学前听障儿童人工耳蜗术后语言康复教学研究

目的通过总结18名学前听障儿童植入人工耳蜗后1年内语言康复情况,分析儿童人工耳蜗术后语言康复的特点．为合理制订语言康复教学目标寻找依据,提出建议。方法定期对人工耳蜗术后儿童语言能力进行评估,记录儿童达到各个阶段语言目标的时间。1年后对以上材料进行整理、对比。分析儿童术后语言发展情况。结果18名儿童人工耳蜗术后康复1年的语言能力较术前有明显提高（P〈0．01）;语言康复呈现明显的阶段发展规律。结论依据儿童语言发展的阶段规律,通过多角度评估和观察,合理制订术后语言康复教学目标,开展多种途径的语言康复教学活动,能够促进儿童人工耳蜗术后语言康复的效果。     

50例听障儿童人工耳蜗植入的康复效果分析

目的 探讨听障儿童单侧人后工耳蜗植入的康复效果及听觉语言发展规律.方法 测试50例听障患儿人工耳蜗植入术前、术后3个月和1年的助听听阈、听觉能力及语言能力,分析人工耳蜗植入前后对声音感知、言语识别及语言发展的情况.结果 50例患儿术前、术后3个月和1年的平均助听听阈分别为73.70±10.02、42.48±10.99、...     

人工耳蜗植入术后儿童二字调个案研究

目的探讨人工耳蜗术后儿童二字调训练的有效方法.方法对1名6岁人工耳蜗植入儿童进行二字调言语训练,采用实验语音学的方法提取其基频(F0)数据,分析其二字组合调形,结合听感监控其训练疗效.结果训练3个月后,被试二字组合的调形,尤其是含有阳平、上声的二字组合调形得到了较大改善;二字组合中时长的稳定性也得到了提高.结论合理的二字调训练方法及呼吸训练、放松训练对二字调言语障碍聋童有较好的疗效.     

人工耳蜗植入幼儿术后发展个案研究

目的 通过追踪一例人工耳蜗植入幼儿术后3年的发展情况,探讨人工耳蜗术后康复的方法 和技巧.方法 利用聋儿听觉语言康复评估词表、希一内学习能力测验工具及标准评估程序.在个案术后康复3年内,对其进行听觉能力、语言能力、学习能力的阶段性评估.结果 个案的听觉能力和语言能力逐年提高,学习能力也有一定程度的提高,但与其他人工耳蜗术后儿童相比,发展速度较为缓慢.结论 人工耳蜗术后幼儿康复速度存在个体差异,智力是影响听觉言语发展的因素之一.     

儿童人工耳蜗植入术后音乐能力发育研究

目的：探讨儿童人工耳蜗植入术后音乐能力的发展趋势,为人工耳蜗植入儿童音乐能力评估提供临床资料。方法：26例人工耳蜗植入儿童,手术年龄为11～68个月,平均35．6个月;以76例1～24月龄的听力正常婴幼儿作为对照组,平均月龄6．1个月。使用小龄人工耳蜗儿童音乐能力等级量表进行评估。人工耳蜗植入儿童评估分别在开机时,开机后1、3、6、9、12及24个月时进行;听力正常婴幼儿评估分别在1、3、6、9、12及24月龄时进行。结果：人工耳蜗植入儿童的音乐能力得分随人工耳蜗使用时间的延长而显著提高（P〈O．05）,听力正常婴幼儿的音乐能力得分亦随年龄的增长而显著提高（P〈O．05）。经两样本比较的秩和检验,人工耳蜗植入儿童与听力正常婴幼儿在听力年龄为1、3、6、9、12个月时音乐能力得分的差异无统计学意义（P〉O．05）,在听力年龄为24个月时音乐能力得分的差异有统计学意义（P〈O．05）。结论：人工耳蜗植入儿童开机后音乐能力随人工耳蜗使用时间的延长而显著提高,并在开机12个月内呈现快速增长趋势。     

佩戴助听器与人工耳蜗听障儿童交流能力的比较

此项研究比较了佩戴助听器和植入人工耳蜗的听障儿童的交流能力。研究对使用不同放大措施的听障儿童进行言语识别和语言评估，并对使用人工耳蜗的听障儿童进行了康复效果的纵向比较。评估实验组为39例佩戴助听器的儿童，裸耳纯音听阈平均为78．2dB HL，对照组为117例人工耳蜗植入术后的儿童，术前纯音听阈平     

微创人工耳蜗植入术及常规人工耳蜗植入术临床比较

目的通过微创人工耳蜗植入术与常规人工耳蜗植入术的临床效果比较,探讨微创人工耳蜗植入术的临床优势。方法回顾性分析121例人工耳蜗植入患者,根据人工耳蜗植入术式的不同分为微创人工耳蜗植入术组(微创组)及常规人工耳蜗植入术组(常规组),比较两组患者的手术时间、电极植入情况、手术切口及并发症的不同,分析两种术式之间的特点。结果 121例人工耳蜗电极均全植入鼓阶,成功率100%。微创组与常规组的平均手术总时间分别为89.53±12.42分钟、92.30±14.16分钟,电极植入平均用时分别为112.16±16.01秒、117.05±26.90秒,平均电极植入次数分别为1.07±0.26次、1.22±0.49次。两组的手术总时间无明显差别(P>0.05),电极植入用时亦无明显差别(P>0.05),微创组平均电极植入次数较常规组少(P<0.05)。微创组及常规组的手术切口长度分别为2.53±0.12cm、8.30±0.56cm,微创组的手术切口长度明显小于常规组(P<0.05)。微创组术后未发现皮下血肿及感染,常规组术后出现皮下血肿3例(4.76%),微创组术后皮下血肿率与常规组比较无明显变化(P>0.05)。微创组和常规组的术后眩晕出现率分别为5.88%、21.83%,微创组术后眩晕率低于常规组术后眩晕率(P<0.05)。结论与常规人工耳蜗植入术相比较,微创人工耳蜗植入术在手术时间不增加的前提下,可确保电极位于鼓阶,并具有外形美观,手术切口小,术中创伤小,术后并发症少等优点。     

人工耳蜗植入幼儿康复个案研究

目的研究人工耳蜗植入幼儿在不同阶段的听觉康复效果和语言康复效果．为人工耳蜗植入幼儿术后康复训练提供经验。方法采用评估和观察的方法,对一名人工耳蜗植入幼儿术后康复一年的情况进行阶段性评估。结果经过一年的康复训练,该幼儿的听觉康复级别和语言康复级别均达到一级水平,可以和健听人进行简单的交流,并能主动和陌生人说话。结论人工耳蜗植入为重度听力损失的幼儿提供了听觉重建的机会：家园配合的术后康复训练可以使幼儿的听觉言语能力在一年内取得较大的进步。     

非常规人工耳蜗植入术

人工耳蜗植入 (ＣＩ)是极重度聋和全聋患者听力语言康复的最有效方法。但因耳结构的异常 ,如中耳结构异常、耳蜗纤维化和 (或 )骨化和内耳先天性发育畸形等 ,常使人工耳蜗植入术不能按常规进行。对这类具有异常耳结构的患者 ,人工耳蜗仍可使其受益。术前影像学检查可帮助判断中耳结构、耳蜗形态、蜗管的通畅情况等 ,有助于术前预测术中可能会遇到的情况 ,以便制定手术方案。针对各种耳结构异常的患者 ,产生了各种相对应的人工耳蜗植入手术方法 ,主要目的是使尽量多的电极接触尽量多的听神经纤维 ,从而提高术后听力语言的康复效果〔1〕。1　…     

影响人工耳蜗植入术后效果的相关因素

人工耳蜗植入是目前重度、极重度感音神经性听障患者重要的康复方式,术后效果至今仍存在较大的个体差异。本文分析了人工耳蜗植入术后效果的影响因素,以期在现有技术水平上为提高患者术后的言语识别率提供帮助,并使术者、患者及其家属对术后效果建立合理预期。     

小儿人工耳蜗植入术后康复--机构康复和家庭康复模式探讨

小儿人工耳蜗植入数量占我国人工耳蜗植入总数的85％以上，人工耳蜗植入术后多数家庭选择将小儿送入机构进行康复。近年来小龄幼儿植入者不断增多，选择家庭康复模式的人数也在增加。本文就机构康复和家庭康复两种模式的优势及局限性作一探讨，供家长及老师参考。     

人工耳蜗不同电极植入术后听觉康复效果比较

目的通过对澳大利亚Nucleus（直电极和弯电极）、奥地利Medel和美国Advanced Bionics人工耳蜗不同电极植入者开机后的调试情况，以及听觉和言语康复效果进行观察比较，探讨不同植入电极患者术后效果是否存在差异。方法我科自1997年3月至2007年6月共植入人工耳蜗313例，选择其中植入年龄、植入时间、术前残余听力、术后康复条件等各方面条件相近的语前聋人工耳蜗植入者70例，将其按植入产品的不同分为4组，包括澳大利亚Nucleus直电极组22人，澳大利亚Nucleus弯电极组25人，奥地利Medel C40＋组12人和美国AB公司90K组11人。比较4组人工耳蜗植入患者开机半年后的阈值（T-levels）．最大舒适强度（C-levels／M-levels）和动态范围（dynamic range）有无差异，并根据听觉行为分级标准（categories of auditory performance，CAP）和言语可懂度分级标准（speech intelligibility rating，SIR）对4组人工耳蜗植入者进行评估，用统计学方法分析不同电极人工耳蜗植入者听觉水平和言语可懂度康复效果是否存在统计学差异。结果经单因素方差分析，4组耳蜗植入者CAP分级和SIR分级得分的差异无统计学意义（P〉0．05）。调试时澳大利亚弯电极组和直电极组的T-levels、C-levels和动态范围大小无统计学差异（P〉0．05）；奥地利C40＋组与其它三组相比，最大舒适强度和动态范围更大；美国90K组阈值最低，所需刺激量最小。结论人工耳蜗不同电极植入术后均能产生良好效果，其阈值，最大舒适强度和动态范围有差别，但不同植入电极术后的听觉水平和言语可懂度等康复效果无明显差异。     

人工耳蜗植入术后听力及言语康复效果相关因素的初步研究

目的 通过对55例人工耳蜗植入患儿的听力及言语能力进行评估,分析各种可能因素在人工耳蜗植入术后听力及言语康复过程中的作用。方法 通过问卷调查的方式对人工耳蜗植入患者的各项可能影响因素进行统计,并根据听觉行为分级标准（CAP）和言语可懂度分级标准（SIR）对患儿的听力及言语能力进行评估。使用卡方检验对影响术后康复效果的相关因素进行单因素分析;最后将从单因素分析中筛选出来的听觉及言语康复效果的影响因素进行logistic回归分析。结果 logistic回归结果显示植入后时间及家庭经济状况与CAP显著相关,植入后时间、居住地、术后康复模式与SIR显著相关。结论 人工耳蜗植入术后时间、经济因素是影响人工耳蜗植入术后患儿康复效果的重要因素。     

先天性外耳道骨性闭锁患者人工耳蜗植入的手术分析

目的探讨先天性外耳道骨性闭锁行人工耳蜗植入患者的听力学检查、影像学特征及手术径路的选择。方法收集2015年7月—2019年1月诊治的5例先天性外耳道骨性闭锁行人工耳蜗植入术的患者,回顾性分析其病史、听力学检查、影像学特征及手术径路。结果5例患者听力均表现为重度感音神经性聋。影像学表现为外耳道骨性闭锁,伴听骨链畸形,面神经走形异常,均无内耳畸形。5例患者均采用鼓窦径路,其中2例患者经面神经后下植入人工耳蜗。所有患者均为圆窗膜植入,植入电极过程顺利,术后开机反应佳。结论针对外耳道骨性闭锁畸形需行人工耳蜗植入的患者,应采用外耳道骨性闭锁的鼓窦径路的手术方式,开放部分乳突及鼓窦,取出畸形的听骨链,在此基础上,进一步暴露圆窗龛。对于面神经乳突段前移,完全遮挡圆窗龛的患者,则可转经面神经后下暴露圆窗龛。     

Participatory design of a music aural rehabilitation programme

Abstract

Objectives

Many cochlear implant (CI) users wish to enjoy music but are dissatisfied by its quality as perceived through their implant. Although there is evidence to suggest that training can improve CI users’ perception and appraisal of music, availability of interactive music-based aural rehabilitation for adults is limited. In response to this need, an ‘Interactive Music Awareness Programme’ (IMAP) was developed with and for adult CI users.

Methods

An iterative design and evaluation approach was used. The process began with identification of user needs through consultations, followed by use of mock-up applications in workshops. Feedback from these were used to develop the prototype IMAP; a programme of 24 interactive sessions, enabling users to create and manipulate music. The prototype IMAP was subsequently evaluated in a home trial with 16 adult CI users over a period of 12 weeks.

Results

Overall ratings for the prototype IMAP were positive and indicated that it met users’ needs. Quantitative and qualitative feedback on the sessions and software in the prototype IMAP were used to identify aspects of the programme that worked well and aspects that required improvement. The IMAP was further developed in response to users’ feedback and is freely available online.

Conclusions

The participatory design approach used in developing the IMAP was fundamental in ensuring its relevance, and regular feedback from end users in each phase of development proved valuable for early identification of issues. Observations and feedback from end users supported a holistic approach to music aural rehabilitation.     

Rare case of bilateral aural atresia and cochlear dysplasia: when cochlear implantation is not the answer

Objective and importance: Reports of patients with concurrent middle and inner ear anomalies are rare. These patients present a surgical challenge for cochlear implantation. The surgical risk must be weighed against the predicted benefit of the patient’s hearing outcome and subsequent development of speech and language as well as their quality of life.

Clinical presentation: Thirteen-year-old boy presented to the Otology clinic for auditory rehabilitation options. He has mild developmental delay, is non-verbal and communicates via American Sign Language. He was born with bilateral aural atresia and never wore amplification. On exam he has grade 1 microtia and complete ear canal atresia bilaterally. His behavioural hearing test shows profound sensorineural hearing loss of both ears. The computed tomography scan shows bilateral underdeveloped and completely opacified mastoid and middle ear, complete bony atresia of the ear canals, and an under-partitioned cochlea with poorly defined modiolus, among other abnormalities. The patient and his family were counselled on the available options as well as the need for any further studies.

Intervention: Counselling of patient and family.

Conclusion: While there have been reports in the literature of performing cochlear implantations in patients with a concurrent atresia and cochlear dysplasia, these were patients whose degree of inner ear anomalies was relatively minor and their prognosis of a good audiological outcome was favourable. The presented case is that of a patient for whom the surgical approach to the cochlea alone would be difficult. More importantly, his quality of life would not significantly improve in light of the predicted limited hearing and language development outcomes, given the severity of his inner ear abnormalities, limited communication abilities, prolonged period of deafness and developmental delays.     

Combined microtia and aural atresia: issues in cochlear implantation

Objectives: This article presents the first report of cochlear implantation in a patient with congenital aural atresia, microtia, dysplastic cochlea and internal auditory canals, and bilateral profound sensorineural hearing loss (HL). This rare combination requires special management considerations. Preoperative issues include thorough evaluation of computed tomography and magnetic resonance imaging to determine favorable anatomy, cochlear implantation candidacy, and surgical planning. Intraoperative concerns include incision placement, surgical approach to the middle ear, and abnormal facial nerve anatomy. Postoperative use of a special headset combining a microphone and transmitter coil is required. Study Design: Case report and literature review. Methods: The patient's chart was reviewed for diagnostic studies, operative strategy, and postoperative auditory stimulation and testing. A literature review was performed. Results: A 2‐year‐old male presented with bilateral aural atresia, microtia, and profound sensorineural HL. Imaging studies revealed multiple abnormalities of the cochlea, vestibule, and internal auditory canal, all of which were more favorable on the right side. An incision was designed to accommodate future microtia repair. The cochlear implant was placed without difficulty by way of a facial recess approach to the middle ear. Postoperative results include the detection of Ling sounds and voices in the environment as well as the ability to locate sounds. Conclusions: This is the first report of cochlear implantation in a patient with bilateral aural atresia, microtia, and profound sensorineural HL in conjunction with multiple inner ear abnormalities. Close collaboration among the otologist, neuroradiologist, and plastic surgeon is essential to coordinate surgical management and optimize cosmetic and functional outcomes in this unique population.     

A follow-up study of long-term results after cochlear implantation in children and adolescents

The time course of speech development in children after cochlear implantation may extend over many years, thus making long-term studies necessary to evaluate any outcome. We report our long-term results after cochlear implantation in children and adolescents. Mean follow-up was 28 months, ranging from 1 to 5 years. After at least 1 year of experience all children were found to benefit from their cochlear implants. The majority of children scored above chance in speech identifcation tasks requiring closed set word and sentence understanding). At the 4-year interval, all children tested including prelingually deaf children had developed open set sentence understanding. The most relevant factor accounting for differences in the results was the duration of implant use in all groups. Even beyond 3 years the results continued to improve. Peri- or postlinguallly deafened children tended to have favorable results. For prelingually deaf children, duration of deafness and age at implantation were correlated negatively with the results.     

Assessment of outcomes of hearing and speech rehabilitation in children with cochlear implantation

ObjectivesThis study aimed to assess the effect of hearing and speech rehabilitation in patients with Nurotron^® cochlear implants.DesignNinety-eight paediatric patients with bilateral severe-to-profound sensorineural deafness who received cochlear implantation were divided into three groups according to age: group A (≤3 years), group B (4–7 years), and group C (8–16 years). All patients were followed up for one year for hearing and speech performance after the surgery. The comprehensive Auditory Perception Assessment, MAIS, CAP and SIR hearing and speech assessments and rating materials were used for assessment before the surgery and at 3, 6, and 12 months after implant activation.ResultsThe scores of patients in the open-set speech assessment, Chinese Auditory Perception Assessment, MAIS, CAP and SIR significantly improved after cochlear implantation in all age groups. The younger the age at implantation, the better the results. Moreover, the hearing and speech performance of cochlear implant recipients gradually improved with the extension of rehabilitation time.ConclusionsNurotron^® Venus? cochlear implantation can improve the hearing and speech performance of patients with bilateral severe-to-profound sensorineural deafness.