成人语前聋和语后聋人工耳蜗植入效果分析
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摘要
目的分析成人人工耳蜗植入术后听觉及言语康复效果情况,探讨成人行人工耳蜗植入适应症的选择。方法对中国医科大学附属第一医院耳鼻咽喉科收治的18岁以上行人工耳蜗植入术患者52例进行测试,分为语前聋无干预组(9例)、语前聋佩戴助听器组(27例)、语后聋(16例)三组。采用声场助听听阈测试、电刺激听觉反应阈值(Threshold,THR)、最大舒适阈值(Maximum comfort level,MCL)评价其声音感知能力;采用普通话言语测听材料MSTMs中双音节词表评价其言语分辨能力。分别在开机6个月及24个月进行评估。结果开机6个月后三组声场助听阈值、THR、MCL均值无统计学差异。双音节识别率在开机6个月时语前聋无干预组8.78%、语前聋助听器组16.44%、语后聋组53.13%;在开机24个月时各组双音节识别率均上升,语前聋无干预组达18.22%、语前聋助听器组达52.89%、语后聋组达84.31%,语前聋助听器组提高明显。结论成人语前聋患者术后可获得与语后聋相近的听觉感知水平,长期使用人工耳蜗可加强言语识别能力,对术前有听觉言语基础的成人语前聋患者应积极行人工耳蜗植入术。
Objective To report hearing and speech rehabilitation outcomes after cochlear implantation in adults and discuss indication selection in this patient population. Methods Fifty two patients over 18 years who underwent cochlear implantation in the Department of Otolaryngology, First Hospital of China Medical University were enrolled, including 9 with prelingual deafness without intervention, 27 with prelingual deafness and use of hearing aids, and 16 with postlingual deafness. Sound field audiometry, electrical stimulation auditory response threshold(THR) and maximum comfort level(MCL) were used to evaluate sound perception. Speech discrimination ability was evaluated using the two-syllable MSTMs word list. Evaluation was performed at 6 months and 24 months after surgery. Results There were no statistical differences in sound field threshold, THR and MCL at 6 months after surgery among the three patient groups. The word recognition rate was 8.78% in the non-intervention prelingual deafness group, 16.44% in the hearing aided prelingual deafness group and 53.13% in the postlingual deafness group at 6 months after surgery. At 24 months after surgery, the word recognition rate in each group increased(18.22%, 52.89% and 84.31% in the three groups, respectively). The improvement was most significant for the hearing aided prelingual deafness group. Conclusion Adult patients with prelingual deafness can obtain auditory perception ability similar to those with postlingual deafness after cochlear implantation. Long-term use of cochlear implant can enhance speech recognition ability. Cochlear implant should be actively performed on adult patients with prelingual deafness and preoperative auditory and speech experiences.
Objective To report hearing and speech rehabilitation outcomes after cochlear implantation in adults and discuss indication selection in this patient population. Methods Fifty two patients over 18 years who underwent cochlear implantation in the Department of Otolaryngology, First Hospital of China Medical University were enrolled, including 9 with prelingual deafness without intervention, 27 with prelingual deafness and use of hearing aids, and 16 with postlingual deafness. Sound field audiometry, electrical stimulation auditory response threshold(THR) and maximum comfort level(MCL) were used to evaluate sound perception. Speech discrimination ability was evaluated using the two-syllable MSTMs word list. Evaluation was performed at 6 months and 24 months after surgery. Results There were no statistical differences in sound field threshold, THR and MCL at 6 months after surgery among the three patient groups. The word recognition rate was 8.78% in the non-intervention prelingual deafness group, 16.44% in the hearing aided prelingual deafness group and 53.13% in the postlingual deafness group at 6 months after surgery. At 24 months after surgery, the word recognition rate in each group increased(18.22%, 52.89% and 84.31% in the three groups, respectively). The improvement was most significant for the hearing aided prelingual deafness group. Conclusion Adult patients with prelingual deafness can obtain auditory perception ability similar to those with postlingual deafness after cochlear implantation. Long-term use of cochlear implant can enhance speech recognition ability. Cochlear implant should be actively performed on adult patients with prelingual deafness and preoperative auditory and speech experiences.
引文
1 De Raeve L.A longitudinal study on auditory perception and speech intelligibility in deaf children implanted younger than 18months in comparison to those implanted at later ages[J].Otol Neurotol,2010,31(8):1261-1267.
2 Galvin KL,Hughes KC,Mok M.Can adolescents and young adults with prelingual hearing loss benefit from a second,sequential cochlear implant[J].Int JAudiol,2010,49(5):368-377.
3田芳洁,李雪盛,李进让,等.近20年人工耳蜗研究的发展趋势[J].空军医学杂志,2017,33(4):286-288.Tian FJ,Li XS,Li JR,et al.The development trend of cochlear implant research in recent 20 years[J].Medical Journal of Air Force,2017,33(4):286-288.
4中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会,中国残疾人康复协会听力语言康复专业委员会.人工耳蜗植入工作指南(2013)[J].中华耳鼻咽喉头颈外科杂志,2014,49(2):89-95.Chinese Medical Association,otorhinolaryngology head and neck surgery branch.Cochlear implant guidelines(2013)[J].China J Otorhinolaryngol Head Neck Surg,2014,(2):89-95.
5 Moore JK,Guan YL.Cytoarchitectural and axonal maturation in human auditory cortex[J].J Assoc Res Otolaryngol,2001,2(4):297-311.
6 Teoh SW,Pisoni DB,Miyamoto RT.Cochlear implantation in adults with prelingual deafness.Part II.Underlying constraints that affect audiological outcomes[J].Laryngoscope,2004,114(10):1714-1719.
7 Sharma A,Campbell J,Cardon G.Developmental and cross-modal plasticity in deafness:evidence from the P1 and N1 event related potentials in cochlear implanted children[J].Int J Psychophysiol,2015,95(2):135-144.
8 Fallon JB,Irvine DR,Shepherd RK.Cochlear implants and brain plasticity[J].Hear Res,2008,238(1):110-117.
9 Kral A,Hartmann R,Tillein J,et al.Delayed maturation and sensitive periods in the auditory cortex[J].Audiol Neurootol,2001,6(6):346-362.
10 Harrison RV,Gordon KA,Mount RJ.Is there a critical period for cochlear implantation in congenitally deaf children?Analyses of hearing and speech perception performance after implantation[J].Dev Psychobiol,2005,46(3):252-261.
11李佳楠,郗昕,洪梦迪,等.语后聋患者多通道人工耳蜗植入后听觉效果分析[J].临床耳鼻咽喉头颈外科杂志,2010,24(13):580-582.LI JN,XI X,HONG MD,et al.Study of aural rehabilitation in post-l ingual deafened patients with multi-channel cochlear implant[J].Clin Ot orhinolaryngol Head Neck Su rg(China),2010,24(13):580-582.
12刁明芳,孙建军,林勇生,等.老年语后聋患者人工耳蜗植入的听觉康复效果分析[J].中华耳科学杂志,2016,14(6):759-763.DIAO MF,SUN JJ,LIN Y,et al.Auditory performance outcomes in the elderly following cochlear implantation[J].Chinese Journal of Otology,2016,14(6):759-763.
13王力福,沈美勤,赵金花.老年语后聋患者人工耳蜗植入效果评价[J].西部医学,2015,27(11):1702-1704.Wang LF,Shen MQ,Zhao JH.Evaluation of cochlear implants of elderly postlingually deaf patient[J].Med J West China,2015,27(11):1702-1704.
14 Javakody DM,Friedland PL,Nel E,et al.Impact of Cochlear Implantation on Cognitive Functions of Older Adults:Pilot Test Results[J].Otol Neurotol,2017,38(8):289-295.
15 Roberts DS,Lin HW,Herrmann BS,et al.Differentialcochlear implant outcomes in older adults[J].Laryngoscope,2013,123(8):1952-1956.
16 Hilly O,Hwang E,Smith L,et al.Cochlear implantation in elderly patients:stability of outcome over time[J].Journal of Laryngology&Otology,2016,130(8):706-711.
17冯永.大龄语前聋患者的人工耳蜗植入-一个不容忽略的群体[J].中国耳鼻咽喉颅底外科杂志,2015,21(3):175-177.Feng Y.Cochlear implantation in elderly patients with prelingual deafness-a population that should not be neglected[J].Chinese Journal of Otorhinolaryngology-Skull Base Surgery,2015,21(3):175-177.
2 Galvin KL,Hughes KC,Mok M.Can adolescents and young adults with prelingual hearing loss benefit from a second,sequential cochlear implant[J].Int JAudiol,2010,49(5):368-377.
3田芳洁,李雪盛,李进让,等.近20年人工耳蜗研究的发展趋势[J].空军医学杂志,2017,33(4):286-288.Tian FJ,Li XS,Li JR,et al.The development trend of cochlear implant research in recent 20 years[J].Medical Journal of Air Force,2017,33(4):286-288.
4中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会,中国残疾人康复协会听力语言康复专业委员会.人工耳蜗植入工作指南(2013)[J].中华耳鼻咽喉头颈外科杂志,2014,49(2):89-95.Chinese Medical Association,otorhinolaryngology head and neck surgery branch.Cochlear implant guidelines(2013)[J].China J Otorhinolaryngol Head Neck Surg,2014,(2):89-95.
5 Moore JK,Guan YL.Cytoarchitectural and axonal maturation in human auditory cortex[J].J Assoc Res Otolaryngol,2001,2(4):297-311.
6 Teoh SW,Pisoni DB,Miyamoto RT.Cochlear implantation in adults with prelingual deafness.Part II.Underlying constraints that affect audiological outcomes[J].Laryngoscope,2004,114(10):1714-1719.
7 Sharma A,Campbell J,Cardon G.Developmental and cross-modal plasticity in deafness:evidence from the P1 and N1 event related potentials in cochlear implanted children[J].Int J Psychophysiol,2015,95(2):135-144.
8 Fallon JB,Irvine DR,Shepherd RK.Cochlear implants and brain plasticity[J].Hear Res,2008,238(1):110-117.
9 Kral A,Hartmann R,Tillein J,et al.Delayed maturation and sensitive periods in the auditory cortex[J].Audiol Neurootol,2001,6(6):346-362.
10 Harrison RV,Gordon KA,Mount RJ.Is there a critical period for cochlear implantation in congenitally deaf children?Analyses of hearing and speech perception performance after implantation[J].Dev Psychobiol,2005,46(3):252-261.
11李佳楠,郗昕,洪梦迪,等.语后聋患者多通道人工耳蜗植入后听觉效果分析[J].临床耳鼻咽喉头颈外科杂志,2010,24(13):580-582.LI JN,XI X,HONG MD,et al.Study of aural rehabilitation in post-l ingual deafened patients with multi-channel cochlear implant[J].Clin Ot orhinolaryngol Head Neck Su rg(China),2010,24(13):580-582.
12刁明芳,孙建军,林勇生,等.老年语后聋患者人工耳蜗植入的听觉康复效果分析[J].中华耳科学杂志,2016,14(6):759-763.DIAO MF,SUN JJ,LIN Y,et al.Auditory performance outcomes in the elderly following cochlear implantation[J].Chinese Journal of Otology,2016,14(6):759-763.
13王力福,沈美勤,赵金花.老年语后聋患者人工耳蜗植入效果评价[J].西部医学,2015,27(11):1702-1704.Wang LF,Shen MQ,Zhao JH.Evaluation of cochlear implants of elderly postlingually deaf patient[J].Med J West China,2015,27(11):1702-1704.
14 Javakody DM,Friedland PL,Nel E,et al.Impact of Cochlear Implantation on Cognitive Functions of Older Adults:Pilot Test Results[J].Otol Neurotol,2017,38(8):289-295.
15 Roberts DS,Lin HW,Herrmann BS,et al.Differentialcochlear implant outcomes in older adults[J].Laryngoscope,2013,123(8):1952-1956.
16 Hilly O,Hwang E,Smith L,et al.Cochlear implantation in elderly patients:stability of outcome over time[J].Journal of Laryngology&Otology,2016,130(8):706-711.
17冯永.大龄语前聋患者的人工耳蜗植入-一个不容忽略的群体[J].中国耳鼻咽喉颅底外科杂志,2015,21(3):175-177.Feng Y.Cochlear implantation in elderly patients with prelingual deafness-a population that should not be neglected[J].Chinese Journal of Otorhinolaryngology-Skull Base Surgery,2015,21(3):175-177.