双侧人工耳蜗植入课件

1、 Bilateral Cochlear Implantation双侧人工(rngng)耳蜗植入 sarah shu20140515第一页，共二十页。内容(nirng)：双侧人工耳蜗植入的历史(lsh)双侧人工耳蜗植入国内外现状双侧人工耳蜗植入效果数据双侧人工耳蜗植入注意事项当前植入双侧人工耳蜗的有利因素双侧案例第二页，共二十页。双侧人工耳蜗植入双侧人工双侧人工(rngng)(rngng)耳蜗植入历耳蜗植入历史史- Auditory system has the potential to process and integrate the additional information provi

2、ded by two different devices. (Balkany et al., 1988; Pijl, 1991; Green et al., 1992; van Hoesel et al.,1993). 听觉中枢可以处理和整合双侧不同设备传来的信号。-1996年，德国维尔茨堡ENT首次为重建(zhn jin)双侧听觉，给成人植入双侧耳蜗。-1998年，上述机构基于同样目的，给儿童植入双侧耳蜗。第三页，共二十页。二、双侧人工耳蜗二、双侧人工耳蜗(r w)(r w)植入国内外现状植入国内外现状国际：截止2007年12月，全球双侧人工耳蜗植入数量8000，占当时总植入数量的5%。具估

3、计目前全球人工耳蜗植入数量350,000例，双侧植入数量已超过10000。截止2007年12月，双侧植入者中，儿童所占比例62%，成人38%。72%的双侧植入为分期植入，28%为同期植入。同期植入的患者中，58%小于3岁。双侧植入的小龄化趋势：以美国(mi u)为例，2007年前，50%的双侧植入者为3-10岁，2007年后，双侧植入小龄化趋势更明显，3岁以下儿童比例越来越大。第四页，共二十页。二、双侧人工耳蜗二、双侧人工耳蜗(r w)(r w)植入国内外现状植入国内外现状国内：截止目前，国内双侧人工耳蜗植入约300例，仅占总数(zngsh)1%左右，双侧植入者中98%为儿童 。近两年增长趋势

4、明显。第五页，共二十页。- 言语(yny)识别- 声源定位- 音乐欣赏- 综合素质三、双侧人工三、双侧人工(rngng)(rngng)耳蜗植入效果数据耳蜗植入效果数据第六页，共二十页。言语识别提升：安静言语识别提升：安静(njng)(njng)环境下（儿童）环境下（儿童）安静环境下双侧耳蜗(r w)的言语识别率提高15%。Khn-Inacker, H., Shehata-Dieler, W., Mller, J., Helms, J. (2004). Bilateral cochlear implants: a way to optimize Khn-Inacker, H., Shehata-

5、Dieler, W., Mller, J., Helms, J. (2004). Bilateral cochlear implants: a way to optimize auditory perception abilities in deaf children. auditory perception abilities in deaf children. Speech discrimination in quite (monosyllabic words) 安静(njng)环境下的单音节词辨别率Speech discrimination score (%)言语识别百分比第七页，共二十

6、页。言语识别言语识别(shbi)(shbi)提升：噪音环境下（儿童）提升：噪音环境下（儿童）噪音环境下双侧耳蜗(r w)的言语识别率提高20-30%。Khn-Inacker, H., Shehata-Dieler, W., Mller, J., Helms, J. (2004). Bilateral cochlear implants: a way to optimize auditory Khn-Inacker, H., Shehata-Dieler, W., Mller, J., Helms, J. (2004). Bilateral cochlear implants: a way to

7、 optimize auditory perception abilities in deaf children. perception abilities in deaf children. 第八页，共二十页。言语识别提升：安静言语识别提升：安静(njng)(njng)环境下（成人）环境下（成人）安静环境下双侧耳蜗的言语(yny)识别率提高18%。Buss, E., Pillsbury, H., Buchman, C., Pillsbury, C., Clark, M., Haynes, D., Labadie, R., Amberg, S., Roland, Buss, E., Pills

8、bury, H., Buchman, C., Pillsbury, C., Clark, M., Haynes, D., Labadie, R., Amberg, S., Roland, P., Kruger, P., Novak, M., Wirth, J., Black, J., Peters, R., Lake, J., Wackym, P., Firszt, J., Wilson, B., P., Kruger, P., Novak, M., Wirth, J., Black, J., Peters, R., Lake, J., Wackym, P., Firszt, J., Wils

9、on, B., Lawson, D., Schatzer, R., DHaese, P., Barco, A. (2008). Multicenter U.S. Bilateral MED-EL Cochlear Lawson, D., Schatzer, R., DHaese, P., Barco, A. (2008). Multicenter U.S. Bilateral MED-EL Cochlear Implantation Study: Speech Perception over the First Year of Use. Implantation Study: Speech P

10、erception over the First Year of Use. Percent correct, 正确率（%）Test interval, 测试时间点Worse unilateral, 使用(shyng)较差一侧耳蜗Better unilateral，使用较好一侧耳蜗Bilateral,使用双侧耳蜗第九页，共二十页。言语识别言语识别(shbi)(shbi)提升：噪音环境下（成人）提升：噪音环境下（成人）噪音环境(hunjng)下双侧耳蜗的言语识别率提高25-30%。Speech Understanding in Quiet and Noise in Bilateral Users

11、of the MED-EL COMBI 40/40 Cochlear Implant SystemSpeech Understanding in Quiet and Noise in Bilateral Users of the MED-EL COMBI 40/40 Cochlear Implant SystemJ. Mller, F. SchJ. Mller, F. Schn, and J. Helmsn, and J. Helms第十页，共二十页。声源定位声源定位(dngwi)(dngwi)提升：儿童提升：儿童双侧植入后，声源定位(dngwi)误差从单侧的45降低到4.7。Schleich

12、, P., Nopp, P., Anderson, I. (2007). Development of localization abilities in bilaterally implanted children.第十一页，共二十页。声源声源(shn yun)(shn yun)定位提升：成人定位提升：成人单侧植入的声源(shn yun)定位误差平均为46，双侧植入平均降低到16.9。Localization in Bilateral Users of MED-EL COMBI 40/40 Cochlear ImplantsLocalization in Bilateral Users of

13、 MED-EL COMBI 40/40 Cochlear ImplantsP. Nopp, P. Schleich, and P. DHaeseP. Nopp, P. Schleich, and P. DHaese第十二页，共二十页。音乐欣赏提升音乐欣赏提升(tshng)(tshng)：双侧植入的乐器识别比单侧平均高出18.8%。比正常(zhngchng)听力的乐器识别率仅低7.7%Comparison of Music Perception in Bilateral and Unilateral Cochlear Implant Users and Normal-Hearing Subjec

14、ts K . Veekmans a, b L. Ressel c Comparison of Music Perception in Bilateral and Unilateral Cochlear Implant Users and Normal-Hearing Subjects K . Veekmans a, b L. Ressel c J. Mueller d M. Vischer f S.J. Brockmeier e, gJ. Mueller d M. Vischer f S.J. Brockmeier e, g第十三页，共二十页。单双侧听觉智力和综合能力单双侧听觉智力和综合能力(

15、nngl)(nngl)对比对比- 如果只有一侧听力：- 35%以上的儿童，至少留级一年。- 60%以上的儿童，在学习上需要额外( wi)的辅助。 Lee, D., Gmez-MarLee, D., Gmez-Marn, O., Lee, H. (1998). n, O., Lee, H. (1998). Prevalence of unilateral hearing Prevalence of unilateral hearing loss in children: the National loss in children: the National Health and Nutritio

16、n Examination Health and Nutrition Examination Survey II and the Hispanic Health Survey II and the Hispanic Health and Nutrition Examination Survey. and Nutrition Examination Survey. Ear Hear, 19(4), 329-32.Ear Hear, 19(4), 329-32.第十四页，共二十页。对双侧人工耳蜗对双侧人工耳蜗(r w)(r w)植入植入效果效果的共识的共识- 不论儿童或成人，双侧植入CI的效果都比

17、单侧植入更好。- 除听觉相关的客观数据优势外，双侧人工耳蜗植入还对患者的言语、情感、认知产生积极影响，提高生活(shnghu)质量。具有良好的投入/获益比。 Balkany et al. (2008). Balkany et al. (2008). William House William House Cochlear Implant Study Group. Position Cochlear Implant Study Group. Position Statement on Bilateral Cochlear Statement on Bilateral Cochlear Impla

18、ntation. Otology & NeurotologyImplantation. Otology & NeurotologyBichey & Miyamoto. (2008). Bichey & Miyamoto. (2008). Outcomes in bilateral cochlear Outcomes in bilateral cochlear implantation. implantation. OtolaryngologyHead and Neck OtolaryngologyHead and Neck Surgery Surgery 第十五

19、页，共二十页。四、双侧人工四、双侧人工(rngng)(rngng)耳蜗植入注意事项耳蜗植入注意事项植入时植入时机机 儿童：研究发现，3.5岁前是较小儿童听觉中枢(zhngsh)快速发育的敏感期。3.5岁前完成双侧耳蜗植入（分期或同期），能充分利用听觉中枢发育的可塑性。成人语后聋：无明显年龄倾向。Sharma, A., Gilley, P., Martin, K., Roland, P., Bauer, P., Dorman, M. (2007). Simultaneous versus sequential bilateral Sharma, A., Gilley, P., Martin, K

20、., Roland, P., Bauer, P., Dorman, M. (2007). Simultaneous versus sequential bilateral implantation in young children: Effects on central auditory system development and plasticity. implantation in young children: Effects on central auditory system development and plasticity. -Bilateral implantation

21、before the age of 3.5 years takes advantage of the plasticity in the developing central auditory nervous system. Bilateral implantation before the age of 3.5 years takes advantage of the plasticity in the developing central auditory nervous system. 第十六页，共二十页。双侧人工耳蜗双侧人工耳蜗(r w)(r w)植入注意事项植入注意事项手术手术儿童双侧植入手术注意事项儿童双侧植入手术注意事项针对婴幼儿病例，术前应进行全面的麻醉评估(pn )。术中积