耳蜗不全分隔畸形患儿耳蜗形态与人工耳蜗术后效果评估
Chinese Journal of Otology（2020）
Abstract
目的 1.利用影像重建技术建立标准耳蜗坐标系统,通过测量骨蜗管结构,量化分析语前聋耳蜗不全分隔畸形患儿耳蜗形态;2.评估语前聋耳蜗不全分隔畸形患儿人工耳蜗术后2年听力言语康复效果,分析不全分隔畸形耳蜗形态与术后听觉言语效果的关系.方法 收集2013年至2015年使用奥地利MED-EL公司FLEX系列人工耳蜗产品的27例语前聋伴耳蜗不全分隔畸形患儿的临床资料.将27例患儿依据耳蜗畸形种类分为不全分隔畸形I型组(IP-I组,17例)和不全分隔畸形II型组(IP-II组,10例).选取耳蜗形态正常且使用FLEX系列人工耳蜗的患儿作为对照组(对照组,17例).影像学评估实验组与对照组患儿术侧耳颞骨CT:通过影像重建骨蜗管,测量骨蜗管长度、耳蜗底转长径和宽径、耳蜗底转蜗管高度与宽度.术后两年使用听觉行为分级标准(CAP)、言语可懂度分级标准(SIR)、有意义听觉整合量表(MAIS)、有意义使用言语量表(MUSS)评估患者听觉及言语康复情况.结果 IP-I组:植入年龄为21.76±10.92月龄,骨蜗管长度20.29±4.39mm,耳蜗底转长径8.11±0.91mm,耳蜗底转宽径5.39±0.73mm,耳蜗底转蜗管高度3.10±0.94mm,耳蜗底转蜗管宽度2.55±0.91mm;术后两年CAP=5.76±1.53,SIR=3.21±1.03,MAIS=26.84±7.63,MUSS=20.84±8.23.IP-II组:植入年龄为18.2±8.94月龄,骨蜗管长度为24.35±2.92mm,耳蜗底转长径为8.58±0.55mm,耳蜗底转宽径为5.72±0.66 mm、耳蜗底转蜗管高度为2.37±0.80mm,耳蜗底转蜗管宽度为1.94±0.26mm;术后两年CAP=6.30±0.95,SIR=3.50±0.85,MAIS=28.40±5.92,MUSS=25.40±5.58;对照组:植入年龄为22.85±10.30月龄,骨蜗管长度31.19±1.88mm,耳蜗底转长径9.05±0.31mm,耳蜗底转宽径6.82±0.43mm,耳蜗底转蜗管高度1.83±0.19mm,耳蜗底转蜗管宽度为1.77±0.20mm;术后两年CAP=6.71±1.14,SIR=4.14±0.86,MAIS=30.93±6.84,MUSS=27.5±7.69.相关性分析发现各组耳蜗底转长径和宽径之间存在明显正相关(P<0.05),耳蜗底转蜗管宽度和高度之间存在明显正相关(P<0.05);IP-I组骨蜗管长度与术后CAP、SIR、MAIS、MUSS得分存在明显正相关(P<0.05);IP-II组骨蜗管长度与术后CAP、SIR、MAIS得分存在明显正相关(P<0.05),与MUSS得分无明显相关关系(P>0.05);对照组骨蜗管长度与术后CAP、SIR、MAIS、MUSS得分无相关关系(P>0.05).结论 不全分隔畸形患儿骨蜗管长度、耳蜗底转长径、耳蜗底转宽径、耳蜗底转蜗管高度、耳蜗底转蜗管宽度明显异于正常对照组;不全分隔畸形患儿耳蜗形态、耳蜗底转蜗管形态存在较大个体差异.通过术后两年CAP、SIR、MAIS、MUSS分析得知,不全分隔畸形患者听觉言语功能显著提高,且与骨蜗管长度存在明显正相关.因此术前对于不全分隔畸形患儿进行耳蜗结构测量具有重要意义.
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