摘要
目的探讨人工耳蜗植入术中进行EABR监测的方法,以了解耳蜗电刺激下听觉传导通路的神经反应情况。方法20例人工耳蜗植入患者,男14例,女6例,平均年龄13.6岁,语前聋患者14例,语后聋患者6例。全麻后安置体表记录电极,将PPS与听觉诱发电位仪触发端口连接,并选定听觉诱发电位仪的外触发模式。人工耳蜗电极植入后,先行常规NRT监测,然后将NRT刺激参数改为EABR模式,采用Basic双极刺激,脉宽50μs,强度由200CL起以10CL为步长递减至反应阈值。结果20例患者均记录到EABR,阈上20CL时Ⅲ波、Ⅴ波的平均潜伏期分别为2.04±0.20ms、3.96±0.41ms。相同刺激条件下的EABR反应平均阈值为148.46±11.63CL,NRT反应平均阈值为160.72±13.56CL。一例脑白质轻度发育异常患儿,术中NRT波形引出良好,EABRⅠ～Ⅳ波分化良好,Ⅴ波波形低钝,Ⅴ波/Ⅲ波振幅比<1/2,考虑可能存在耳蜗核上性神经发育不良,现正在语言康复训练随访中。结论人工耳蜗植入术中进行EABR监测比NRT能提供更完整的、更接近听觉中枢的神经反应信息,能更进一步了解听觉传导通路的功能状态,以期对患者听力康复的效果提供更准确的预测。
Objective To evaluate the method of conducting EABR monitoring in cochlear implantation and have a better understanding of neural response of auditory pathway under electrical stimulation. Methods Twenty cochlear implantees were studied, including 14 males and 6 females with the average age at 13.6 years. And 14 out of the 20 cases were prelingually deaf, 6 were postlingually deaf. The surface recording electrodes were placed on the patients under complete aesthesia with PPS connected to the triggering port of the auditory evoked potential device. After cochlear implantation, conventional NRT monitoring was conducted firstly. Then NRT stimulation parameters were changed to EABR mode and Basic bipolar stimulation pattern. With pulse width at 50 ;u s, the stimulation intensity decreased from 250CL to the response threshold with a step of 10 CL. Results EABR was recorded in all of the 20 cases. The average latencies of Wave III and wave V were 2.04±0.20 ms, 3.96±0.41 ms respectively when it was 20 CL above the threshold. Under the same stimulation condition, the average EABR response threshold was 148.46 ± 11.63 CL and the average NRT response threshold was 160.72 ±13.56 CL. During the implantation, one child patient with slight dysfunction of white matter development in the brain showed well-recognized NRT waveforms, well- differentiated EABR Ⅰ-Ⅳ waveforms, but low and blunt waveform Ⅴ. The wave amplitude ratio of waveform Ⅴ/ Ⅲ was less than 1/2. Considering the possibility of＂ supranuclear dysplasia of cochlea＂, we are observing the effect of speech training for the patient during post-operative follow-up visits. Conclusion EABR monitoring in cochlear implantation surgery can provide more thorough and accurate information of neural response in the auditory center than NRT. This can help us further understand the function and mechanism of the auditory pathway and therefore achieve a more accurate forecast on the effect of hearing rehabilitation.
出处
《中国听力语言康复科学杂志》
2008年第1期18-21,共4页
Chinese Scientific Journal of Hearing and Speech Rehabilitation
