Luo J F, Chao X H, Wang R J, Liu X M, Xu Q A, Fan Z M, Xu L, Wang H B
Department of Otolaryngology Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250022, China Department of Auditory Implantation, Shandong Provincial ENT Hospital, Jinan 250022, China Shandong Provincial Institute of Otolaryngology, Jinan 250022, China Shandong Provincial Hearing and Balance Medical Engineering Laboratory, Jinan 250022, China.
Department of Otolaryngology Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250022, China Shandong Provincial Institute of Otolaryngology, Jinan 250022, China Shandong Provincial Hearing and Balance Medical Engineering Laboratory, Jinan 250022, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Dec 7;56(12):1283-1291. doi: 10.3760/cma.j.cn115330-20210126-00038.
To analyze the temporal bone CT and inner ear magnetic resonance imaging characteristics of cochlear implant patients with no cochlear nerve display in the inner auditory canal under MRI. To retrospectively analyze the long-term hearing and speech rehabilitation effects of such patients after cochlear implant. And to analyze the correlation between the results of imaging examinations and the postoperative effects of cochlear implant patients with this type of cochlear nerve deficiency. A total of 88 children with cochlear nerve deficiency, who underwent cochlear implantation in Shandong Provincial ENT Hospital from May 2014 to October 2018, were enrolled. Patients with cochlear malformations were excluded,only the patients with cochlear nerve deficiency whose cochlear structure was normal and no cochlear nerve displayed in inner auditory canal under MRI were enrolled. There were 64 patients, including 4 bilaterally implanted, 68 ears in total, with an average age of (2.8±1.7) years (range 1-6 years) at the time of implantation. The implanted product was Cochlear, including 24RECA and 512 models. All patients underwent inner ear magnetic resonance imaging and temporal bone CT scan before operation. Auditory speech function assessments were performed at 12 months, 24 months, and 36 months after surgery, including categories of auditory performance (CAP), speech intelligibility rating (SIR) and hearing aid threshold test. The imaging evaluation content included the width of the cochlear nerve canal of temporal bone CT, the width of the internal auditory canal, the width of the auditory nerve at the cerebellopontine angle of the inner ear MRI, and the ratio of the facial nerve to the width of the auditory nerve at the cerebellopontine angle. The correlations between the results of postoperative hearing aid hearing threshold, CAP, SIR and imaging results were analyzed. Among the 64 cases of cochlear nerve not shown under MRI, 56 ears with CT data showed that the width of the cochlear nerve canal in temporal bone CT was (0.72±0.30) mm (mean±standard deviation, the same below), and the width of the internal auditory canal was (4.07±1.10) mm; 66 ears with MRI data showed that the diameter of the auditory nerve at the cerebellopontine angle of the inner ear MRI was (1.58±0.27) mm, the diameter of the facial nerve was (1.57±0.27) mm, and the ratio of the diameter of the facial nerve to the auditory nerve was (1.02±0.23). The average hearing thresholds at 12, 24, and 36 months after surgery were (46.8±2.5) dB HL, (40.7±0.8) dB HL, and (36.8±1.5) dB HL, respectively. The preoperative and postoperative CAP scores at 12, 24 and 36 months were (1.0±1.0), (3.8±1.4), (4.5±1.4) and (5.1±0.7) points, respectively. The preoperative and postoperative SIR scores at 12, 24, and 36 months were (1.1±0.3), (1.9±0.9), (2.5±0.9), and (2.9±0.6) points, respectively. The hearing threshold at 24 months after surgery was negatively correlated with the width of the internal auditory canal of temporal bone CT (=-0.349, =0.037), and the hearing threshold at 36 months after surgery was positively correlated with the ratio of the diameter of the facial nerve to the auditory nerve at the cerebellopontine angle of the inner ear MRI (=0.740, =0.001). Children with cochlear implants whose cochlear nerves are not shown on MRI can benefit from cochlear implantation, and their speech and auditory functions can improve significantly after surgery. The width of the internal auditory canal in the temporal bone CT and the ratio of the diameter of the facial nerve to the auditory nerve at the cerebellopontine angle of the inner ear MRI may be related to the long-term hearing threshold after surgery.
分析磁共振成像（MRI）显示内耳道无蜗神经显示的人工耳蜗植入患者的颞骨CT及内耳磁共振成像特征。回顾性分析此类患者人工耳蜗植入后的长期听力及言语康复效果。并分析影像学检查结果与此类蜗神经缺如的人工耳蜗植入患者术后效果的相关性。选取2014年5月至2018年10月在山东省耳鼻喉医院行人工耳蜗植入的88例蜗神经缺如患儿。排除耳蜗畸形患者，仅纳入蜗神经缺如且耳蜗结构正常、MRI显示内耳道无蜗神经显示的患者。共64例，其中双侧植入4例，共68耳，植入时平均年龄为（2.8±1.7）岁（范围1 - 6岁）。植入产品为科利耳公司产品，包括24RECA和512型号。所有患者术前均行内耳磁共振成像及颞骨CT扫描。术后12个月、24个月和36个月进行听觉言语功能评估，包括听觉表现类别（CAP）、言语可懂度评分（SIR）及助听阈值测试。影像学评估内容包括颞骨CT蜗神经管宽度、内耳道宽度、内耳MRI桥小脑角处听神经宽度及面神经与桥小脑角处听神经宽度比值。分析术后助听阈值、CAP、SIR结果与影像学结果的相关性。64例MRI显示无蜗神经的病例中，56耳有CT数据，颞骨CT蜗神经管宽度为（0.72±0.30）mm（均值±标准差，下同），内耳道宽度为（4.07±1.10）mm；66耳有MRI数据，内耳MRI桥小脑角处听神经直径为（1.58±0.27）mm，面神经直径为（1.57±0.27）mm，面神经与听神经直径比值为（1.02±0.23）。术后12个月、24个月和36个月的平均听阈值分别为（46.8±2.5）dB HL、（40.7±0.8）dB HL和（36.8±1.5）dB HL。术后12个月、24个月和36个月的术前及术后CAP评分分别为（1.0±1.0）、（3.8±1.4）、（4.5±1.4）和（5.1±0.7）分。术后12个月、24个月和36个月的术前及术后SIR评分分别为（1.1±0.3）、（1.9±0.9）、（2.5±0.9）和（2.9±0.6）分。术后24个月听阈值与颞骨CT内耳道宽度呈负相关（r = -0.349，P = 0.037），术后36个月听阈值与内耳MRI桥小脑角处面神经与听神经直径比值呈正相关（r = 0.740，P = 0.001）。MRI显示无蜗神经的人工耳蜗植入患儿可从人工耳蜗植入中获益，术后其言语及听觉功能可显著改善。颞骨CT内耳道宽度及内耳MRI桥小脑角处面神经与听神经直径比值可能与术后长期听阈值有关。
