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儿童人工耳蜗植入后的残余听力保留。

Residual hearing preservation after pediatric cochlear implantation.

机构信息

Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.

出版信息

Otol Neurotol. 2010 Oct;31(8):1221-6. doi: 10.1097/MAO.0b013e3181f0c649.

DOI:10.1097/MAO.0b013e3181f0c649
PMID:20818293
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2946455/
Abstract

OBJECTIVE

This study is designed to test the hypothesis that preservation of residual hearing in a pediatric population is possible using standard electrode arrays with full-length insertions. Surgical technique during implantation also is described.

STUDY DESIGN

Retrospective review of patient medical records.

SETTING

Academic tertiary care center.

PATIENTS

Thirty-one severely to profoundly hearing impaired pediatric patients with some residual hearing precochlear implantation.

INTERVENTION

Cochlear implantation using a modified "soft surgery" protocol.

MAIN OUTCOME MEASURES

Preimplant and postimplant pure tone thresholds and pure-tone average were calculated from unaided preoperative and postoperative audiograms from 250, 500, and 1,000 Hz. Hearing preservation rates were determined to be complete (loss of ≤10 dB), moderate (loss of 11-20 dB), marginal (loss of 21-40 dB), or none (loss of >40 dB or no response at the limits of the audiometer). Functional residual hearing rates (defined in this study as at least 1 threshold better than or equal to 75 dB HL for 250, 500, or 1,000 Hz were calculated.

RESULTS

Complete hearing preservation was achieved in 14 (45.2%) of 31 patients, whereas 28 (90.3%) of 31 had at least partial hearing preservation (loss of ≤40 dB). The preoperative to postoperative low-frequency pure-tone average had a mean change of 18.5 dB and median change of 20 dB. Of the patients who had preoperative functional hearing, 9 (50.0%) of 18 maintained functional residual hearing postoperatively for at least 1 pitch.

CONCLUSION

Preservation of residual hearing is feasible in pediatric cochlear implant patients using standard-length electrode arrays with full insertions. These data have implications for cochlear implantation in pediatric patients who are at higher risk of progressive hearing loss than adults.

摘要

目的

本研究旨在验证以下假设,即使用全长插入的标准电极阵列,在儿童人群中保留残余听力是可行的。同时也描述了植入过程中的手术技术。

研究设计

回顾性患者病历分析。

设置

学术性三级护理中心。

患者

31 名严重至极重度听力障碍的儿童患者,在植入前有一定的残余听力。

干预措施

使用改良的“软手术”方案进行人工耳蜗植入。

主要观察指标

术前和术后未助听纯音阈值和纯音平均值,通过术前和术后 250、500 和 1000Hz 的听力图计算得出。听力保留率确定为完全(损失≤10dB)、中度(损失 11-20dB)、边缘(损失 21-40dB)或无(损失>40dB 或听力计极限无反应)。功能性残余听力率(在本研究中定义为至少 1 个阈值在 250、500 或 1000Hz 时比听力计极限好 1 倍或以上)也进行了计算。

结果

31 名患者中有 14 名(45.2%)达到完全听力保留,而 31 名患者中有 28 名(90.3%)有至少部分听力保留(损失≤40dB)。低频纯音平均术前至术后的平均变化为 18.5dB,中位数变化为 20dB。在术前有功能性听力的患者中,有 9 名(50.0%)在术后至少有 1 个音保持功能性残余听力。

结论

使用全长插入的标准电极阵列,在儿童人工耳蜗植入患者中保留残余听力是可行的。这些数据对那些比成年人更有进行性听力损失风险的儿童患者的耳蜗植入具有重要意义。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4ecf/2946455/34ef35141112/nihms229530f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4ecf/2946455/34ef35141112/nihms229530f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4ecf/2946455/34ef35141112/nihms229530f1.jpg

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本文引用的文献

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2
Two ears and two (or more?) devices: a pediatric case study of bilateral profound hearing loss.两只耳朵与两台(或更多?)设备:双侧极重度听力损失的儿科病例研究
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Results of partial deafness cochlear implantation using various electrode designs.使用各种电极设计的部分性耳聋人工耳蜗植入结果。
残余听力的保护:中阶电极的长期结果。
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Effects of Cochlear Implantation and Steroids on the Aging Guinea Pig Cochlea.耳蜗植入和类固醇对老年豚鼠耳蜗的影响。
Otolaryngol Head Neck Surg. 2024 Aug;171(2):530-537. doi: 10.1002/ohn.732. Epub 2024 Mar 28.
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Residual Hearing Improves Early Auditory Perception and Speech Intelligibility in Mandarin-Speaking Children with Cochlear Implants.人工耳蜗植入术后儿童残余听力对普通话早期听觉感知和言语可懂度的影响。
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Bilateral Cochlear Implants or Bimodal Hearing for Children with Bilateral Sensorineural Hearing Loss.双侧感音神经性听力损失儿童的双侧人工耳蜗植入或双耳选配助听器
Curr Otorhinolaryngol Rep. 2020 Dec;8(4):385-394. doi: 10.1007/s40136-020-00314-6. Epub 2020 Oct 2.
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Intracochlear Pressure Transients During Cochlear Implant Electrode Insertion: Effect of Micro-mechanical Control on Limiting Pressure Trauma.耳蜗内压瞬变在人工耳蜗电极插入过程中的作用:微机械控制对限制压力损伤的影响。
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Hearing preservation in children with electric-acoustic stimulation after cochlear implantation : Outcome after electrode insertion with minimal insertion trauma.人工耳蜗植入后电声刺激儿童的听力保留:最小插入创伤电极插入后的结果
HNO. 2018 Jul;66(Suppl 2):56-62. doi: 10.1007/s00106-018-0532-3.
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