Niu X M, Ping L, Fan X M, Fan Y, Chen X W
Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Apr 7;56(4):346-350. doi: 10.3760/cma.j.cn115330-20200910-00733.
To evaluate the therapeutic effects of unilateral/bilateral bone conduction hearing rehabilitation in patients with bilateral microtia accompanied with severe conductive hearing loss following staged auricle reconstruction and bonebridge implantation. Thirty-two patients, including 20 males and 12 females, with an average age of 11.8, who received surgical treatment in Peking Union Medical College Hospital (PUMCH) from March, 2016 to January, 2020 with bilateral microtia-atresia were included. Hearing thresholds, speech perception and high-resolution CT of the temporal bone were evaluated prior to surgery and individualized surgery plans (staged auricle reconstruction and bonebridge implantation) were made. Hearing thresholds and speech perception in quiet and noise (SNR = 5 dB) using unilateral Bonebridge were tested two weeks after the implantation surgery when the Bonebridge was activated and at 3, 6, 12 month after activation. Hearing thresholds and speech perception were also tested at least three months after the activation of the Bonebridge under three conditions: unaided, unilateral Bonebridge, and bilateral bone conduction hearing devices (Bonebridge plus contralateral ADHEAR). The international hearing aid assessment questionnaire (IOI-HA) and Glasgow children's benefit questionnaire were used to evaluate the subjective benefits of the patients. SPSS 21.0 software was used for statistical analysis. Among these 32 patients, nine were conducted Bonebridge implantation surgery before auricle reconstruction, six were simultaneously with auricle reconstruction and 17 were implanted after auricle reconstruction surgery. Compared with unaided, the mean hearing thresholds (0.5, 1, 2, and 4 kHz) and speech perception following unilateral BCHD and bilateral BCHD attachment were improved significantly (<0.05 each). The speech perceptin in noise of bilateral BCHD was better than unilateral (<0.05 each). The modified questionnaire revealed high levels of patient satisfaction following use of both unilateral and bilateral devices. Individulized surgical procedures involving auricle reconstruction and Bonebridge implantation are safe and effective for patients with bilateral microtia-atresia, solving both appearance and hearing problems. Speech perception in noise is better following bilateral BCHD than unilateral BCHD attachment.
评估分期耳廓再造和骨桥植入术后，单侧/双侧骨传导听力康复对双侧小耳畸形伴重度传导性听力损失患者的治疗效果。纳入2016年3月至2020年1月在北京协和医院接受手术治疗的32例双侧小耳畸形闭锁患者，其中男性20例，女性12例，平均年龄11.8岁。术前评估听力阈值、言语感知和颞骨高分辨率CT，并制定个体化手术方案（分期耳廓再造和骨桥植入）。植入手术两周后骨桥激活时、激活后3、6、12个月，使用单侧骨桥测试安静和噪声环境（信噪比=5dB）下的听力阈值和言语感知。在骨桥激活至少三个月后，在三种情况下测试听力阈值和言语感知：未佩戴辅助装置、单侧骨桥、双侧骨传导听力装置（骨桥加对侧ADHEAR）。使用国际助听器评估问卷（IOI-HA）和格拉斯哥儿童受益问卷评估患者的主观受益情况。采用SPSS 21.0软件进行统计分析。这32例患者中，9例在耳廓再造前进行了骨桥植入手术，6例与耳廓再造同时进行，17例在耳廓再造手术后植入。与未佩戴辅助装置相比，单侧骨传导听力装置和双侧骨传导听力装置佩戴后的平均听力阈值（0.5、1、2和4kHz）及言语感知均有显著改善（均P<0.05）。双侧骨传导听力装置在噪声环境下的言语感知优于单侧（均P<0.05）。改良问卷显示，使用单侧和双侧装置后患者满意度较高。涉及耳廓再造和骨桥植入的个体化手术对双侧小耳畸形闭锁患者安全有效，可同时解决外观和听力问题。双侧骨传导听力装置在噪声环境下的言语感知优于单侧骨传导听力装置佩戴。
