人工耳蜗术后早期电极阻抗变化规律的研究

Study on the Change of Electrode Impedance in the Early Stage after Cochlear Implantation

张俊戈;孙家强;杨洁;陈建文;侯晓燕;孙敬武;

1:皖南医学院安徽省立医院

2:中国科学技术大学附属第一医院(安徽省立医院)耳鼻咽喉头颈外科

摘要
目的探讨人工耳蜗植入术后电极阻抗值与电极位置的关系及电极阻抗的总体变化特点。方法对2018年9月至2019年9月在中国科学技术大学附属第一医院行人工耳蜗植入术的患者100例(100耳),于术中、术后3天、术后1月(开机时)及术后3月测试电极阻抗值,分析结果。结果 (1)100例患者总体及不同分区电极阻抗均值术中时最低,开机时(术后1月)升至最高,开机后(术后3月)呈降低趋势,三个时间点均值比较,差异均有统计学意义(P<0.05);(2)在术中、术后1月与术后3月均为蜗顶区电极阻抗值最高,与蜗中区及蜗底区比较,差异均有统计学意义(P<0.05);(3)蜗顶区1号和2号电极的阻抗值在术后3天即已升高,与术中差异有统计学意义(P<0.05)。结论电极阻抗值总体变化趋势为术中最低,术后1月(开机时)升至最高,开机后下降。蜗顶区阻抗值术后3天即明显升高且始终较蜗中区和蜗底区高。
关键词
感音神经性聋;人工耳蜗植入;电极阻抗
基金项目(Foundation):
安徽省重点研究与开发计划项目(201904a07020084);; 安徽省学术和技术带头人科研活动经费资助项目(2018H161);; 安徽省自然科学基金(1808085MH248)
作者
张俊戈;孙家强;杨洁;陈建文;侯晓燕;孙敬武;
参考文献

1 Zeng FG,Rebscher SJ,Fu QJ,et al.Development and evaluation of the Nurotron 26 electrode cochlear implant system[J].Hearing Research,2015,322(5):188-199.

2 Scheperle RA,Tejani VD,Omtvedt JK,et al.Delayed changes in auditory status in cochlear implant users with preserved acoustic hearing[J].Hear Res,2017,350(2):45-57.

3 Choi J,Payne MR,Campbell LJ,et al.Electrode impedance fluctuations as a biomarker for inner ear pathology after cochlear implantation[J].Otol Neurotol,2017,38(10):1433-1439.

4 Thompson Nicholas J,Dillon Margaret T,Emily B,et al.Electrode array type and its impact on impedance fluctuations and loss of residual hearing in cochlear implantation[J].Otol Neurotol,2020,41(2):186-191.

5 Ahmad AO,Amjad N,Bani AM,et al.Accuracy of intraoperative electrophysiological testing in confirming correct cochlear implant electrode positions[J].Cochlear Implants Int,2019,20(6):324-330.

6 Tavartkiladze G,Bakhshinyan V,Irwin C.Evaluation of new technology for intraoperative evoked compound action potential threshold measurements[J].Int J Audiol,2015,54(5):347-352.

7 Landsberger DM,Mertens G,Punte AK,et al.Perceptual changes in place of stimulation with long cochlear implant electrode arrays[J].J Acoust Soc Am,2014,135(2):175-181.

8 Duan YY,Clark GM,Cowan RS.A study of intra-cocldear electrodes and tissue interface by electrochemical impedance methods in vivo[J].Biomateria1s,2004,25(17):3813-3828.

9 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言语康复专业委员会.人工耳蜗植入工作指南(2013)[J].中华耳鼻咽喉头颈外科杂志,2014,44(2):89-95.

10 Brill S,Muller J,Hagen R,et al.Site of cochlear stimulation and its effect on electrically evoked compoundaction potentials using the MED -EL standard electrode array[J].Biomed Eng Online,2009,8(12):1-10.

11 蔡鑫章,冯永,贺楚峰,等.多导人工耳蜗植入后电极阻抗的初步研究[J].中国耳鼻咽喉颅底外科杂志,2005,4(4):240-242.

12 Marsella P,Scorpecci A,Pacifico C,et a1.Safety and functional results of early cochlear implant switch-on children[J].Otology&Neurotology,2014,35(2):277-282.

13 乔晓峰,王东.小儿正常耳蜗与内耳畸形人工耳蜗植入术后电极阻抗及NRT值对比研究[J].临床耳鼻咽喉头颈外科杂志,2013,22(22):1231-1233.

14 Su GL,Colesa DJ,Pfingst BE,et al.Effects of deafening and cochlear implantation procedures on postimplantation psychophysical electrical detection thresholds[J].Hear Res,2008,241(7):64-72.

15 Somdas MA,Li PM,Whiten DM.Quantitative evaluation of new bone and fibrous tissue in the cochlea following cochlear implantation in the human[J].Audil Neurootol,2007,12(5):277-284.

16 Mirman CS,Sanli H,Gibson WP,et al.Impendance,neural response telemetry,and speech perception outcomes after reimplantation of cochlear implants in children[J].Otol Neurotol,2014,35(8):1385-1393.

17 李旭,温立婷,高磊,等.Nucleus24 CA 型人工耳蜗植人后电极阻抗及 T/ C 值变化分析[J].中华耳科学杂志,2012,10(1):19-22.

18 吴文瑾,贾欢,李蕴,等.20 例 Med- EL Combi40+人工耳蜗术后电极阻抗和检测阈值及最大舒适阈值变化的观察[J].临床耳鼻咽喉头颈外科杂志,2013,22(22):1328-1342.

19 Saunders E,Cohen L,Aschendorff A,et al.Threshold,comfortable level and impedance changes as a function of electrode-modiolar distance[J].Ear Hear,2002,23(2):28-40.

20 Jeon EK,Brown CJ,Etler CP,et al.Comparison of electrically evoked compound action potential thresholds and loudness esti-mates for the stimuli used to program the Advanced Bionics cochlear implant[J].J Am Acad Audiol,2010,21(1):16-27.

21 Hu HC,Chen JKC,Li LPH,et al.Evolution of impedance values in two different electrode array designs following activation of cochlear implants 1 day after surgery:a study of 58 patients[J].Clin Otolaryngol,2019,12(4):1-7.

22 Domenico C,Alessandra M.Assessment of cochlear trauma and telemetry measures after cochlear implantation:a comparative study between Nucleus CI512 and CI532 electrode arrays[J].Audiol Res,2019,9(1):14-22.

23 Bas E,Goncalve S,Adams M,et al.Spiral ganglion cells and macrophages initiate neuro-inflammation and scarring following cochlear implantation[J].Front Cell Neurosci,2015,9(8):303-305.