人工電子耳綜論

Cochlear Implantation

吳哲民(Che-Ming Wu) ； 鄒詠婷(Yung-Ting Tsou)

《台灣耳鼻喉頭頸外科雜誌》 50卷4期 (2015/12) Pp. 197-210

https://doi.org/10.6286/2015.50.4.197

摘要

本文回顧國內外兒童與成人人工電子耳植入手術領域的現況、趨勢與重要議題，進行介紹與探討，並報告聽語復健成效相關研究結果。隨著電子耳植入體與語音處理器的不斷改良，電子耳患者在聽能、說話，乃至於生活品質方面都有很大的進步，植入病患的篩選標準亦有放寬的趨勢，開始將1歲以下嬰孩及具有單側聽損、多重障礙、內耳結構異常與聽神經病變等的病患納入考慮，殘餘聽力的保留與雙側電子耳的植入則為近年集中討論的焦點。正因此，在電子耳手術前，需要專業醫療團隊的內科、外科、聽力與語言等評估，以了解電子耳植入的適切度與可能預後成效。術後經過聽語復健，多數植入兒童在安靜環境下表現良好，語音辨識率超過75%，亦有能力使用電話，並具基本句型閱讀理解及寫作能力，然構詞與句法方面知識較為低落，掌握文章結構與敘事技巧也不足，部分患童術後也有注意力與認知方面的問題。多數文獻皆顯示盡早接受植入手術(兩歲以前)對於術後成效有顯著的正面影響。而語後失聰的成人植入者，術後聽知覺表現多有顯著改善，一般在術後3至6個月間便能看出成效。然而，對於噪音及音樂聆聽等較困難的聆聽環境，由於電子耳無法提供足夠的頻率解析度，病患的成效仍不佳，噪音下的聽知覺或可透過另一耳配戴助聽器或雙側電子耳得到改善，音樂的聆聽能力則可能藉由音樂訓練來加強。目前人工電子耳植入手術成功率高，術後併發症的發生率低，是為安全有效的技術，但為確保電子耳發揮最佳療效，術前充分諮詢與術後密集聽語訓練追蹤為重要的一環。

關鍵字

人工電子耳 ； 感覺神經性聽力損失 ； 病患篩選 ； 術後成效 ； 聽語復健

並列摘要

This article reviews the current status, trends, and issues related to cochlear implantation in both adults and children, and demonstrates the research results of the post-implant outcomes after auditory-verbal rehabilitation. With the advances in the design of implants and speech processing strategies, patients with cochlear implants show significant improvements in various areas, such as auditory performance, speech intelligibility and quality of life. The candidate selection criteria have also expanded to include patients under 12 months of age and those with special auditory, otologic or medical problems, such as single-sided deafness, multiple medical and developmental disorders, inner ear malformation and auditory neuropathy spectrum disorder. Moreover, hearing preservation and bilateral cochlear implants are two focal issues in many cochlear implant centers in the recent years. Careful preoperative medical, radiological, audiological and speech evaluations thus occupy a crucially important role in the process of cochlear implantation, which allows professionals to determine the suitability of the candidate and predict the prognosis. After several years of post-implant rehabilitation, most children with cochlear implants are able to reach a speech perception score of 75% in quiet condition, use telephone to communicate with familiar people, and develop basic skills of reading comprehension and written language. However, compared to normal-hearing age mates, their knowledge about word and sentence formation is limited, and their narrative skills and ability to comprehend the main point of an article are poor. Some children also show attention and cognitive problems after implantation. The majority of the studies indicate the benefit of early implantation (before 24 months of age) in developing better post-implant performances. As to postlingually deafened adult recipients of cochlear implants, most of them demonstrate improved speech perception within 3 to 6 months after implantation. Yet, in difficult listening conditions, especially when perceiving speech in noise and listening to music, cochlear implant users still show unfavorable outcomes due to the limited frequency resolution provided by the implants. Speech perception in noise may be improved by bimodal hearing (i.e., with a hearing aid on the contralateral ear) or bilateral cochlear implants, and the ability to perceive music may be enhanced by music training programs. Cochlear implantation has been proven to be safe and effective, with low rates of postoperative complications. To ensure optimal post-implant outcomes, proper preoperative evaluations/consultations and regular auditory-verbal rehabilitation are of critical importance.

並列關鍵字

cochlear implant ； sensorineural hearing loss ； candidate selection ； post-implant outcomes ； auditoryverbal rehabilitation