Oghalai John S, Tonini Ross, Rasmus Jamie, Emery Claudia, Manolidis Spiros, Vrabec Jeffrey T, Haymond Joann
The Hearing Center at Texas Children's Hospital, Houston, Texas, USA.
Cochlear Implants Int. 2009 Mar;10(1):1-18. doi: 10.1002/cii.372.
The objective of this study was to determine if intra-operative auditory monitoring is feasible during cochlear implantation and whether this can be used as feedback to the surgeon to improve the preservation of residual hearing. This prospective non-randomised study was set in a paediatric tertiary referral hospital. Thirty eight consecutive paediatric patients undergoing cochlear implantation who had measurable auditory thresholds pre-operatively were divided into two cohorts. The unmonitored cohort included the first 22 patients and the monitored cohort included the last 16 patients. The main outcome measure(s) were pre-operative, intra-operative and more than one month post-operative average auditory thresholds at 500, 1000 and 2000 Hz measured using auditory steady-state response audiometry. The average pre-operative thresholds were 103.5 dB HL and 99.7 dB HL in the unmonitored and monitored cohorts, respectively. These were not statistically different (p > 0.3). In the monitored cohort, we measured auditory thresholds to assess cochlear function at multiple time points during the operation. Compared to baseline, thresholds were increased 0.7 dB after drilling the mastoidectomy and well, 0.2 dB after opening the cochlea and 4.6 dB after inserting the electrode array. One month post-operatively, the average thresholds were 114.0 dB HL in the unmonitored cohort but only 98.8 dB HL in the monitored cohort (p < 0.001). Both the use of intra-operative auditory monitoring and higher pre-operative thresholds were associated with improved preservation of residual hearing (p <or= 0.001). Intra-operative auditory monitoring is a viable tool that can provide real-time feedback to the surgeon during cochlear implant surgery. These data suggest that this can lead the surgeon to modify his or her surgical technique in ways that can improve the rate of long-term hearing preservation.
本研究的目的是确定术中听觉监测在人工耳蜗植入过程中是否可行，以及这是否可作为反馈给外科医生以改善残余听力的保留情况。这项前瞻性非随机研究在一家儿科三级转诊医院进行。38例术前有可测量听觉阈值的连续接受人工耳蜗植入的儿科患者被分为两组。未监测组包括前22例患者，监测组包括后16例患者。主要结局指标是术前、术中及术后1个月以上使用听觉稳态反应测听法测量的500、1000和2000赫兹的平均听觉阈值。未监测组和监测组的术前平均阈值分别为103.5 dB HL和99.7 dB HL。这些差异无统计学意义（p>0.3）。在监测组中，我们在手术期间的多个时间点测量听觉阈值以评估耳蜗功能。与基线相比，乳突切开术及钻孔后阈值升高0.7 dB，打开耳蜗后升高0.2 dB，插入电极阵列后升高4.6 dB。术后1个月，未监测组的平均阈值为114.0 dB HL，而监测组仅为98.8 dB HL（p<0.001）。术中听觉监测的使用和较高的术前阈值均与残余听力保留的改善相关（p≤0.001）。术中听觉监测是一种可行的工具，可在人工耳蜗植入手术期间为外科医生提供实时反馈。这些数据表明，这可引导外科医生以能够提高长期听力保留率的方式修改其手术技术。
