本文選題：人工耳蝸植入 + 前庭功能檢查��； 參考：《福建醫(yī)科大學》2010年碩士論文

【摘要】： 目的 探討人工耳蝸植入術對前庭功能的影響。 患者與方法 本研究入選對象為2001年至2009年于福建醫(yī)科大學附屬第一醫(yī)院耳鼻咽喉科由同一術者行人工電子耳蝸植入術,術后6個月以上,并于2009年11月至2010年1月期間于我科隨訪,現(xiàn)年齡大于6歲的患者。排除1例非前庭因素自行放棄使用人工耳蝸者,共有12例患者參與本項研究。應用視頻眼震電圖儀常規(guī)進行自發(fā)眼震和雙耳變溫冷熱試驗,并結合前庭誘發(fā)肌源性電位檢查進行前庭功能檢測。以P13、N23波潛伏期與振幅,半規(guī)管輕癱與方向,優(yōu)勢偏向值與方向,自發(fā)性眼震的強度與方向為評定指標。 結果 12例患者中1人術前伴有眩暈術后眩暈消失,2人術前術后均有眩暈,主觀眩暈癥狀出現(xiàn)率16.67%,VEMP異常率66.67%,雙耳變溫冷熱試驗異常率100%。 患者行VEMP檢查,雙側短純音刺激P13波和N23波出現(xiàn)率為50%(6/12),誘發(fā)出波形的手術耳組P13潛伏期與非手術耳組相比,兩者無明顯差異(P0.05),手術耳組N23潛伏期與非手術耳組相比,兩者無明顯差異(P0.05),△P13-N23手術耳組與非手術耳組相比,兩者無明顯差異(t=0.009,P0.05);手術耳組振幅低于非手術耳組振幅,差值具有統(tǒng)計學意義(t=3.75, P0.05)。 12人中41.67%的患者(5/12)出現(xiàn)雙側半規(guī)管輕癱,58.33%的患者(7/12)出現(xiàn)單側迷路反應減弱,41.67%的患者(5/12)出現(xiàn)優(yōu)勢偏向。 結論 1.人工耳蝸植入術后前庭功能檢查異常不一定出現(xiàn)臨床平衡障礙。 2.人工耳蝸植入術后主觀性眩暈出現(xiàn)率低于前庭功能檢查異常率可能與前庭代償有關。 3.人工耳蝸植入術前伴有前庭功能障礙的患者術后容易出現(xiàn)主觀性眩暈。 4.內(nèi)耳畸形患者人工耳蝸植入術后前庭功能檢查異常率高于內(nèi)耳正常患者。 5.人工耳蝸植入術后可通過VEMP檢查和雙耳變溫冷熱試驗檢查來判斷患者術后球囊和水平半規(guī)管的功能,人工耳蝸植入術對VEMP的傳導并無影響,但可造成手術耳VEMP的振幅下降,可能與人工耳蝸植入術的手術刺激或長期的電極植入對球囊功能的影響有關;手術耳容易出現(xiàn)水平半規(guī)管功能減弱,對側優(yōu)勢偏向,優(yōu)勢偏向的出現(xiàn)可能與位置性眼震和電極長期安置造成的前庭損傷有關。 6.前庭功能檢查可廣泛運用于人工耳蝸植入術前、術后的前庭評估。
[Abstract]:Objective to investigate the effect of cochlear implantation on vestibular function. Methods from 2001 to 2009, cochlear implant was performed in the Department of Otorhinolaryngology, the first affiliated Hospital of Fujian Medical University. From November 2009 to January 2010, we followed up the patients over 6 years old. A total of 12 patients took part in the study, excluding one case of non-vestibular factors voluntarily abandoning the use of cochlear implants. The spontaneous nystagmus and binaural temperature change cold and hot tests were carried out by video nystagmography, and vestibular function was detected with vestibular evoked myogenic potential (VEMP). The latent period and amplitude of P13 N23 wave, semicircular canal paresis and direction, dominant deviation value and direction, intensity and direction of spontaneous nystagmus were taken as the evaluation index. Results one patient with vertigo disappeared before operation and two patients had vertigo before and after operation. The occurrence rate of subjective vertigo symptom was 16.67 and the abnormal rate of VEMP was 66.67. The abnormal rate of bilateral ear warming test was 100. The frequency of P13 and N23 waves of bilateral short tone stimulation was 50% (6 / 12). There was no significant difference in P13 latency between the operation group and the non-operative ear group (P0.05). The N23 latency of the operation ear group was higher than that of the non-operative ear group. There was no significant difference between the two groups (P0.05), and there was no significant difference between the P13-N23 group and the non-operative group (t 0.009 P 0.05), the amplitude of the operated ear group was lower than that of the non-operative ear group, the amplitude of the operation ear group was lower than that of the non-operative ear group. The difference was statistically significant (t = 3.75, P0.05). 41.67% of the 12 patients (5 / 12) had bilateral semicircular canal paresis (58.33%) and 41.67% (5 / 12) had a dominant bias. Conclusion 1. Abnormal vestibular function after cochlear implantation does not necessarily lead to clinical imbalance. 2. The occurrence rate of subjective vertigo after cochlear implantation was lower than that of vestibular function examination. Patients with vestibular dysfunction before cochlear implantation are prone to subjective vertigo. 4. The abnormal rate of vestibular function in patients with inner ear malformation after cochlear implantation was higher than that in normal inner ear patients. After cochlear implantation, the function of balloon and horizontal semicircular canal after cochlear implantation can be judged by VEMP and binaural warming test. Cochlear implantation has no effect on the conduction of VEMP, but it can cause the amplitude of VEMP to decrease. It may be related to the effects of cochlear implantation or long-term electrode implantation on the saccular function, the horizontal semicircular canal function is weakened and the contralateral dominant bias is found in the operated ear. The occurrence of dominant bias may be related to the vestibular injury caused by positional nystagmus and long-term electrode placement. Vestibular function examination can be widely used in vestibular evaluation before and after cochlear implantation.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R764

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