Francis Howard W, Buchman Craig A, Visaya Jiovani M, Wang Nae-Yuh, Zwolan Teresa A, Fink Nancy E, Niparko John K
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland 21287-0910, USA.
Otol Neurotol. 2008 Jun;29(4):502-8. doi: 10.1097/MAO.0b013e318170b60b.
To assess the impact of surgical factors on electrode status and early communication outcomes in young children in the first 2 years of cochlear implantation.
Prospective multicenter cohort study.
Six tertiary referral centers.
Children 5 years or younger before implantation with normal nonverbal intelligence.
Cochlear implant operations in 209 ears of 188 children.
Percent active channels, auditory behavior as measured by the Infant Toddler Meaningful Auditory Integration Scale/Meaningful Auditory Integration Scale and Reynell receptive language scores.
Stable insertion of the full electrode array was accomplished in 96.2% of ears. At least 75% of electrode channels were active in 88% of ears. Electrode deactivation had a significant negative effect on Infant Toddler Meaningful Auditory Integration Scale/Meaningful Auditory Integration Scale scores at 24 months but no effect on receptive language scores. Significantly fewer active electrodes were associated with a history of meningitis. Surgical complications requiring additional hospitalization and/or revision surgery occurred in 6.7% of patients but had no measurable effect on the development of auditory behavior within the first 2 years. Negative, although insignificant, associations were observed between the need for perioperative revision of the device and 1) the percent of active electrodes and 2) the receptive language level at 2-year follow-up.
Activation of the entire electrode array is associated with better early auditory outcomes. Decrements in the number of active electrodes and lower gains of receptive language after manipulation of the newly implanted device were not statistically significant but may be clinically relevant, underscoring the importance of surgical technique and the effective placement of the electrode array.
评估手术因素对人工耳蜗植入后头两年幼儿电极状态及早期交流结果的影响。
前瞻性多中心队列研究。
六个三级转诊中心。
植入前5岁及以下且非语言智力正常的儿童。
对188名儿童的209只耳朵进行人工耳蜗植入手术。
有效通道百分比、通过婴幼儿有意义听觉整合量表/有意义听觉整合量表测量的听觉行为以及雷尼尔接受性语言得分。
96.2%的耳朵成功稳定插入完整电极阵列。88%的耳朵中至少75%的电极通道有效。电极失活对24个月时的婴幼儿有意义听觉整合量表/有意义听觉整合量表得分有显著负面影响，但对接受性语言得分无影响。有脑膜炎病史的患儿有效电极明显较少。6.7%的患者发生了需要额外住院和/或翻修手术的手术并发症，但对前两年内听觉行为的发展没有可测量的影响。在2年随访时，观察到设备围手术期翻修需求与1）有效电极百分比和2）接受性语言水平之间存在负面但不显著的关联。
整个电极阵列的激活与更好的早期听觉结果相关。新植入设备操作后有效电极数量的减少和接受性语言增益的降低在统计学上不显著，但可能具有临床相关性，强调了手术技术和电极阵列有效放置的重要性。
