内听道狭窄的人工耳蜗植入术效果观察并文献复习

摘要：目的通过观察一例内听道狭窄患者人工耳蜗植入术后的远期康复效果，结合文献复习探讨该类畸形的手术选择指标。方法收集患儿术前听力学资料以及颞骨薄层CT资料，分别于术后半年、2年、4年时进行声场测试、MAIS量表评分、言语识别率测试分析患者康复疗效。并以内听道狭窄、蜗神经管狭窄、蜗神经孔狭窄以及蜗神经发育不良为关键词搜索与人工耳蜗康复的相关文献。结果半年时声场测试500、1 000、2 000、4 000 Hz分别为35、40、40、45 dBHL，2年时MAIS量表评分24分，4年时言语识别率80%，患儿于术后3年时言语理解能力进步明显，康复效果优于文献搜索结果。结论存在内听道狭窄的患者，人工耳蜗植入前对影像学及听力测试结果的综合分析非常重要，选择耳蜗神经发育相对较好侧以及助听效果较好侧手术，同时需坚持术后康复治疗。

Cochlear implantation in patients with stenosis of internal auditory canal

Abstract:ObjectiveTo probe surgical selection indexes of cochlear implantation in patients with internal auditory canal stenosis via observing long term rehabilitation effect in one patient combined with literature review.MethodsPreoperative audiological data and temporal bone CT images were collected. Sound field test, meaningful auditory integration scale (MAIS) and speech recognition rate test were used to evaluate auditory language skills in half a year, 2 years and 4 years after operation, respectively. Internal auditory canal stenosis, cochlear nerve canal stenosis and cochlear nerve deficiency were used as keywords to browse papers related with rehabilitation effect of cochlear implantation.ResultsHearing thresholds at half a year after operation at 500 Hz,1 KHz, 2 KHz and 4 KHz were 35, 40, 40 and 45 dBHL. Score of MAIS assessment scale at 2 years after operation was 24. Speech recognition rate at 4 years after operation was 80%. The speech comprehension ability was improved significantly 3 years after operation. The rehabilitation effect of our patient was better than those from obtained papers.ConclusionPreoperative analyses of audiological and imaging data are of vital important for cochlear implantation in patients with internal auditory canal stenosis. It is better to choose the side with better cochlear nerve development and hearing aid effect. Meanwhile, it will take long term commitment to obtain good postoperative rehabilitation.