复安置效果。结果①受赠聋儿康复安置一年后，言语识别率、语言年龄和学习能力商成绩都较安置初期取得明显效果（P〈0．01）；②家长对受赠聋儿康复安置效果的满意度评价前后具有非常显著差异（P〈0．01）；③人工耳蜗植入年龄因素和术后一年内接受康复安置时间的长短是影响言语识别率平均成绩的关键因素（P〈0．01）。结论已经实施的康复安置策略效果明显，儿童人工耳蜗植入后接受康复安置的时间最少为1年是合理的，有效的康复安置策略还应囊括更大范围的内容，尽快建立起儿童人工耳蜗术前和术后一体化康复服务机制是确保儿童人工耳蜗植入后康复效果的长远考虑。     

语前聋患儿一侧人工耳蜗植入对侧佩戴助听器聆听效果分析

目的：分析语前聋患儿一侧人工耳蜗植入（cochlear implant ,CI）对侧佩戴助听器模式下的聆听效果,以及非植入耳残余听力对聆听效果的影响。方法选取一侧人工耳蜗植入对侧佩戴助听器的语前聋患儿18例,分别测试其在单侧人工耳蜗植入、一侧人工耳蜗植入对侧佩戴助听器的双耳聆听模式（ bimodal fitting ,BIM ）安静环境及稳态噪声环境下标准中文短句、双音节词、单音节词的识别率。结果安静状态下本组患儿CI、BIM 模式单音节词言语识别率分别为82．67％±12．23％、83．61％±12．22％,双音节词分别为76．00％±16．13％、78．11％±14．84％,标准中文短句分别为60．11％±17．18％、65．43％±16．76％;信噪比10 dB环境下CI、BIM 助听模式患儿单音节词识别率分别为75．50％±14．12％、76．83％±14．15％,双音节词分别为68．22％±17．15％、77．18％±16．83％,标准中文短句分别为49．39％±19．26％、56．33％±19．55％,除两种模式下单音节词外其余言语识别率差异均有统计学意义（P＜0．05）,且非植入耳250、500 Hz助听听阈与BIM 模式言语识别率呈负相关。结论语前聋患儿双耳双模式聆听时有一定优势,这种优势可能主要来自低频残余听力。     

对侧助听器对人工耳蜗使用者言语感知贡献研究

目的探讨讲汉语普通话的人工耳蜗(Cochlear Implantation,以下简称CI)使用者对侧佩戴助听器(Hearing Aid,以下简称HA)的获益。方法:选取对侧使用HA的14名母语为汉语普通话的CI使用者,分别测试其在使用CI和CI+HA(即双模式)两种助听模式下的声调、双音节词、及句子的识别表现,并分析助听器耳残余听力对双模式言语表现的影响。结果:安静环境下使用CI和CI+HA模式下的声调识别率分别为67.6%±10.5%、71.6%±12.5%,双音节词识别率分别为72.3%±21.8%、74.2%±23.3%,句子识别率分别为62.3%±28.3%、61.8%±31.3%,噪声环境句子识别率分别为37.6%±36.5%、42.4%±35.9%。统计分析发现声调识别表现在CI+HA模式下显著优于CI模式(t=-2.285,P=0.04),其余言语识别表现在两种聆听模式下均无显著差异;且1000Hz及以下频率的助听器耳残余听力与CI+HA模式下言语识别表现显著相关。结论::对于"大龄"语前聋患者,一侧人工耳蜗植入联合对侧助听器的双模式应用,需考虑助听器耳的残余听力情况,极重度感音神经性聋助听器辅助效果有限,必要时需考虑双侧人工耳蜗植入。     

儿童人工耳蜗植入效果与手术年龄的关系

研究接受多导人工耳蜗植入术患儿的手术效果与手术年龄的关系。回顾性分析 2 95例患儿资料 ,按手术年龄分为 5组 :1～ 3岁、 3～ 5岁、 5～ 7岁、7～ 9岁和 9～ 11岁。分别于术后 12月、 2 4月、 36月行言语识别率测试 ,各组间行方差统计学分析。对象 :2 95例患儿 ,手术年龄从 12月到 11岁。手术方案 :所有患儿均接受单侧人工耳蜗植入。方法 :分别于术后 12月、 2 4月、 36月行言语识别率测试 ,了解患儿手术年龄与手术效果的关系。结果 :所有 5组患儿人工耳蜗植入术后听力改善均优于术前佩戴助听器。方差分析显示 ,5项测试中的3项有显著性统…     

人工耳蜗植入者的听力康复及其评估

人工耳蜗植入是当今双侧重度和极重度感音神经性聋患者重获听力的最佳途径.通过耳蜗电极刺激螺旋神经节所产生的“声音”与自然声音有较大区别,其声音类似于电子琴或金属撞击声.耳蜗植入术后的康复工作在整个过程中占有不可忽视的地位.本文结合一例人工耳蜗植入病例谈谈言语康复的情况.1 资料和方法患者,女性,36岁.自幼双耳听力较差,其父亲和两个姐妹有不同程度的感音神经性聋.植入手术前2年因接受庆大霉素治疗而致双耳重度聋.助听器对她来说只有声感而无语感.患者讲话口齿虽较清楚,但语速较慢.平时借唇读及笔谈与他人交流.     

年龄对语前聋儿人工耳蜗植入听觉言语康复效果的影响

在对语前聋小儿的人工耳蜗植入后的听觉言语康复的随访评估中了解到 ,年龄较小聋儿的人工耳蜗植入术后的听觉语言康复效果优于年龄大者。现将 2岁以下最小年龄组的人工耳蜗植入后的听觉、言语康复效果与大年龄组比较评估 ,报告如下 :1　材料与方法1.1　临床资料选择 1998年 2月～ 2 0 0 0年 7月人工耳蜗植入后 ,经过了半年以上的听觉言语康复训练 ,除不能参加本组评估的特殊病例 ,共 2 2例不超过 17岁的语前聋儿 ,进行评估讨论。男 13例 ,女 9例。人工耳蜗植入时年龄 :最小 1.5岁 ,最大 17.0岁 ,平均 7.2岁。其中 1.5～ 2 .0岁 5例 ,2 .1～ …     

Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear

The aim of this study was to determine the improvement in speech recognition provided by a cochlear implant (CI) in conjunction with a hearing aid (HA) in the opposite ear. The study was a retrospective cohort study in the context of a university teaching hospital CI programme. Seven CI patients who still use their HA in the opposite ear were tested. The scores with the CI alone and the CI in conjunction with an HA were evaluated by using three speech perception tests in quiet (Freiburger Numbers. Freiburger Monosyllables, and Innsbrucker Sentence Test). In the majority of tests and subjects. the CI alone performed better than the HA alone, and the bimodal (CI + HA) condition was superior to the CI alone. On the sentence test, the patients as a group improved from 47 96% (mean: 79%; CI alone) to 50-100% (mean: 88.1%; CI + HA, pv < 0.05). With the more difficult monosyllable test, the scores improved from 15-52% (mean: 37.2%; CI alone) to 15 82% (mean: 48.7%; CI + HA, p < 0.05). On the numbers test. scores increased from 65-98% (mean: 83%; CI alone) to 75-98% (mean: 88.7%; CI + HA, p < 0.05). All patients in this study were implanted in the poorer ear. The results of the present study suggest the advantage of CI usage in conjunction with an HA in the opposite ear.     

Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear

The aim of this study was to determine the improvement in speech recognition provided by a cochlear implant (CI) in conjunction with a hearing aid (HA) in the opposite ear. The study was a retrospective cohort study in the context of a university teaching hospital CI programme. Seven CI patients who still use their HA in the opposite ear were tested. The scores with the CI alone and the CI in conjunction with an HA were evaluated by using three speech perception tests in quiet (Freiburger Numbers, Freiburger Monosyllables, and Innsbrucker Sentence Test). In the majority of tests and subjects, the CI alone performed better than the HA alone, and the bimodal (CI+HA) condition was superior to the CI alone. On the sentence test, the patients as a group improved from 47-96% (mean: 79%; CI alone) to 50-100% (mean: 88.1%; CI+HA, pv<0.05). With the more difficult monosyllable test, the scores improved from 15-52% (mean: 37.2%; CI alone) to 15-82% (mean: 48.7%; CI+ HA, p<0.05). On the numbers test, scores increased from 65-98% (mean: 83%; CI alone) to 75-98% (mean: 88.7%; CI+ HA, p<0.05). All patients in this study were implanted in the poorer ear. The results of the present study suggest the advantage of CI usage in conjunction with an HA in the opposite ear.     

人工耳蜗植入术后听觉言语效果的影响因素

目的〓〖HTK〗探讨影响人工耳蜗植入术后听觉言语恢复效果的相关因素。〖HTW〗方法〓〖HTK〗对24例双耳重度或极重度感音神经性耳聋患者,术前进行智力、听力学、影像学检查,配带助听器评估,并严格掌握手术适应证,经乳突－面隐窝进路行人工耳蜗植入术,记载术中情况,术终测电极电阻,术后1个月开机调试,语前聋者进行听觉语言培训,术后追踪随访疗效满意度和言语可懂度,对所得临床资料进行分析。〖HTW〗结果〓〖HTK〗23例耳蜗植入手术一次成功,1例电极移位二次手术成功,术后暂时性面瘫2例、眩晕1例,两周X线颞骨拍片证实耳蜗电极位于耳蜗内,1个月开机调试,全部病例获取听力。3例语后聋患者听觉言语恢复,其他语前聋患者均行半年以上的听觉语言培训,随访4～6年,半开放式言语识别率＞80％,全部患者及家属达到术前的期望值。〖HTW〗结论〓〖HTK〗人工耳蜗是治疗重度极重度感音神经性耳聋及全聋的有效方法,术后效果主要与人工耳蜗植入时的年龄、术前听力与言语基础、听神经及其传导功能、智力、植入电极在规定的部位、术后调机与康复的有效性等关系密切。     

Trends in rehabilitation after cochlear implantation

Although postimplant rehabilitation is generally considered to be an important aspect of a cochlear implant program, the literature reports widely varying practices in the implementation of such programs. The National Institutes of Health consensus statement on cochlear implantation (May 1988), while recognizing that aural rehabilitation facilitates maximal use of the implant, offers no specific guidelines or recommendations. A questionnaire survey was made of over 200 otolaryngologists to determine current practices in a variety of aspects of their cochlear implant programs. Results were obtained from a total of more than 1400 patients, including adults, adolescents, and children. Rehabilitation is an integral part of the cochlear implant program in the vast majority of active programs surveyed. General aspects of cochlear implant programs, as well as those of rehabilitation programs in particular, are discussed.     

Double challenge: cochlear implantation in the only hearing ear with progressive hearing loss following meningitis and vestibular dysfunction after implantation

ObjectiveVestibular dysfunction associated with cochlear implantation is rare. It is usually seen in patients with otosclerosis due to spread of electrical activity throughout the demineralized bone. A 17-year old female with progressive hearing loss 2 years after meningitis and vestibular dysfunction in the implanted ear is presented in this study.FindingsThe patient had mild hearing loss in the right ear and total hearing loss on the left side because of complete ossification of the cochlea following meningitis. She had to have cochlear implantation in the right ear because of progression of hearing loss. She had successful implantation but she experienced vestibular dysfunction following activation of cochlear electrodes. Closure of two electrodes caused disruption of auditory programming. Then the patient was subjected to long term vestibular rehabilitation program.ConclusionTiming for implantation before the completion of cochlear ossification is crucial not to miss the chance for hearing restoration. However, difficulties in hearing rehabilitation due to extensive ossification can be doubled by vestibular problems triggered by stimulation of the vestibular nerve by cochlear electrodes. Attempts to reduce the balance problem will complicate auditory programming. Vestibular rehabilitation for long term helps to carry on hearing progress.     

Hearing rehabilitation in cerebral palsy: development of language and hearing after cochlear implantation

IntroductionAuditory rehabilitation in children with bilateral severe-to-profound sensorineural hearing loss with cochlear implant has been developed in recent decades; however, the rehabilitation of children with cerebral palsy still remains a challenge to otolaryngology and speech therapy professionals.ObjectiveTo verify the effectiveness of cochlear implants in the development of auditory and language skills in children with cerebral palsy.MethodsA prospective analytical study. The evaluation of auditory responses to speech test was applied to the children in this study at regular intervals following implantation. Standardized tests that assess and quantify the development of auditory and language skills were administered and speech therapy video records and speech therapy files were analyzed. All children went through individually tailored intensive audiological rehabilitation programs following cochlear implantation.ResultsTwo participants had gradual auditory and language development when compared to other participants who reached advanced levels in hearing and oral language classifications.ConclusionThe use of the Cochlear implant enabled participants to reach advanced stages of hearing and language skills in three of the five participants with cerebral palsy in this study. This electronic device is a viable therapeutic option for children with cerebral palsy to help them achieve complex levels of auditory and language skills.     

Loss of residual hearing after cochlear implantation

Many cochlear implant recipients have some measurable hearing prior to implantation. Animal studies have demonstrated some loss of viable neural elements resulting from both mechanical insertion trauma and long-term electrical stimulation. The effect of implantation of a long intracochlear multichannel electrode array and subsequent electrical stimulation on residual hearing was evaluated. Forty consecutive cochlear implant recipients were assessed by audiometry at the Colorado Ear Clinic between July 1985 and June 1988. Twelve of these patients (30%) had some measurable residual hearing before implantation, although all had profound hearing loss, with no understanding of speech. All patients received a multichannel cochlear implant with all 22 electrodes inserted in each patient by an experienced cochlear implant surgeon. Audiometric testing was repeated between 2 and 24 months after implantation. Pure-tone threshold responses in the implanted ear were significantly reduced postimplant, while puretone threshold responses in the nonimplanted ear were stable.     

43例人工耳蜗植入患者基因检测及术后康复效果分析

目的总结川南地区43例人工耳蜗植入患者的基因突变类型,分析其人工耳蜗术后康复效果,了解两者的相关性。方法对43例耳聋患者行GJB2、SLC26A4、mtDNA 12S rRNA基因检测,有基因位点发生致病突变者为耳聋基因检测阳性,归为A组;其余为基因检测阴性,归为B组。两组患者均行单侧人工耳蜗植入术,于术前、术后3、6、12个月行听觉行为分级（categories of auditory performance,CAP）、言语可懂度分级（speech intelligibility rating,SIR）评估。结果43例患者中基因位点发生致病突变者14例（A组）;耳聋基因筛查阴性29例（B组）。A组中9例患者GJB2检测阳性,6例患者SLC26A4检测阳性,其中1例患者GJB2、SLC26A4检测结果均为阳性,两组患者术后1年内不同时间点 CAP 和SIR 评分均较术前明显提高,且评分随着术后时间的延长逐渐提高(P<0.05),但两组患者术前及术后不同时间点CAP和SIR评分比较均无差异(P>0.05)。结论43例患者中常见致病耳聋基因为GJB2、SLC26A4,人工耳蜗植入术能有效提高患者听力及言语能力,但耳聋基因突变与人工耳蜗植入术后康复效果无明显相关性。