Departments of Neurosurgery.
J Neurosurg. 2014 Feb;120(2):546-58. doi: 10.3171/2013.9.JNS12686. Epub 2013 Dec 13.
Patients with bilateral auditory nerve destruction may perceive some auditory input with auditory brainstem implants (ABIs). Despite technological developments and trials in new stimulation sites, hearing is very variable and of limited quality. The goal of this study was to identify advantageous and critical factors that influence the quality of auditory function, especially speech perception.
The authors conducted a prospective study on ABI operations performed with the aid of multimodality neuromonitoring between 2005 and 2009 in 18 patients with neurofibromatosis Type 2. Outcome was evaluated by testing word recognition (monotrochee-polysyllabic word test at auditory-only mode [MTPa]) and open speech perception (Hochmair-Schulz-Moser [HSM] sentence test), both in pure auditory mode. The primary outcome was the HSM score at 24 months. The predictive meaning of general clinical data, tumor volume, number of active electrodes, duration of deafness, and early hearing data was examined.
In 16 successful ABI activations the average score for MTPa was 89% (SD 13%), and for HSM it was 41% (SD 32%) at 24 months. There were 2 nonresponders, 1 after radiosurgery and the other in an anatomical variant. Direct facial nerve reconstruction during the same surgery was followed by successful nerve recovery in 2 patients, with a simultaneous very good HSM result. Patients' age, tumor extension, and tumor volume were not negative predictors. There was an inverse relationship between HSM scores and deafness duration; 50% or higher HSM scores were found only in patients with ipsilateral deafness duration up to 24 months. The higher the deafness sum of both sides, the less likely that any HSM score will be achieved (p = 0.034). In patients with total deafness duration of less than 240 months, higher numbers of active electrodes were significantly associated with better outcomes. The strongest cross-correlation was identified between early MTPa score at 3 months and 24-month HSM outcome.
This study documents that open-set speech recognition in pure auditory mode is feasible in patients with ABIs. Large tumor volumes do not prevent good outcome. Positive preconditions are short ipsilateral and short bilateral deafness periods and high number of auditory electrodes. Early ability in pure auditory word recognition tests indicates long-term capability of open speech perception.
双侧听神经破坏的患者可能会通过听觉脑干植入物（ABI）感知一些听觉输入。尽管技术不断发展，并且在新的刺激部位进行了试验，但听力仍然非常不稳定，且质量有限。本研究的目的是确定影响听觉功能（尤其是言语感知）质量的有利和关键因素。
作者在 2005 年至 2009 年间，使用多模态神经监测，对 18 例神经纤维瘤病 2 型患者进行了 ABI 手术的前瞻性研究。通过仅在听觉模式下测试单词识别（单音多音节词测试[MTPa]）和开放式言语感知（Hochmair-Schulz-Moser [HSM]句子测试）来评估结果。主要结果是 24 个月时的 HSM 评分。检查了一般临床数据、肿瘤体积、活动电极数量、耳聋持续时间和早期听力数据的预测意义。
在 16 次成功的 ABI 激活中，MTPa 的平均得分率为 89%（SD 13%），HSM 在 24 个月时的得分率为 41%（SD 32%）。有 2 例无反应者，1 例为放射治疗后，另 1 例为解剖变异。在同一手术中直接行面神经重建的 2 例患者面神经恢复良好，同时 HSM 结果也非常好。患者年龄、肿瘤延伸和肿瘤体积均不是负预测因子。HSM 评分与耳聋持续时间呈反比关系；只有在同侧耳聋持续时间为 24 个月或更短的患者中，才发现 50%或更高的 HSM 评分。两侧耳聋持续时间之和越高，获得任何 HSM 评分的可能性就越低（p=0.034）。在耳聋总持续时间小于 240 个月的患者中，活动电极数量较多与更好的结果显著相关。早期 3 个月的 MTPa 评分与 24 个月的 HSM 结果之间存在最强的交叉相关性。
本研究证明了在 ABI 患者中，开放式言语识别在纯听觉模式下是可行的。大的肿瘤体积并不能阻止良好的结果。有利的前提条件是同侧和双侧耳聋持续时间短，听觉电极数量多。早期纯听觉单词识别测试的能力表明长期开放式言语感知的能力。
