發(fā)布時間：2018-06-06 11:41

  本文選題：人工耳蝸植入 + 重度感音神經(jīng)性耳聾��； 參考：《中南大學》2010年碩士論文

【摘要】： 目的通過對湘雅醫(yī)院接受人工耳蝸植入患者臨床資料的回顧性分析,探討人工耳蝸植入術(shù)在聾啞癥合并中耳炎、大前庭水管綜合征,及腦白質(zhì)發(fā)育不良的臨床應用。 數(shù)據(jù)與方法對湘雅醫(yī)院2002年1月至2010年3月接受人工耳蝸植入的124例患者進行回顧性分析,CT發(fā)現(xiàn)慢性分泌性中耳炎9例,大前庭水管綜合征(LVAS)6例；MRI發(fā)現(xiàn)腦白質(zhì)發(fā)育不良5例；其中男11例,女9例,年齡1歲-8歲。在104例單純聾啞癥患者中抽取20例,做為對照,評估有合并癥患者的術(shù)后康復效果；其中男13例,女7例,年齡1歲-9歲。術(shù)前行臨床醫(yī)學、影像學、聽力學、助聽器效果、語言能力等各方面評估。40例患者均經(jīng)乳突后鼓室面神經(jīng)隱窩入路行工期人工耳蝸植入,均采用澳大利亞Cochlear公司CI24型人工耳蝸裝置,術(shù)中行阻抗測試及神經(jīng)反應遙測(NRT)。術(shù)后三天行耳蝸拍片,術(shù)后一個月開機調(diào)試。術(shù)后隨訪一年電極阻抗、言語識別率等康復指標。 結(jié)果此40例患者均為語前聾；術(shù)前腦干誘發(fā)電位(ABR)、多頻穩(wěn)態(tài)誘發(fā)電位(ASSR)、畸變產(chǎn)物耳聲發(fā)射(DPOAE)證實40例患者均為極重度感音神經(jīng)性聾。40例患者全部成功完成I期人工耳蝸植入術(shù),耳蝸造孔及電極插入順利,術(shù)中測試電極阻抗及NRT均良好。9例聾啞癥合并慢性分泌性中耳炎患者,術(shù)中可見乳突小房及鼓室粘膜增厚,其內(nèi)可見淡黃色膠凍樣分泌物。6例LVAS患者,術(shù)中均發(fā)生鐙井噴,電極插入順利,用軟組織封閉后井噴停止。5例腦白質(zhì)發(fā)育不良患者,術(shù)中無特殊發(fā)現(xiàn)。所有病例未發(fā)生并發(fā)癥；術(shù)后三天行耳蝸拍片,均顯示電極在耳蝸內(nèi)；術(shù)后一個月開機調(diào)試,均有聽覺反應。術(shù)后隨訪未發(fā)現(xiàn)耳部炎性并發(fā)癥及其它并發(fā)癥；患者康復良好,有合并癥的耳蝸植入者的電極阻抗值及言語識別率,與單純聾啞癥患者無統(tǒng)計學差異。 結(jié)論聾啞癥合并慢性分泌性中耳炎及大前庭水管綜合癥并不是人工耳蝸植入的禁忌證,但慢性分泌性中耳炎患者圍術(shù)期應加強觀察和預防感染；大前庭水管綜合癥患者術(shù)中遇“鐙井噴”,恰當處理不影響電極植入。短期來看,腦白質(zhì)發(fā)育不良并未影響聾啞癥患者人工耳蝸植入術(shù)后康復效果,但其長期是否影響患者的智力、語言發(fā)育,應視腦白質(zhì)發(fā)育不良本身的病變而定。
[Abstract]:Objective to analyze retrospectively the clinical data of cochlear implants in Xiangya Hospital, and to explore the application of cochlear implantation in deaf-mutism complicated with otitis media and vestibular aqueduct syndrome. Data and methods 124 patients received cochlear implant in Xiangya Hospital from January 2002 to March 2010 were analyzed retrospectively and 9 cases of chronic secretory otitis media were found by CT. Six patients with large vestibular aqueduct syndrome (LVASS) were diagnosed by MRI in 5 patients, including 11 males and 9 females aged 1-8 years. Twenty of 104 patients with simple deaf-mutism were selected as control group to evaluate the postoperative rehabilitation effect of patients with complications, including 13 males and 7 females, aged 1-9 years. Preoperative evaluation of clinical medicine, imaging, audiology, hearing aid, speech ability and other aspects. 40 patients underwent cochlear implantation through the posterior tympanic recess. All patients were treated with cochlear CI24 cochlear implant in Australia. Impedance test and nerve response telemetry were performed during the operation. Cochlear film was taken 3 days after operation, and the machine was debugged one month after operation. One year after operation, the electrode impedance, speech recognition rate and other rehabilitation indexes were followed up. Results all the 40 patients were prelingual deafness. Preoperative brainstem evoked potential (ABR), multi-frequency steady-state evoked potential (ASSR), distortion product otoacoustic emission (DPOAE) confirmed that all 40 patients with extremely severe sensorineural deafness underwent stage I cochlear implantation successfully, cochlear foramen and electrode insertion were successful. The electrode impedance and NRT were good in 9 cases of deaf-mutism complicated with chronic secretory otitis media. The mucosal thickening of mastoid chamber and tympanic chamber was observed during the operation. There were 6 cases of LVAS with light yellow gelatinous secretions. The stirrup blowout occurred during the operation. The electrode was inserted smoothly and the blowout stopped in 5 patients with leukoplasia after soft tissue sealing. No special findings were found during the operation. There were no complications in all cases. Cochlea film was taken 3 days after operation and the electrode was found in the cochlea. No postoperative inflammatory and other complications were found, and the electrode impedance and speech recognition rate of cochlear implants with complicated cochlear implantation were well recovered. Conclusion chronic secretory otitis media and large vestibular aqueduct syndrome are not contraindication for cochlear implantation. However, the patients with chronic secretory otitis media should strengthen observation and prevention of infection during perioperative period, and the patients with large vestibular aqueduct syndrome should be treated properly with stirrup blowout during operation, and the electrode implantation should not be affected by proper treatment. In the short term, leukoplasia does not affect the rehabilitation effect of cochlear implantation in deaf and mute patients, but whether it affects the patient's intelligence and language development in the long run should depend on the lesion of leukoplasia itself.
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R764

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本文編號：1986400