中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2012年
3期
196-201
,共6页
王斌%曹克利%王轶%路远
王斌%曹剋利%王軼%路遠
왕빈%조극리%왕질%로원
耳蜗植入术%诱发电位,听觉%电刺激
耳蝸植入術%誘髮電位,聽覺%電刺激
이와식입술%유발전위,은각%전자격
Cochlear implantation%Evoked potentials,auditory%Electric stimulation
目的 建立人工耳蜗植入术中电刺激中潜伏期听觉诱发电位(electrical evoked middle latency response,EMLR)的检测方法,为进一步评估植入者听觉传导通路及高位听觉反应的特点奠定基础.方法 20例人工耳蜗植入者,其中语前聋14例,语后聋6例,全部使用Cochlear公司Nucleus CI24R (CA)人工耳蜗.术中将言语处理器与计算机接口及听觉诱发电位仪触发端口连接,电极植入后,选取第3号电极,先常规进行电刺激听神经复合动作电位(electrically evoked auditory nerve compound active potentials,ECAP)测试初步了解听神经功能状态,然后进行EMLR检测.选择电刺激听性脑干反应(electrical auditory brainstem response,EABR)模式,采用单极刺激,双相交替脉冲电流方波,脉宽50 ～ 100μs,强度(电流级,current leve1,CL)由ECAP阈值上20 CL起,以5 CL为步长递减或递增,听觉诱发电位仪记录EMLR波形.对ECAP阈值与EMLR阈值进行相关性分析.另外选择6名听力正常健康受试者,行声刺激中潜伏期听觉诱发电位(auditory middle latency response,AMLR)测试,作为EMLR波形和潜伏期的声刺激对照.结果 6例听力正常受试者均可记录到AMLR波形,平均反应阈为(12.5±8.6)dBnHL,接近纯音测听阈值(10.8 ±7.3)dBHL.20例人工耳蜗植入者均可记录到EMLR波形,与AMLR波形相似,但各波潜伏期和波间期缩短,波幅变化不大；语前聋较语后聋总体上波幅小,潜伏期长.EMLR平均阈值为(140.55 ±9.92)CL,低于ECAP的平均阈值 ( 160.75±13.34) CL,差异具有统计学意义(t=10.467,P＜0.01)；二者阈值之间呈正相关(r=0.763,P＜0.01).结论 人工耳蜗植入术中可成功记录到EMLR波形,其阈值较ECAP低,可以作为判断植入者中枢高位听觉传导功能的客观检查.
目的 建立人工耳蝸植入術中電刺激中潛伏期聽覺誘髮電位(electrical evoked middle latency response,EMLR)的檢測方法,為進一步評估植入者聽覺傳導通路及高位聽覺反應的特點奠定基礎.方法 20例人工耳蝸植入者,其中語前聾14例,語後聾6例,全部使用Cochlear公司Nucleus CI24R (CA)人工耳蝸.術中將言語處理器與計算機接口及聽覺誘髮電位儀觸髮耑口連接,電極植入後,選取第3號電極,先常規進行電刺激聽神經複閤動作電位(electrically evoked auditory nerve compound active potentials,ECAP)測試初步瞭解聽神經功能狀態,然後進行EMLR檢測.選擇電刺激聽性腦榦反應(electrical auditory brainstem response,EABR)模式,採用單極刺激,雙相交替脈遲電流方波,脈寬50 ～ 100μs,彊度(電流級,current leve1,CL)由ECAP閾值上20 CL起,以5 CL為步長遞減或遞增,聽覺誘髮電位儀記錄EMLR波形.對ECAP閾值與EMLR閾值進行相關性分析.另外選擇6名聽力正常健康受試者,行聲刺激中潛伏期聽覺誘髮電位(auditory middle latency response,AMLR)測試,作為EMLR波形和潛伏期的聲刺激對照.結果 6例聽力正常受試者均可記錄到AMLR波形,平均反應閾為(12.5±8.6)dBnHL,接近純音測聽閾值(10.8 ±7.3)dBHL.20例人工耳蝸植入者均可記錄到EMLR波形,與AMLR波形相似,但各波潛伏期和波間期縮短,波幅變化不大；語前聾較語後聾總體上波幅小,潛伏期長.EMLR平均閾值為(140.55 ±9.92)CL,低于ECAP的平均閾值 ( 160.75±13.34) CL,差異具有統計學意義(t=10.467,P＜0.01)；二者閾值之間呈正相關(r=0.763,P＜0.01).結論 人工耳蝸植入術中可成功記錄到EMLR波形,其閾值較ECAP低,可以作為判斷植入者中樞高位聽覺傳導功能的客觀檢查.
목적 건립인공이와식입술중전자격중잠복기은각유발전위(electrical evoked middle latency response,EMLR)적검측방법,위진일보평고식입자은각전도통로급고위은각반응적특점전정기출.방법 20례인공이와식입자,기중어전롱14례,어후롱6례,전부사용Cochlear공사Nucleus CI24R (CA)인공이와.술중장언어처리기여계산궤접구급은각유발전위의촉발단구련접,전겁식입후,선취제3호전겁,선상규진행전자격은신경복합동작전위(electrically evoked auditory nerve compound active potentials,ECAP)측시초보료해은신경공능상태,연후진행EMLR검측.선택전자격은성뇌간반응(electrical auditory brainstem response,EABR)모식,채용단겁자격,쌍상교체맥충전류방파,맥관50 ～ 100μs,강도(전류급,current leve1,CL)유ECAP역치상20 CL기,이5 CL위보장체감혹체증,은각유발전위의기록EMLR파형.대ECAP역치여EMLR역치진행상관성분석.령외선택6명은력정상건강수시자,행성자격중잠복기은각유발전위(auditory middle latency response,AMLR)측시,작위EMLR파형화잠복기적성자격대조.결과 6례은력정상수시자균가기록도AMLR파형,평균반응역위(12.5±8.6)dBnHL,접근순음측은역치(10.8 ±7.3)dBHL.20례인공이와식입자균가기록도EMLR파형,여AMLR파형상사,단각파잠복기화파간기축단,파폭변화불대；어전롱교어후롱총체상파폭소,잠복기장.EMLR평균역치위(140.55 ±9.92)CL,저우ECAP적평균역치 ( 160.75±13.34) CL,차이구유통계학의의(t=10.467,P＜0.01)；이자역치지간정정상관(r=0.763,P＜0.01).결론 인공이와식입술중가성공기록도EMLR파형,기역치교ECAP저,가이작위판단식입자중추고위은각전도공능적객관검사.
Objective To establish the method of conducting electrical evoked middle latency response (EMLR) monitoring in cochlear implantation operation and further to assess the neural response of auditory pathway under electrical stimulation.Methods Twenty cases of cochlear implantation subjects were investigated in this study. Fourteen cases were pre-lingual deaf and 6 were post-lingual deaf.The surface recording electrodes were placed on the patients under general anesthesia,with language processor connected to the triggering port of the auditory evoked potential device.After the electrode was implanted,the electrode No.3 was selected to conduct. The electrically evoked auditory nerve compound active potentials(ECAP) were firstly tested in all patients,thereafter the EABR mode was selected,and the stimulation parameters were changed to EMLR mode with monopole biphasic,alternation stimulation,pulse width from 50 to 100 μs,the stimulation intensity decreased or increased from 20 CL above the strength of the ECAP threshold to the reaction threshold with a step of 5CL.To evaluate the correlation between the ECAP thresholds and EMLR,another 6 cases of normal hearing healthy subjects were recruited to record their short-sound evoked auditory middle-latency response (AMLR),as the control of morphology and latency of MLR by electrical stimulation.Results The typical AMLR waveforms could be recorded by the composition of five waves in the 6 cases of normal hearing healthy subjects,with an average response threshold of ( 12.5 ± 8.6) dBnHL,close to the behavioral audiometric threshold( 10.8 ± 7.3 ) dBHL.The EMLR waveforms could be recorded in 20 patients,which was similar to the AMLR waveforms.However,the wave latency and wave interval shortened.There were lower volatility and longer latency in pre-lingual deaf than post-lingual deaf.The EMLR threshold( 140.55 ± 9.92) CL was significantly lower than the ECAP threshold (160.75 ± 13.34)CL( t =10.467,P ＜ O.01 ),a positive correlation between the thresholds was detected ( r =0.763,P ＜ 0.01 ).Conclusions We successfully established the method of EMLR monitoring in cochlear implantation surgery.The EMLR threshold is lower than the ECAP threshold but it is close to the behavioral audiometric threshold; EMLR can provide neural response information closer to the auditory center,and can serve as an effective objective method to evaluate the effect of hearing rehabilitation.
