Otolaryngology, Head & Neck Surgery Division, School of Surgery, Fremantle Hospital Campus, University of Western Australia, Fremantle, Australia.
Laryngoscope. 2012 Jan;122(1):190-5. doi: 10.1002/lary.22142.
Hearing Preservation is becoming increasingly important in cochlear implantation as there is growing evidence that preserving the residual hearing, especially in the low frequencies in combination with the electric stimulation can significantly improve hearing and speech outcomes in noise. Besides the ongoing development of atraumatic implant electrodes and insertion techniques, the implementation of pharmacologic hair cell protection is thought to increase hearing preservation. This study investigates the effects of preoperative intratympanic glucocorticoid application on hearing preservation rates in cochlear implantation.
Prospective interventional study.
Tertiary neurotology referral center.
Patients undergoing cochlear implantation with measurable preoperative hearing thresholds using either a Flex soft electrode or a Flex EAS electrode depending on the degree of residual low frequency hearing.
Preoperative intratympanic steroid application during cochlear implantation via round window insertion.
Level of hearing preservation after cochlear implantation; electrode- and frequency-specific hearing preservation rates.
Preoperative hearing thresholds were comparable in the control group and the interventional Flex soft group (70.5 db±12.5 dB vs. 73.5 dB±10.5 dB, P=.27). As per selection criteria the low-frequency hearing thresholds were significantly lower in interventional Flex EAS groups when compared to the control group. Hearing preservation was significantly better in the interventional group with no case of complete hearing loss in this group (11 dB±2.5 dB vs. 19.5 dB 3.5 dB, P<.05). The interventional group displayed a higher stability of hearing preservation after implantation (r=.8, P=.03). Level of hearing preservation was higher when a specific hearing preservation electrode was used (r=.85, P<.05). Hearing preservation in the low frequencies was significantly higher than in the high frequencies.
Our study suggests that the additional preoperative use of intratympanic glucocorticoids improves and stabilizes hearing preservations rates in round window cochlear implantation for adults and children with residual hearing.
随着越来越多的证据表明保留残余听力（尤其是低频听力）与电刺激相结合可以显著改善噪声环境下的听力和言语效果，在人工耳蜗植入中，听力保护变得越来越重要。除了不断开发微创植入电极和插入技术外，还认为应用药物毛细胞保护可以提高听力保护率。本研究调查了术前鼓室内糖皮质激素应用对人工耳蜗植入中听力保护率的影响。
前瞻性干预研究。
三级神经耳科转诊中心。
接受人工耳蜗植入术且术前可测量听力阈值的患者，根据残余低频听力的程度，使用 Flex 软电极或 Flex EAS 电极。
通过圆窗插入在人工耳蜗植入术中进行术前鼓室内类固醇应用。
人工耳蜗植入后的听力保护水平；电极和频率特异性听力保护率。
对照组和干预性 Flex 软电极组的术前听力阈值相当（70.5 dB±12.5 dB 与 73.5 dB±10.5 dB，P=.27）。根据选择标准，干预性 Flex EAS 组的低频听力阈值明显低于对照组。干预组的听力保护明显更好，且该组无完全听力丧失病例（11 dB±2.5 dB 与 19.5 dB±3.5 dB，P<.05）。干预组在植入后听力保护的稳定性更高（r=.8，P=.03）。使用特定的听力保护电极时，听力保护水平更高（r=.85，P<.05）。低频听力保护明显高于高频听力。
我们的研究表明，对于具有残余听力的成人和儿童，在圆窗人工耳蜗植入术中额外使用术前鼓室内糖皮质激素可提高并稳定听力保护率。
