植入深度会影响侧壁电极的言语感知和听力保留。
Insertion depth impacts speech perception and hearing preservation for lateral wall electrodes.
作者信息
O'Connell Brendan P, Hunter Jacob B, Haynes David S, Holder Jourdan T, Dedmon Matt M, Noble Jack H, Dawant Benoit M, Wanna George B
机构信息
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, U.S.A.
Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, Tennessee, U.S.A.
出版信息
Laryngoscope. 2017 Oct;127(10):2352-2357. doi: 10.1002/lary.26467. Epub 2017 Mar 17.
OBJECTIVES
- Examine angular insertion depths (AID) and scalar location of Med-El (GmbH Innsbruck, Austria) electrodes; and 2) determine the relationship between AID and audiologic outcomes controlling for scalar position.
STUDY DESIGN
Retrospective review.
METHODS
Postlingually deafened adults undergoing cochlear implantation with Flex 24, Flex 28, and Standard electrode arrays (Med-El) were identified. Patients with preoperative and postoperative computed tomography scans were included so that electrode location and AID could be determined. Outcome measures were 1) speech perception in the cochlear implant (CI)-only condition, and 2) short-term hearing preservation.
RESULTS
Forty-eight implants were included; all electrodes (48 of 48) were positioned entirely within the scala tympani. The median AID was 408° (interquartile [IQ] range 373°-449°) for Flex 24, 575° (IQ range 465°-584°) for Flex 28, and 584° (IQ range 368°-643°) for Standard electrodes (Med-El). The mean postoperative CNC score was 43.7% ± 21.9. A positive correlation was observed between greater AID and better CNC performance (r = 0.48, P < 0.001). Excluding patients with postoperative residual hearing, a strong correlation between AID and CNC persisted (r = 0.57, P < 0.001). In patients with preoperative residual hearing, mean low-frequency pure-tone average (PTA) shift was 27 dB ± 14. A correlation between AID and low-frequency PTA shift at activation was noted (r = 0.41, P = 0.04).
CONCLUSION
Favorable rates of scala tympani insertion (100%) were observed. In the CI-only condition, a direct correlation between greater AID and CNC score was noted regardless of postoperative hearing status. Deeper insertions were, however, associated with worse short-term hearing preservation. When patients without postoperative residual hearing were analyzed independently, the relationship between greater insertion depth and better performance was strengthened.
LEVEL OF EVIDENCE
- Laryngoscope, 127:2352-2357, 2017.
目的
1）检查奥地利因斯布鲁克美迪乐公司（Med-El）电极的角度插入深度（AID）和蜗管位置；2）确定AID与蜗管位置可控的听力学结果之间的关系。
研究设计
回顾性研究。
方法
纳入接受Flex 24、Flex 28和标准电极阵列（美迪乐）人工耳蜗植入的语后聋成人。纳入术前行计算机断层扫描和术后行计算机断层扫描的患者，以便确定电极位置和AID。结果指标为：1）仅使用人工耳蜗（CI）时的言语感知；2）短期听力保留。
结果
纳入48例植入病例；所有电极（48/48）均完全置于鼓阶内。Flex 24电极的AID中位数为408°（四分位间距[IQ]范围373° - 449°），Flex 28电极的AID中位数为575°（IQ范围465° - 584°），标准电极（美迪乐）的AID中位数为584°（IQ范围368° - 643°）。术后CNC评分的平均值为43.7%±21.9。观察到AID越大与CNC表现越好之间存在正相关（r = 0.48，P < 0.001）。排除术后仍有残余听力的患者后，AID与CNC之间仍存在强相关性（r = 0.57，P < 0.001）。在术前有残余听力的患者中，低频纯音平均听阈（PTA）的平均变化为27 dB±14。注意到AID与开机时低频PTA变化之间存在相关性（r = 0.41，P = 0.04）。
结论
观察到鼓阶插入成功率良好（100%）。在仅使用CI的情况下，无论术后听力状况如何，均观察到AID越大与CNC评分之间存在直接相关性。然而，更深的插入与更差的短期听力保留相关。当单独分析术后无残余听力的患者时，插入深度越大与表现越好之间的关系得到加强。
证据级别
4。《喉镜》，2017年，第127卷，第2352 - 2357页。
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