DPOAE部分异常患者人工耳蜗植入的ECAP研究
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摘要
目的:
通过对听力学检查表现为DPOAE部分异常而听性脑干反应ABR无波反应的患者行人工耳蜗术后NRT检测中ECAP的研究来探讨此类听力学特征是否为耳蜗伴有蜗后性聋的诊断依据,用MAIS评价这类患者人工耳蜗植入的效果。
方法:
采取回顾性病例对照研究的方法,在2002-2010年行人工耳蜗植入的226名患者中选取符合纳入和排除标准的DPOAE部分异常患者18例和DPOAE完全异常患者18例。分析DPOAE的引出情况,比较两组ECAP未引出率、ECAP阈值,及MAIS得分。
结果:
1、研究组A中患者的DPOAE有3个、4个及5个频率引出,引出的频率主要集中在中、高频区。
2、各电极ECAP未引出数比较,术中2号电极A组高于B组,差异有统计学意义(P<0.05)。总的ECAP未引出数比较,术中、开机、复诊及三次检测A组均高于B组,差异有统计学意义(P<0.05)。按直弯电极构成校正三次总ECAP未引出率,A组大于B组,差异有统计学意义(P<0.05)。A、B两组组内不同时间ECAP检出率比较,其中术中与开机、术中与复诊所得P<0.05差异均有统计学意义,但开机与复诊P>0.05差异均无统计学意义。各电极ECAP阈值比较,术中22号电极、复诊2、6、18、22号电极A组大于B组差异有统计学意义(P<0.05)。
3、MAIS得分比较,A、B两组3-10题得分术后均高于术前,差异有统计学意义(P<0.05)。A、B两组术后得分比较,差异无统计学意义P>0.05。
4、A1与B1、A2与B2、A与B的年龄比较,差异无统计学意义P>0.05。
结论:
DPOAE部分异常患者耳蜗外毛细胞有病变,但在中高频对应的耳蜗区域仍残存部分有功能的外毛细胞。在人工耳蜗植入候选患者中可能存在耳蜗与蜗后病变并存性耳聋,DPOAE部分异常(中高频正常)且ABR无波反应是这一类患者的诊断依据之一。本研究中DPOAE部分异常且ABR无波反应的患者其蜗后病变部位在螺旋神经节细胞或听神经或两者病变共存。本研究中DPOAE部分异常且ABR无波反应不可看做人工耳蜗植入的禁忌症,这类患者人工耳蜗植入效果良好,适宜行人工耳蜗植入。
Objective:
The purpose of this study was to explore the clinical diagnosis of the cochlear and retrocochlear damages through investigating the ECAP recorded in the NRT after implanting cochlear of the patients ,and evaluate the effect of cochlear implantation with MAIS ,whose major clinical manifestations of the hearing loss are severely abnormal ABR findings accompanied with partly abnormal DPOAE result.
Method:
This is a retrospective case control study. In 226 unilateral cochlear implantation patients between 2002 and 2010,18 cases with partly abnormal DPOAE result were enrolled in group A and 18 cases with completely abnormal DPOAE result were enrolled in group B. The responses of DPOAE were analyzed and the thresholds of DPOAE were compared among the group A and B. The responses of ECAP were analyzed and the thresholds of ECAP were compared among the group A and B. The score was compared among the group A and B.
Result:
1、The DPOAE results showed that intermediate frequency and high frequency were elicited in group A.
2、The non-eliciting rates in group A in intraoperative、initial stimulation、3 months after initial stimulation and 3 times were higher than in group B, and there were statistical significance between the two groups. In group A and B, the non-eliciting rates were different between surgery and initial stimulation、surgery and
3 months after initial stimulation, and there were statistical significance. But no significant differences of the non-eliciting rates were found between initial stimulation and 3 months after initial stimulation. There were not statistical significance in the difference of the non-eliciting rates of each electrode except the number 2 electrode intraoperative between the two groups. Except that the threshold means of electrode 10 in initial stimulation were similar, ECAP thresholds in group A were higher than in group B at each time point, and significant differences were found in electrode 22 intraoperative and electrodes 2、6、18、22 between the two groups.
3、The scores of questions 3-10 in group A and B at postoperation were higher than at preoperation, and there were statistical significance between the two times. At postoperation,the scores of questions 1-10 in group A were higher than in group B, and there were not statistical significance between the two times.
4、There were not statistical significance in the difference of the age between the two groups.
Conclusion:
There were damage in the cochlears of the patients whose DPOAE results show partly abnormal, but some out hear cells remained normal function. The cells were located in intermediate and high frequency corresponding cochlear area.The sensorineural deafness patients with cochlear impairment, some of which have retrocochlear auditory nerve impairment at the same time. The clinical features that DPOAE result shows partly abnormal and ABR result is severe abnormal provide an important proof for diagnosis of cochlear and retrocochlear damages. In this study, the main site of lesion of the patients with these features is in spiral ganglion or auditory nerve , or both of them.In this study, the effect of implanting cochlear to the patients with these features have no significant difference compared with cochlear damaged patients. These features are not the contraindication for implanting cochlear, and are the indication for it.
通过对听力学检查表现为DPOAE部分异常而听性脑干反应ABR无波反应的患者行人工耳蜗术后NRT检测中ECAP的研究来探讨此类听力学特征是否为耳蜗伴有蜗后性聋的诊断依据,用MAIS评价这类患者人工耳蜗植入的效果。
方法:
采取回顾性病例对照研究的方法,在2002-2010年行人工耳蜗植入的226名患者中选取符合纳入和排除标准的DPOAE部分异常患者18例和DPOAE完全异常患者18例。分析DPOAE的引出情况,比较两组ECAP未引出率、ECAP阈值,及MAIS得分。
结果:
1、研究组A中患者的DPOAE有3个、4个及5个频率引出,引出的频率主要集中在中、高频区。
2、各电极ECAP未引出数比较,术中2号电极A组高于B组,差异有统计学意义(P<0.05)。总的ECAP未引出数比较,术中、开机、复诊及三次检测A组均高于B组,差异有统计学意义(P<0.05)。按直弯电极构成校正三次总ECAP未引出率,A组大于B组,差异有统计学意义(P<0.05)。A、B两组组内不同时间ECAP检出率比较,其中术中与开机、术中与复诊所得P<0.05差异均有统计学意义,但开机与复诊P>0.05差异均无统计学意义。各电极ECAP阈值比较,术中22号电极、复诊2、6、18、22号电极A组大于B组差异有统计学意义(P<0.05)。
3、MAIS得分比较,A、B两组3-10题得分术后均高于术前,差异有统计学意义(P<0.05)。A、B两组术后得分比较,差异无统计学意义P>0.05。
4、A1与B1、A2与B2、A与B的年龄比较,差异无统计学意义P>0.05。
结论:
DPOAE部分异常患者耳蜗外毛细胞有病变,但在中高频对应的耳蜗区域仍残存部分有功能的外毛细胞。在人工耳蜗植入候选患者中可能存在耳蜗与蜗后病变并存性耳聋,DPOAE部分异常(中高频正常)且ABR无波反应是这一类患者的诊断依据之一。本研究中DPOAE部分异常且ABR无波反应的患者其蜗后病变部位在螺旋神经节细胞或听神经或两者病变共存。本研究中DPOAE部分异常且ABR无波反应不可看做人工耳蜗植入的禁忌症,这类患者人工耳蜗植入效果良好,适宜行人工耳蜗植入。
Objective:
The purpose of this study was to explore the clinical diagnosis of the cochlear and retrocochlear damages through investigating the ECAP recorded in the NRT after implanting cochlear of the patients ,and evaluate the effect of cochlear implantation with MAIS ,whose major clinical manifestations of the hearing loss are severely abnormal ABR findings accompanied with partly abnormal DPOAE result.
Method:
This is a retrospective case control study. In 226 unilateral cochlear implantation patients between 2002 and 2010,18 cases with partly abnormal DPOAE result were enrolled in group A and 18 cases with completely abnormal DPOAE result were enrolled in group B. The responses of DPOAE were analyzed and the thresholds of DPOAE were compared among the group A and B. The responses of ECAP were analyzed and the thresholds of ECAP were compared among the group A and B. The score was compared among the group A and B.
Result:
1、The DPOAE results showed that intermediate frequency and high frequency were elicited in group A.
2、The non-eliciting rates in group A in intraoperative、initial stimulation、3 months after initial stimulation and 3 times were higher than in group B, and there were statistical significance between the two groups. In group A and B, the non-eliciting rates were different between surgery and initial stimulation、surgery and
3 months after initial stimulation, and there were statistical significance. But no significant differences of the non-eliciting rates were found between initial stimulation and 3 months after initial stimulation. There were not statistical significance in the difference of the non-eliciting rates of each electrode except the number 2 electrode intraoperative between the two groups. Except that the threshold means of electrode 10 in initial stimulation were similar, ECAP thresholds in group A were higher than in group B at each time point, and significant differences were found in electrode 22 intraoperative and electrodes 2、6、18、22 between the two groups.
3、The scores of questions 3-10 in group A and B at postoperation were higher than at preoperation, and there were statistical significance between the two times. At postoperation,the scores of questions 1-10 in group A were higher than in group B, and there were not statistical significance between the two times.
4、There were not statistical significance in the difference of the age between the two groups.
Conclusion:
There were damage in the cochlears of the patients whose DPOAE results show partly abnormal, but some out hear cells remained normal function. The cells were located in intermediate and high frequency corresponding cochlear area.The sensorineural deafness patients with cochlear impairment, some of which have retrocochlear auditory nerve impairment at the same time. The clinical features that DPOAE result shows partly abnormal and ABR result is severe abnormal provide an important proof for diagnosis of cochlear and retrocochlear damages. In this study, the main site of lesion of the patients with these features is in spiral ganglion or auditory nerve , or both of them.In this study, the effect of implanting cochlear to the patients with these features have no significant difference compared with cochlear damaged patients. These features are not the contraindication for implanting cochlear, and are the indication for it.
引文
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