Department of Otolaryngology-Head and Neck Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong 30099, Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
Medicina (Kaunas). 2022 Oct 17;58(10):1474. doi: 10.3390/medicina58101474.
Background and Objectives: Many otologists face a dilemma in the decision-making process of surgical management of patients with cochlear nerve (CN) aplasia. The goal of this study is to provide fresh evidence on cochlear implantation (CI) results in patients with CN aplasia. Materials and Methods: We scrutinized functional outcomes in 37 ears of 21 children with bilateral CN aplasia who underwent unilateral or bilateral CI based on cross-sectional and longitudinal assessments. Results: The Categories of Auditory Performance (CAP) scores gradually improved throughout the 3-year follow-up; however, variable outcomes existed between individuals. Specifically, 90% of recipients with a 1-year postoperative CAP score ≤1 could not achieve a CAP score over 1 even at 3-year postoperative evaluation, while the recipients with a 1-year postoperative CAP score >1 had improved auditory performance, and 72.7% of them were able to achieve a CAP score of 4 or higher. Meanwhile, intraoperative electrically evoked compound action potential was not correlated with postoperative CAP score. Conclusions: Our results further refine previous studies on the clinical feasibility of CI as the first treatment modality to elicit favorable auditory performance in children with CN aplasia. However, special attention should be paid to pediatric patients with an early postoperative CAP score ≤1 for identification of unsuccessful cochlear implants and switching to auditory brainstem implants.
许多耳科医生在处理蜗神经（CN）发育不全患者的手术管理决策过程中面临两难境地。本研究旨在为 CN 发育不全患者的人工耳蜗植入（CI）结果提供新的证据。
我们对 21 例双侧 CN 发育不全儿童的 37 耳进行了功能评估，这些儿童根据横断面和纵向评估进行单侧或双侧 CI。
3 年随访期间， Categories of Auditory Performance（CAP）评分逐渐提高；但个体之间存在不同的结果。具体而言，术后 1 年 CAP 评分≤1 的患者中，90%的患者即使在术后 3 年评估时也无法获得 CAP 评分>1，而术后 1 年 CAP 评分>1 的患者的听觉表现有所改善，其中 72.7%的患者能够达到 CAP 评分 4 或更高。同时，术中电诱发复合动作电位与术后 CAP 评分无相关性。
我们的结果进一步完善了先前关于 CI 作为 CN 发育不全儿童的首选治疗方式以获得良好听觉表现的临床可行性的研究。然而，对于术后 CAP 评分≤1 的儿科患者，应特别注意识别不成功的人工耳蜗植入，并切换至听觉脑干植入。
