Nedzelski J M, Chiong C M, Cashman M Z, Stanton S G, Rowed D W
Department of Otolaryngology, Sunnybrook Health Science Center, University of Toronto.
Otolaryngol Head Neck Surg. 1994 Dec;111(6):703-9. doi: 10.1177/019459989411100602.
This study reviews the hearing results in 80 consecutive patients who underwent complete removal of histologically proven acoustic neuromas by use of the suboccipital approach. Of these, 56 patients had successful monitoring of cochlear compound action potentials; 20 were not monitored because their surgery predated monitoring; and 4 had unsuccessful monitoring. A significant difference was found in hearing preservation rates between the group in whom compound action potential monitoring was performed and those in whom monitoring was either unavailable or failed (p = 0.02). Overall, 38% (30 of 80) had preserved hearing. There were 51 patients in whom the click threshold for the cochlear compound action potential was measured during surgery. Twenty-one patients had a threshold shift of 20 dB or less, 15 (71%) of these retained serviceable hearing (speech reception threshold < or = 50 dB; speech discrimination score > or = 60%). Of 12 patients in whom the threshold shift was 30 to 60 dB, none had serviceable hearing after surgery. The click threshold shift was predictive of a significant postoperative hearing change (p < 0.001).
本研究回顾了80例连续接受经枕下入路完全切除组织学证实的听神经瘤患者的听力结果。其中，56例患者成功监测了耳蜗复合动作电位；20例因手术时间早于监测而未监测；4例监测未成功。在进行复合动作电位监测的组与未进行监测或监测失败的组之间，听力保留率存在显著差异（p = 0.02）。总体而言，38%（80例中的30例）保留了听力。有51例患者在手术期间测量了耳蜗复合动作电位的短声阈值。21例患者的阈值偏移在20 dB或更小，其中15例（71%）保留了有用听力（言语接受阈值≤50 dB；言语辨别得分≥60%）。在阈值偏移为30至60 dB的12例患者中，术后均无有用听力。短声阈值偏移可预测术后明显的听力变化（p < 0.001）。
