Łukaszewicz Zuzanna, Soluch Paweł, Niemczyk Kazimierz, Lachowska Magdalena
Katedra i Klinika Otolaryngologii Warszawskiego Uniwersytetu Medycznego.
Otolaryngol Pol. 2010 Jun;64(7):10-6. doi: 10.1016/S0030-6657(10)70002-0.
An assumption was taken that in central nervous system (CNS) in patients above 15 years of age there are possible mechanisms of neuronal changes. Those changes allow for reconstruction or formation of natural activation pattern of appropriate brain structures responsible for auditory speech processing.
The aim of the study was to observe if there are any dynamic functional changes in central nervous system and their correlation to the auditory-verbal skills of the patients.
Nine right-handed patients between 15 and 36 years of age were examined, 6 females and 3 males. All of them were treated with cochlear implantation and are in frequent follow-up in the Department of Otolaryngology at the Medical University of Warsaw due to profound sensorineural hearing loss. In present study the patients were examined within 24 hours after the first fitting of the speech processor of the cochlear implant, and 1 and 2 years subsequently. Combination of performed examinations consisted of: positone emission tomography of the brain, and audiological tests including speech assessment. In the group of patients 4 were postlingually deaf, and 5 were prelinqually deaf.
Postlingually deaf patients achieved great improvement of hearing and speech understanding. In their first PET examination very intensive activation of visual cortex V1 and V2 (BA17 and 18) was observed. There was no significant activation in the dominant (left) hemisphere of the brain. In PET examination performed 1 and 2 years after the cochlear implantation no more V1 and V2 activation region was observed. Instead particular regions of the left hemisphere got activated. In prelingually deaf patients no significant changes in central nervous system were noticeable neither in PET nor in speech assessment, although their hearing possibilities improved.
Positive correlation was observed between the level of speech understanding, linguistic skills and the activation of appropriate areas of the left hemisphere of the brain in postlingually deaf patients treated with cochlear implants. No such correlation was noted in prelingualy patients treated with the same method.
假定15岁以上患者的中枢神经系统（CNS）存在神经元变化的可能机制。这些变化有助于重建或形成负责听觉言语处理的适当脑结构的自然激活模式。
本研究的目的是观察中枢神经系统是否存在任何动态功能变化及其与患者听觉言语技能的相关性。
对9名15至36岁的右利手患者进行了检查，其中6名女性，3名男性。他们均因严重感音神经性听力损失接受了人工耳蜗植入治疗，并在华沙医科大学耳鼻喉科进行定期随访。在本研究中，患者在首次佩戴人工耳蜗言语处理器后的24小时内接受检查，随后在1年和2年时再次检查。所进行的检查组合包括：脑部正电子发射断层扫描和听力测试，包括言语评估。患者组中4名是语后聋，5名是语前聋。
语后聋患者的听力和言语理解能力有了很大改善。在他们的首次PET检查中，观察到视觉皮层V1和V2（BA17和18）非常强烈的激活。大脑优势（左）半球没有明显激活。在人工耳蜗植入后1年和2年进行的PET检查中，未观察到V1和V2激活区域。相反，左半球的特定区域被激活。语前聋患者在PET检查和言语评估中，中枢神经系统均未出现明显变化，尽管他们的听力有所改善。
在接受人工耳蜗植入治疗的语后聋患者中，观察到言语理解水平、语言技能与大脑左半球相应区域的激活之间存在正相关。在用相同方法治疗的语前聋患者中未发现这种相关性。
