Adunka Oliver, Roush Patricia, Grose John, Macpherson Corinne, Buchman Craig A
Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7600, USA.
Laryngoscope. 2006 Jun;116(6):1017-20. doi: 10.1097/01.mlg.0000217224.94804.bb.
To report the feasibility of monitoring cochlear function during cochlear implantation.
Case report.
Tertiary care referral center.
A child with audiologic features typical of bilateral auditory neuropathy underwent cochlear implantation. The scala tympani was entered inferior and slightly anterior to the round window membrane margin and smooth electrode insertion was achieved. Using single polarity click stimuli, the cochlear microphonic was measured at several steps during surgery.
Cochlear microphonics were present at all stages during the implantation process and were clearly distinguished from neural responses by stimulus polarity inversion and constant latencies, despite changes in stimulus level. With the electrode in situ, amplitudes were smaller but persisted until the final measurement at 10 minutes after insertion. At follow-up 2 weeks after surgery, behavioral audiometry results indicated profound hearing loss in the operated ear.
This paper demonstrates the feasibility of monitoring cochlear function during cochlear implantation. The routine surgical approach did not appear to adversely affect the functional measurements. Standard size, full electrode insertion did diminish the amplitude of the cochlear microphonics, possibly as a result of intracochlear mechanical impairment. Ultimately, profound hearing loss was documented, indicating that factors other than immediate changes induced by electrode insertion were likely responsible for the loss of cochlear function.
报告在人工耳蜗植入过程中监测耳蜗功能的可行性。
病例报告。
三级医疗转诊中心。
一名具有双侧听觉神经病典型听力学特征的儿童接受了人工耳蜗植入。经圆窗膜边缘下方并稍靠前进入鼓阶，实现了电极的顺利插入。在手术过程中的几个步骤，使用单极短声刺激测量耳蜗微音电位。
在植入过程的所有阶段均存在耳蜗微音电位，尽管刺激强度有所变化，但通过刺激极性反转和恒定潜伏期可将其与神经反应清晰区分。电极就位后，振幅较小，但一直持续到插入后10分钟的最后测量。术后2周随访时，行为测听结果显示手术耳为极重度听力损失。
本文证明了在人工耳蜗植入过程中监测耳蜗功能的可行性。常规手术方法似乎未对功能测量产生不利影响。标准尺寸的完整电极插入确实减小了耳蜗微音电位的振幅，这可能是由于耳蜗内机械损伤所致。最终，记录到极重度听力损失，表明除电极插入引起的即时变化外，其他因素可能是导致耳蜗功能丧失的原因。
