Müller-Deile J, Rudert H, Brademann G, Frese K
Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Christian-Albrechts-Universität zu Kiel.
Laryngorhinootologie. 1998 Mar;77(3):136-43. doi: 10.1055/s-2007-996948.
Cochlear implants have proven to be the method of choice for postlingually deafened adults. The great success of this application requires discussion of the degree in which the indication for cochlear implantation should be expanded to include patients with residual hearing.
Following an initial discussion of the term deafness, we present the preoperative and postoperative results in five patients with residual hearing. These patients achieve a certain degree of speech recognition with their well fitted hearing aids. However, their aided speech intelligibility did not exceed 30% with the standardized Freiburg monosyllabic word test at 70 dB. In each case the worse hearing ear was treated with a cochlear implant. Speech discrimination in silence and noise are compared with the results of a group of postlingually deafened cochlear implant patients.
The five patients are very satisfied with the cochlear implant and use the telephone to communicate with unknown partners. They score 100% in the standardized four-syllable number test above 55 dB and they document a loss of speech discrimination between 0 and 25% within the open-set monosyllabic word test. The mean increase of best monosyllable intelligibility by the cochlear implant over the hearing aids is 65%. Using the innsbruck sentence test the patients score 100% at 70 dB; with the Göttingen sentence test, the mean result is 75%. Their mean results in noise are also very good, 76% at 10 dBS/N and 57% at 5 dBS/N respectively. None of these patients use the hearing aid on the untreated, better hearing ear.
A multichannel cochlear implant lead to a significant improvement of speech comprehension in these patients with residual hearing. We can successfully implant patients with minimal benefit of their well fitted hearing aids. Our group is too small to be able to define general selection criteria. For the time being we use as an audiological indication a open-set monosyllabic word intelligibility of not more than 30% at 70 dB with well fitted hearing aids.
人工耳蜗已被证明是语后聋成年人的首选治疗方法。这种应用的巨大成功需要讨论将人工耳蜗植入适应症扩大到有残余听力患者的程度。
在初步讨论耳聋这一术语后，我们展示了5例有残余听力患者的术前和术后结果。这些患者使用适配良好的助听器能达到一定程度的言语识别。然而，在70分贝时，使用标准化的弗莱堡单音节词测试，他们佩戴助听器后的言语可懂度不超过30%。在每种情况下，听力较差的耳朵接受了人工耳蜗植入。将安静和噪声环境下的言语辨别结果与一组语后聋人工耳蜗植入患者的结果进行比较。
这5例患者对人工耳蜗非常满意，并使用电话与陌生人交流。在55分贝以上的标准化四音节数字测试中，他们的得分是100%，并且在开放式单音节词测试中，他们记录的言语辨别损失在0到25%之间。人工耳蜗相比助听器，单音节最佳可懂度的平均提高幅度为65%。使用因斯布鲁克句子测试时，患者在70分贝时的得分是100%；使用哥廷根句子测试时，平均结果是75%。他们在噪声环境下的平均结果也非常好，在信噪比为10分贝时为76%，在信噪比为5分贝时为57%。这些患者中没有一人在未治疗的、听力较好的耳朵上使用助听器。
多通道人工耳蜗使这些有残余听力的患者的言语理解能力得到显著改善。我们能够成功地为佩戴适配良好的助听器但获益极小的患者植入人工耳蜗。我们的样本量太小，无法确定通用的选择标准。目前，我们将在70分贝时佩戴适配良好的助听器，开放式单音节词可懂度不超过30%作为听力学适应症。
