Brackmann D E
Laryngoscope. 1976 Mar;86(3):373-88. doi: 10.1288/00005537-197603000-00007.
In recent years the cochlear implant has been a subject of much discussion and controversy. The clinician has often been confused by the conflicting reports of success and failure. In this paper the development of the cochlear implant is reviewed and its present status summarized. It is hoped that the clinician may thereby gain an understanding of this device so that he can better evaluate its present and future status. Selection of Patients for Cochlear Implantation. The cochlear implant will benefit only those patients with hair cell loss who have remaining viable auditory neurons. In order to determine whether viable neurons remain, an electric current is passed through a small needle which is place into the promontory through the tympanic membrane. If patients experience an auditory sensation as a result of this electrical stimulation, it is felt that they are suitable candidates for a cochlear implant. Feasibility of Long-Term VIIIth Nerve Stimulation. Many questions have been raised regarding the feasibility of long-term stimulation of the auditory nerve. The first question raised was whether the auditory nerve would survive severe hair cell degeneration. Studies have shown that in most cases at least a few auditory neurons remain. The next question was whether the cochlear implant itself would destroy the remaining auditory neurons. Preliminary studies have shown that the nerve will survive the placement of electrodes both into the modiolus and the scala tympani. Several electrode materials and insulation have been found to be well tolerated, and there has been minimal damage from thermal or electrolytic processes; therefore, it appears feasible to stimulate the auditory nerve over a long period. Information Transfer by Electrical Stimulation. Single-channel stimulation produces only periodicity pitch, and information transfer is insufficient for speech discrimination. Experience to date indicates that it will be possible to produce both place and volley pitch by electrical stimulation with multiple electrodes in the scala tympani. These findings give promise for the feasibility of producing a device which will transfer sufficient information to produce speech discrimination. Present Status of the Cochlear Implant. To the present time 15 patients have been implanted with a unipolar electrode under the direction of the Ear Research Institute. These patients have all benefited from their devices. They are able to perceive background sounds and receive a cadence or rhythm to speech which makes the device helpful in lipreading. None of the patients have developed significant speech discrimination.
近年来，人工耳蜗一直是备受讨论和争议的话题。临床医生常常被关于其成败的相互矛盾的报告所迷惑。本文回顾了人工耳蜗的发展历程并总结了其现状。希望临床医生借此了解该设备，以便能更好地评估其当前和未来的状况。人工耳蜗植入患者的选择。人工耳蜗仅对那些毛细胞丧失但仍有存活听觉神经元的患者有益。为了确定是否仍有存活的神经元，将电流通过一根小针，该小针经鼓膜插入岬部。如果患者因这种电刺激而产生听觉感受，则认为他们是人工耳蜗植入的合适候选人。第八脑神经长期刺激的可行性。关于听觉神经长期刺激的可行性，人们提出了许多问题。首先提出的问题是听觉神经能否在严重的毛细胞退化中存活。研究表明，在大多数情况下至少会有一些听觉神经元留存。接下来的问题是人工耳蜗本身是否会破坏剩余的听觉神经元。初步研究表明，将电极植入蜗轴和鼓阶时，神经能够存活。已发现几种电极材料和绝缘材料耐受性良好，并且热或电解过程造成的损伤极小；因此，长期刺激听觉神经似乎是可行的。电刺激的信息传递。单通道刺激仅产生周期性音调，信息传递不足以进行语音辨别。迄今为止的经验表明，通过在鼓阶中使用多个电极进行电刺激，有可能产生部位音调与群发放电音调。这些发现为制造一种能够传递足够信息以实现语音辨别的设备的可行性带来了希望。人工耳蜗的现状。到目前为止，有15名患者在耳研究所的指导下植入了单极电极。这些患者都从他们的设备中受益。他们能够感知背景声音，并感受到语音的节奏，这使得该设备有助于唇读。但没有一名患者发展出显著的语音辨别能力。
