Colletti Liliana, Wilkinson Eric P, Colletti Vittorio
Department of Otorhinolaryngology, University of Verona, Verona, Italy.
Ann Otol Rhinol Laryngol. 2013 Oct;122(10):605-12.
We compared the perceptual auditory abilities of 21 children with suspected cochlear nerve deficiency (CND) and a surgically verified absent cochlear nerve (CN) who first underwent cochlear implantation (CI) and subsequently underwent auditory brainstem implantation (ABI).
In this retrospective cohort study, from 2000 to 2011, 21 children initially underwent CI at an outside institution and failed to progress in their perceptual auditory abilities. Before CI, all of the children had severe to profound sensorineural hearing loss and a diagnosis of CND. Magnetic resonance imaging (MRI) documented an absent CN in 13 children and a small CN in 8 children. We performed explantation of the cochlear implant and simultaneous ABI on the same side. We performed MRI if no previous MRI results were available. All surgical videos were reviewed to determine the presence or absence of the CN. Measures of the patients' perceptual auditory abilities obtained after CI and after ABI were converted to the Category of Auditory Performance (CAP) scale.
At surgery, all patients demonstrated an absent CN. After CI, all patients had a CAP score of 2 or less (mean, 0.52 +/- 0.68). After ABI, all patients had a CAP score of 2 or more (mean, 4.33 +/- 1.68); the improvement was statistically significant (p < 0.001). The complication rates were similar for CI and ABI.
In this cohort of patients who had poor performance after CI, ABI achieved significantly improved performance as measured by the CAP and was shown to successfully rehabilitate hearing. Cases of a small CN may in reality represent an absent CN. Although this cohort was selected from patients with failed CI, the results have implications for the selection of device for patients with CND, in that ABI is a potential alternative to CI in select cases. In patients who fail to progress with intensive rehabilitation with CI or who have no progression in evoked auditory brainstem response, ABI must be considered early.
我们比较了21名疑似蜗神经缺损（CND）且经手术证实蜗神经（CN）缺失的儿童的听觉感知能力，这些儿童首先接受了人工耳蜗植入（CI），随后接受了听觉脑干植入（ABI）。
在这项回顾性队列研究中，从2000年至2011年，21名儿童最初在外部机构接受了CI，但听觉感知能力没有进展。在CI之前，所有儿童均患有重度至极重度感音神经性听力损失，并被诊断为CND。磁共振成像（MRI）显示13名儿童的CN缺失，8名儿童的CN较小。我们进行了人工耳蜗植入物取出术，并在同一侧同时进行了ABI。如果之前没有MRI结果，则进行MRI检查。回顾所有手术视频以确定CN的存在与否。将CI后和ABI后获得的患者听觉感知能力测量值转换为听觉表现类别（CAP）量表。
手术时，所有患者均显示CN缺失。CI后，所有患者的CAP评分为2分或更低（平均，0.52±0.68）。ABI后，所有患者的CAP评分为2分或更高（平均，4.33±1.68）；改善具有统计学意义（p<0.001）。CI和ABI的并发症发生率相似。
在这组CI后表现不佳的患者中，ABI通过CAP测量显示出显著改善的表现，并被证明能成功恢复听力。CN较小的病例实际上可能代表CN缺失。虽然这组患者是从CI失败的患者中挑选出来的，但结果对CND患者的设备选择有影响，因为在某些情况下ABI是CI的潜在替代方案。对于CI强化康复无进展或听觉脑干诱发电位无进展的患者，必须尽早考虑ABI。
