人工耳蜗植入术中电诱发镫骨肌反射及听觉神经反应遥测监测分析

The Intraoperative Analysis of SONATATI~(100) Cochlear Implantation

田颖;庞湃;张涛;王智翔;李伟光;姜学钧;

1:中国医科大学附属第一医院耳鼻咽喉科

摘要
目的探讨在人工耳蜗植入术中应用电诱发镫骨肌反射(electrically elicited stapedius reflex,ESR)及听觉神经反应遥测(auditory nerve response telemetry,ART)判断听觉通路功能的临床意义。方法对20例行SONATATI100型人工耳蜗植入者,于术中应用MEDEL公司的Maestro软件分别进行ESR和ART检测,分别检测蜗底(10、12号电极)、蜗中(6、8号电极)及蜗顶(2、4号电极)的ESR阈值和电诱发复合动作电位(electrically evoked compound action potentials,ECAP)。结果 20例患者120个电极中,ESR和ART检出率分别为96.67%(116/120)和95.0%(114/120);刺激蜗底、蜗中和蜗顶时,ESR、ECAP阈值均逐渐下降,但ESR阈值均显著高于ECAP阈值(P<0.05);ECAP幅值及幅值增长曲线斜率逐渐上升。结论人工耳蜗植入术中应用ESR和ART监测可以及时判断植入体是否完好及听觉传导通路是否正常。
关键词
人工耳蜗植入;镫骨肌反射;神经反应遥测;动作电位
基金项目(Foundation):
作者
田颖;庞湃;张涛;王智翔;李伟光;姜学钧;
参考文献

1 Jerger J,Jenkins H,Fifer R,et al.Stapedius reflex to electrical stimulation in a patient with a cochlear implant[J].Ann Otol Rhinol Laryngol,1986,95(2Pt1):151.

2 Crawford MW,White MC,Propst EJ,et al.Dose-dependent suppression of the electrically elicited stapedius reflex by general anesthetics in children undergoing cochlear implant surgery[J].Anesth Analg,2009,108:1 480.

3 Todd NW,Ajayi E,Hasenstab MS,et al.Childhood otitis media and electrically elicited stapedius reflexes in adult cochlear implantees[J].Otol Neurotol,2003,24:621.

4 Nadol JB Jr.Patterns of neural degeneration in the human cochlea and auditory nerve:implications for cochlear implantation[J].Otolaryngol Head Neck Surg,1997,117(3Pt1):220.

5 Caner G,Olgun L,Gultekin G,et al.Optimizing fitting in children using objective measures such as neural response imaging and electrically evoked stapedius reflex threshold[J].Otol Neurotol,2007,28:637.

6 熊观霞,刘敏,陈锡辉.神经反应遥测技术在人工耳蜗植入术中的应用[J].听力学及言语疾病杂志,2004,12:293.

7 Lindstron B,Gredberg G,Intraoperative electrical stimulation of the stapedius reflex in children[J].The American Journal of Otology,1997,18(Suppl):S118.

8 Opie JM,Allum JH,Probst R.Evaluation of electrically elicited stapedius reflex threshold measured through three different cochlear implant systems[J].The American Journal of Otology,1997,18(Suppl):S107.

9 Spivak LG,Chute PM,Popp AL,Programming the cochlear implant based on electrical acoustic reflex thresholds:patient performance[J].Laryngoscope,1994,104:1 225.

10 Van den Borne B,Snik AFM,Mens LHM,et al.Stapedius reflex measurements during surgery for cochlear implantation in children[J].The American Journal of Otology,1996,17:554.

11 Hodges AV,Balkany TJ,Ruth RA,et al.Electrical middle ear muscle reflex use in cochlear implant programming[J].Otolaryngol Head Neck Surg,1997,117:255.

12 Mason SM,Gibbin KP,Garnham CW,et al.Intraoperative elelctro-physiological and objective tests after cochlear reimplantation in a young child[J].Br J Audiol,1996,30:67.

13 Van Weert S,Stokroos RJ,Rikers MM,et al.Effect of perimodiolar cochlear implant positioning on auditory nerve responses:a neural response telemetry study[J].Acta Otolaryngol,2005,125:725.

14 Van den Borne B,Mens LHM,Snik FAM,et al.Stapedius reflex and EABR thresholds in experienced users of the Nucleus cochlear implant[J].Acta Otolaryngol(Stockh),1994,114:141.

15 Battmer RD,Laszig R,Lehnhardt E.Electrically elicited stapedius reflex in cochlear implant patients[J].Ear Hear,1990,11:370.

16 Smoorenburg GF,Willeboer C,Van Dijk JE.Speech perception in nucleus CI24Mcochlear implant users with processor settings based on electrically evoked compound action potential thresholds[J].Audiol Neurootol,2002,7:335.

17 陈雪清,韩德民,赵啸天,等.人工耳蜗植入术后神经反应遥测阈值与行为阈值及舒适阈的比较[J].中华耳鼻咽喉科杂志,2002,37:435.

18 Stphan K,Welzl-Muller K,Stigbrunner H.Acoustic reflex in patients with cochlear implants(analog stimulation)[J].Am J Otol,1991,12:48.

19 Brown CJ,Abbas PJ,Fryanf-Bertschy H,et al.Intraoperative and postoperative electrically evoked auditory brain stem-response in Nucleus cochlear implant users:implications for the fitting process[J].Ear Hear,1994,15:168.

20 Mason SM,Garnham CW,Sheppard S,et al.An intraoperative test protocol for objectitive assessment of the Nucleus 22channel cochlear implant[J].Adv Otorhinolaryngol,1995,50:38.