神经反应遥测技术应用于婴幼儿人工耳蜗植入的作用和体会

The role and application experience of nerve response telemetry in infant cochlear implant

摘要:

目的探讨应用神经反应遥测技术（NRT）在人工耳蜗植入术中监测，术后调机中的作用和经验体会。方法回顾性分析38例经历人工耳蜗植入的婴幼儿的临床资料，收集每例患者在术中、术后开机、调机应用NRT测试电诱发听神经复合动作电位（ECAP）的阈值数据，应用听觉整合量表（ITMAIS）评估行为听觉言语功能。结果38例婴幼儿在术中植电极进入耳蜗后均实施NRT测试，每例测试5个电极，分别为1、6、11、16、22号电极，共测试了190个电极，其中163个电极（85.8%）引出了ECAP，其平均阈值为（163.8±21.2）CL。近端1号电极ECAP阈值显著高于远端22号电极（P<0.05）。从开机到开机后12个月，各电极ECAP阈值无显著变化。3岁以下患儿中，25例患儿在各次NRT测试时所有电极都能引出ECAP，而8例患儿存在1~5个电极不能引出ECAP，在开机12个月后，后者的ITMAIS积分与前者比较差异无统计学意义（P>0.05）。结论人工耳蜗植入后NRT测试的ECAP阈值在近端电极显著高于远端电极，耳蜗内数个电极引不出ECAP不影响术后的听觉言语康复。

关键词:人工耳蜗|神经反应遥测|听觉言语康复

Abstract:

ObjectiveTo explore the role and application experience of nerve response telemetry (NRT) in intraoperativve monitoring and postoperative management of cochlear implant.MethodsClinical data of 38 infants undergoing cochlear implant were analyzed retrospectively. The thresholds of electrically evoked auditory nerve compound action potential (ECAP) were measured by NRT during and after operation, and the rehabilitation of behavior hearing and language was evaluated by InfantToddler Meaningful Auditory Integration Scale (ITMAIS).ResultsECAP was evoked in 85.8% (163/190 electrodes) of the test electrodes by NRT during the procedure of cochlear implant, and the ECAP threshold of the proximal first electrode was significantly higher than that of the distal twentysecond electrode (P<0.05). There was no significant change in the ECAP thresholds of each electrode from switchon of cochlear devices to 12 months after switchon. Among infants younger than 3 years old, ECAP was evoked in all electrodes from each NRT test in 25 cases, absent in 1 to 5 electrodes in 8 cases. Twelve months after switchon, the difference of ITMAIS score between them was statistically insignificant (P>0.05).ConclusionsThe ECAP threshold of NRT after cochlear implant in the proximal electrode is significantly higher than that in the distal electrode. Absence of several electrodes in ECAP evoked by NRT does not affect the hearing and speech rehabilitation.

Key words:Cochlear implant|Nerve response telemetry|Rehabilitation