共同腔畸形患者经乳突缝状迷路切开入路联合定制电极人工耳蜗植入术后长期效果研究

doi:10.3969/j.issn.1006-7795.2024.06.003

首都医科大学学报 ›› 2024, Vol. 45 ›› Issue (6): 946-955.doi: 10.3969/j.issn.1006-7795.2024.06.003

• 内耳畸形人工耳蜗植入 • 上一篇下一篇

共同腔畸形患者经乳突缝状迷路切开入路联合定制电极人工耳蜗植入术后长期效果研究

张李芳¹, 魏兴梅², 孔颖², 杨梦戈³, 高振橙², 薛书锦², 陆思萌², 陈彪², 陈婧媛², 石颖², 李永新^2*

1.民政职业大学康复工程学院，北京 102600； 2.首都医科大学附属北京同仁医院耳鼻咽喉头颈外科，北京 100730;3.北京市垂杨柳医院耳鼻咽喉科，北京 100022

收稿日期:2024-08-25 出版日期:2024-12-21 发布日期:2024-12-18
通讯作者: 李永新 E-mail:entlyx@sina.com
基金资助:
国家自然科学基金项目（81670923），国家重点研发计划项目（2022YFC2402705），北京市自然科学基金项目（7244308）,北京市医院管理中心青年人才培养“青苗”计划项目（QML20230204），中央高校基本科研业务费资助项目（JBKYKJCX2024-7）。

Long-term outcomes after cochlear implantation with customized electrodes via transmastoid slotted labyrinthotomy approach in patients with common cavity deformity

Zhang Lifang¹, Wei Xingmei², Kong Ying², Yang Mengge³, Gao Zhencheng², Xue Shujin², Lu Simeng², Chen Biao², Chen Jingyuan², Shi Ying², Li Yongxin^2*

1.Department of Rehabilitation Engineering, China Civil Affairs University, Beijing 102600, China； 2.Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China；3.Department of Otorhinolaryngology, Beijing Chuiyangliu Hospital, Beijing 100022, China

Received:2024-08-25 Online:2024-12-21 Published:2024-12-18
Supported by:
This study was supported by National Natural Science Foundation of China (81670923), National Key Research and Development Program of China (2022YFC2402705), Natural Science Foundation of Beijing (7244308), Beijing Municipal Administration of Hospitals' Youth Programme (QML20230204), Funding Program for Basic Research Operating Costs of Central Universities (JBKYKJCX2024-7).

摘要/Abstract

摘要： 目的探讨共同腔畸形（common cavity deformity, CCD）患者使用定制电极经乳突缝状迷路切开入路（transmastoid slotted labyrinthotomy approach, TSLA）行人工耳蜗植入（cochlear implantation, CI），术后长期听觉及言语功能发展规律。方法本研究共纳入了首都医科大学附属北京同仁医院36例CCD经TSLA径路植入定制电极的单侧CI患儿及61例同年龄段内耳结构无异常的单侧CI患儿。由同一组经过统一规范化培训的专业人员使用听觉行为分级标准（Categories of Auditory Performance，CAP）量表、言语可懂度分级标准（Speech Intelligibility Rating，SIR）量表、婴幼儿有意义听觉整合量表（Infant-Toddler Meaningful Auditory Integration Scale，IT-MAIS）/有意义听觉整合量表（Meaningful Auditory Integration Scale，MAIS）、有意义使用言语量表（Meaningful Use of Speech Scale，MUSS）评估所有受试者听觉和言语能力。分别CI术前及开机后分别在1、3、6、12、18、24、36、48、60、72、84个月时进行评估。结果广义估计方程分析结果提示，本研究受试者术前及术后听觉言语康复效果组别、时间及其交互效应均有统计学意义（P<0.05）。CCD组患儿CAP得分在术前和术后开机1、3、6、12、18个月之间差异均有统计学意义（P<0.05），在开机24、36、48、60个月间差异均无统计学意义（P>0.05）；IT-MAIS/MAIS得分百分比在开机1、3、6、12、24个月间差异有统计学意义（P<0.05），在开机24、36、48、60个月间差异均无统计学意义（P>0.05）；SIR得分在术前、开机1、3个月间差异均无统计学意义（P>0.05），在开机6、12、18个月间差异有统计学意义（P<0.05），在开机18、24、36、48、60个月间差异均无统计学意义（P>0.05）；MUSS得分百分比在术前、开机1、3个月间差异均无统计学意义（P>0.05），在开机3、6、12、18个月间差异有统计学意义（P<0.05），在开机24、36、48、60个月间差异均无统计学意义（P>0.05）。CCD组患儿CI术后CAP得分及IT-MAIS/MAIS得分百分比在开机后1、3、6、12、18、24、36、48及60个月均显著低于对照组（P<0.05），SIR得分及MUSS得分百分比在开机后3、6、12、18、24、36、48及60个月均显著低于对照组（P<0.05）。结论经TSLA径路配合定制电极的CI可以有效帮助CCD患儿获得长期听觉言语收益，但较内耳结构无异常患儿CI术后听觉言语功能发育迟缓。CCD患儿CI术后听觉功能发育呈现开机2年内快速增长的趋势，在两年后呈缓慢增长趋势；其言语能力发育在开机后6个月至18个月内呈快速增长趋势，在18个月至7年内呈现缓慢增长趋势。

关键词: 共同腔畸形, 经乳突缝状迷路切开入路, 人工耳蜗植入, 听觉言语康复效果

Abstract: Objective To investigate the long-term development of auditory and speech function after cochlear implantation (CI) using the transmastoid slotted labyrinthotomy approach (TSLA) with customized electrodes in patients with common cavity deformity (CCD).Methods Thirty-six children with CCD, all of whom underwent unilateral CI, were included in this study, and 61 children match on age who underwent unilateral CI but with normal inner ear structure were selected as a control group from Beijing Tongren Hospital, Capital Medical University. The auditory and speech performance of all subjects were assessed by the professionals staff with uniform standardized training using the following assessment tools: Categories of Auditory Performance (CAP), Speech Intelligibility Rating (SIR), Infant-Toddler Meaningful Auditory Integration Scale/Meaningful Auditory Integration Scale (IT-MAIS/MAIS), and Meaningful Use of Speech Scale (MUSS). Assessments were performed at pre-surgery and 1, 3, 6, 12, 18, 24, 36, 48, 60, 72, and 84 months after CI switch-on.Results The generalized estimating equation analysis suggested that the preoperative and postoperative auditory speech rehabilitation effects of the subjects in this study were statistically significant in terms of group, time, and their interaction effects (P<0.05). The differences in CAP scores of the CCD group were statistically significant among preoperative and postoperative 1, 3, 6, 12, and 18 months after switch-on (P<0.05), while the increase stabilized among 24, 36, 48, and 60 months (P>0.05). The percentages of IT-MAIS/MAIS scores were significantly different among preoperative and postoperative 1, 3, 6, 12, and 24 months after switch-on (P< 0.05), with no significant difference among 24, 36, 48, and 60 months (P>0.05). SIR scores were not significantly different among preoperative and 1, 3 months after switch-on (P>0.05), but significantly different among 6, 12, and 18 months after switch-on (P<0.05), again it showed no significantly difference among 18, 24, 36, 48, and 60 months after switch-on (P> 0.05). The percentages of MUSS score was not significantly different among preoperative and 1, 3 months after switch-on (P>0.05), among 3, 6, 12, and 18 months after switch-on (P<0.05), and among 24, 36, 48, and 60 months after switch-on (P>0.05).Compared with the control group, CCD group had significantly lower CAP scores and percentage of IT-MAIS/MAIS scores from 1 to 60 months after switch-on (P<0.05), and significantly lower SIR scores and percentage of MUSS scores from 3 to 60 months after switch-on (P<0.05). Conclusions CI via the TSLA with customized electrodes can be effective in achieving long-term auditory and speech benefits in CCD children, but the development of auditory speech function is delayed after CI compared with that of children without structural abnormality of the inner ear. The development of auditory performance in children with CCD after CI shows a trend of rapid growth within 2 years of switch-on, and then a trend of slow growth after 2 years. The development of their speech ability shows a trend of rapid growth from 6 months to 18 months after switch-on, and then a trend of slow growth from 18 months to 7 years.

Key words: common cavity deformity, transmastoid slotted labyrinthotomy approach, cochlear implantation, auditory and speech rehabilitation outcomes

中图分类号:

R764

张李芳, 魏兴梅, 孔颖, 杨梦戈, 高振橙, 薛书锦, 陆思萌, 陈彪, 陈婧媛, 石颖, 李永新. 共同腔畸形患者经乳突缝状迷路切开入路联合定制电极人工耳蜗植入术后长期效果研究[J]. 首都医科大学学报, 2024, 45(6): 946-955.

Zhang Lifang, Wei Xingmei, Kong Ying, Yang Mengge, Gao Zhencheng, Xue Shujin, Lu Simeng, Chen Biao, Chen Jingyuan, Shi Ying, Li Yongxin. Long-term outcomes after cochlear implantation with customized electrodes via transmastoid slotted labyrinthotomy approach in patients with common cavity deformity[J]. Journal of Capital Medical University, 2024, 45(6): 946-955.

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[1]	薛书锦, 魏兴梅, 高振橙, 孔颖, 陆思萌, 陈彪, 石颖, 崔丹默, 李永新. 耳蜗发育不全解剖学特点及人工耳蜗植入术后效果研究[J]. 首都医科大学学报, 2024, 45(6): 956-965.
[2]	魏兴梅, 李永新. 内耳畸形人工耳蜗植入进展[J]. 首都医科大学学报, 2024, 45(6): 1001-1007.

共同腔畸形患者经乳突缝状迷路切开入路联合定制电极人工耳蜗植入术后长期效果研究

Long-term outcomes after cochlear implantation with customized electrodes via transmastoid slotted labyrinthotomy approach in patients with common cavity deformity

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