經前庭階之多頻道人工耳蝸植入術

背景：人工耳蝸在植入過程中遭遇鼓室階骨化（scala tympani ossification）或纖維化並不少見，這常增加電極自鼓室階植入的困難及限制植入的深度，而植入深度與有效電極所涵蓋的聽神經纖維數目之多寡則將直接影響術後聽能復健成效。為設法使有效電極植入更深入，使所涵蓋之聽神經纖維愈多，改由前庭階（scala vestibuli）植入理論上可作為一變通的手術方式。探討兩種不同電極植入路徑在聽力、聽能復健成效（speech perception performance），及所耗電流量的差異為本研究之目的。方法：本科1997年12月至1998年11月間共29名嚴重失聰（profound hearing impairment）患者接受人工耳蝸植入手術。依據病歷紀錄及手術過程錄影帶，針對25名使用MED-EL的學語前失聰（pre-lingual）患者（2-19歲，14歲11女，平均6.08歲），依據不同的植入路徑分成2組做比較。所有患者術後1個月開機頻率譜圖示（mapping），並追蹤聽力檢查及聽能復健至少3個月以上（平均9.32個月）。結果：篩選其中植入MED-EL/C40+共25例（鼓室階13例；前庭階12例），比較開機後3個月之可察覺最小電流值（T-level），可接受最大電流值（C-level），動態範圍電流值（dynamic range）以及術後1個月與3個月的聲場聽力測驗（sound-field test，取0.5k、1k、2k、4k之平均值），並未有顯著差異。在封閉式（close-set）與開放式（open-set）言語聽力檢查方法（奇美中文揚揚格語詞聽閩檢定表），自前庭階植入亦有不錯的成果。結論：本研究顯示對於鼓室階骨化或纖維化的嚴重失聰患者，當人工耳蝸自鼓室階植入遭遇困難時，改由前庭階植入是可行且值得考慮的方式。

關鍵字

人工耳蝸；前庭階；鼓室階

並列摘要

BACKGROUND:Labyrinthine offification or fibrosis in the scala tympani usually results in difficult or incomplete electrode insertions. It is nor an uncommon problem in cochlear implant surgery. However, the depth of inserted electrode arrays and the number of auditory nerve fibers under active electrodes are significant factors in post-operative auditory performance. In order to insert the device completely and maintain maximal hearing perception, insertion via the scala vestibuli would theoretically be an alternate method. METHODS:Retrospective data from 25 profoundly hearing-impaired candidates in whom MED-EL/C40+ cochlear implants were inserted between December 1997 and November 1998 were collected and analyzed. The 25 pre-lingual subjects(14 boys and 11 girls between 2 and 19 years old, mean age 6.08 years), were divided into 2 groups according to the implant methods. Twelve had implantation via the scala vestibuli, and the other 13 via the scala tympani. After the operation, all patients were mapped at one month, and the follow-up period lasted for 9.32 months on average with a minimum of 3.5 months. RESULTS:Three months after the first mapping, there were no significant differences at the T-level, C-level, or dynamic range between the two different implant methods using an independent sample t-test. At one and 3 months after surgery, there were no significant differences in sound-field tests between these two pathways. Furthemore, the cases implanted via the scala vestibuli had favorable scores in both close-set and open-set speech perception tests with the Mandarin Chi-Mei Foundation Hospital Auditory Test Bettery. CONCLUSIONS:This study revealed that scala vestibuli implantation is both a useful and indicative method when ossification in the scala tympani makes implantation difficult.

並列關鍵字

cochlear implant ； scala vestibule ； scala tympani

國際替代計量

經前庭階之多頻道人工耳蝸植入術

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