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人工耳蜗植入术中残余听力电生理术中监测的初步结果与技术

Preliminary results and technique for electrophysiological intra-operative monitoring of residual hearing during cochlear implantation.

作者信息

Harris Robert, Cruise Andrew, Gibson William, Bate Karen, Sanli Halit

机构信息

St George's Hospital, London, UK.

出版信息

Cochlear Implants Int. 2011 Nov;12(4):209-15. doi: 10.1179/146701011X12950038111657.

Abstract

AIMS

To assess the feasibility of intra-operative monitoring of residual hearing using electrocochleography (ECOG) during cochlear implantation. We present our methods and preliminary results.

METHODS

We attempted to monitor 21 consecutive paediatric and adult subjects during cochlear implantation. All subjects were implanted via a promontory cochleostomy with full electrode insertions of Cochlear(TM) Nucleus® (Cochlear Nucleus, Cochlear Ltd, Australia) devices: 8 with straight electrodes and 13 with contoured electrodes. Baseline recordings were made after the completion of the posterior tympanotomy, and subsequently at stages of the cochleostomy and electrode insertion.

RESULTS

We were unable to obtain recordings on five patients because the ear-insert tubing kinked, which disrupted transmission of the stimulus. Five had insufficient cochlear function to be able to record a baseline ECOG. No subjects in whom we were able to obtain a satisfactory baseline ECOG (n=11) had a reduction in ECOG action potential (AP) amplitude, morphology or threshold up to completion of the cochleostomy. Seven maintained an unchanged ECOG throughout the procedure to full insertion. An implant had to be replaced because of a faulty straight electrode in one patient. The amplitude significantly reduced during insertion of the replacement array. Two had a reduction in amplitude, threshold, and shape of the wave related to inadvertent suction of the perilymph. Subsequently, one maintained this changed ECOG to the end of the procedure, but the other progressed to complete loss of the ECOG during insertion of the array. One other subject had a significant reduction in the amplitude during insertion of the electrode from a depth of approximately 18mm to full insertion.

CONCLUSIONS

Intra-operative monitoring of residual hearing may be possible in most patients undergoing cochlear implantation. This pilot study suggests that cochleostomy is not associated with intra-operative loss of residual hearing; ECOG can be preserved during the procedure in most patients; intra-operative loss of hearing is most likely to occur when the tip of the array reaches the basal turn of the cochlea. This risk may increase if the array has to be removed and re-inserted. Suction of perilymph causes immediate changes, which may not recover.

摘要

目的

评估在人工耳蜗植入术中使用电耳蜗图(ECOG)对残余听力进行术中监测的可行性。我们展示了我们的方法和初步结果。

方法

我们尝试在21例连续的儿科和成人患者人工耳蜗植入术中进行监测。所有患者均通过岬蜗开窗术植入,完全插入澳大利亚科利耳公司(Cochlear)的Nucleus®系列设备电极:8例使用直电极,13例使用弯电极。在完成后鼓室切开术后进行基线记录,随后在蜗开窗术和电极插入的各个阶段进行记录。

结果

5例患者因耳内插入管扭结而无法获得记录,这干扰了刺激的传输。5例患者耳蜗功能不足,无法记录到基线ECOG。在能够获得满意基线ECOG的11例患者(n = 11)中,直至蜗开窗术完成,ECOG动作电位(AP)的幅度、形态或阈值均未降低。7例患者在整个手术过程直至电极完全插入时ECOG保持不变。1例患者因直电极故障不得不更换植入体。在更换电极阵列插入过程中,幅度显著降低。2例患者因意外吸取外淋巴,与波相关的幅度、阈值和形状降低。随后,1例患者在手术结束时ECOG保持这种变化,但另1例患者在电极阵列插入过程中ECOG逐渐完全消失。另1例患者在电极从约18mm深度插入至完全插入过程中,幅度显著降低。

结论

大多数接受人工耳蜗植入术的患者术中可能可以监测残余听力。这项初步研究表明,蜗开窗术与术中残余听力丧失无关;大多数患者在手术过程中ECOG可以保留;当电极阵列尖端到达耳蜗底转时,术中听力丧失最有可能发生。如果必须取出并重新插入电极阵列,这种风险可能会增加。吸取外淋巴会立即引起变化,可能无法恢复。

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