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1、 BilateralCochlearImplantation双侧人工耳蜗植入 sarah shu20140515内容:1双侧人工耳蜗植入的历史2双侧人工耳蜗植入国内外现状3双侧人工耳蜗植入效果数据4双侧人工耳蜗植入注意事项5当前植入双侧人工耳蜗的有利因素6双侧案例1 1双侧人工耳蜗植入历史双侧人工耳蜗植入历史-Auditory system has the potential to process and integrate the additional information provided by two different devices. (Balkany et al., 1988;
2、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。二、双侧人工耳蜗植入国内外现状二、双侧人工耳蜗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
3、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。二、双侧人工耳蜗植入国内外现状二、双侧人工耳蜗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1%左右,双侧植入者中98%为儿童 。近两年增长趋势明显。-言语识别-声源定位-音乐欣赏-综合素质三、双侧人工耳蜗植入效果数据三、双侧人工耳蜗植入效果数据言语识别提升:安静环境下(儿童)言语识别提升:安静环境下(儿童)安静环境下双侧耳蜗的言语识别率提高15%。Khn-Inack
4、er, H., Shehata-Dieler, W., Mller, J., Helms, J. (2004). Bilateral cochlear implants: a way to Khn-Inacker, H., Shehata-Dieler, W., Mller, J., Helms, J. (2004). Bilateral cochlear implants: a way to optimize auditory perception abilities in deaf children. optimize auditory perception abilities in de
5、af children. Speech discrimination in quite (monosyllabic words) 安静环境下的单音节词辨别率Speech discrimination score (%)言语识别百分比言语识别提升:噪音环境下(儿童)言语识别提升:噪音环境下(儿童)噪音环境下双侧耳蜗的言语识别率提高20-30%。Khn-Inacker, H., Shehata-Dieler, W., Mller, J., Helms, J. (2004). Bilateral cochlear Khn-Inacker, H., Shehata-Dieler, W., Mller,
6、 J., Helms, J. (2004). Bilateral cochlear implants: a way to optimize auditory perception abilities in deaf children. implants: a way to optimize auditory perception abilities in deaf children. 言语识别提升:安静环境下(成人)言语识别提升:安静环境下(成人)安静环境下双侧耳蜗的言语识别率提高18%。Buss, E., Pillsbury, H., Buchman, C., Pillsbury, C.,
7、Clark, M., Haynes, D., Labadie, R., Amberg, S., Buss, E., Pillsbury, 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, Roland, P., Kruger, P., Novak, M., Wirth, J., Black,
8、 J., Peters, R., Lake, J., Wackym, P., Firszt, J., Wilson, B., Lawson, D., Schatzer, R., DHaese, P., Barco, A. (2008). Multicenter U.S. Bilateral J., Wilson, B., Lawson, D., Schatzer, R., DHaese, P., Barco, A. (2008). Multicenter U.S. Bilateral MED-EL Cochlear Implantation Study: Speech Perception o
9、ver the First Year of Use. MED-EL Cochlear Implantation Study: Speech Perception over the First Year of Use. Percent correct, 正确率(%)Test interval, 测试时间点Worse unilateral, 使用较差一侧耳蜗Better unilateral,使用较好一侧耳蜗Bilateral,使用双侧耳蜗言语识别提升:噪音环境下(成人)言语识别提升:噪音环境下(成人)噪音环境下双侧耳蜗的言语识别率提高25-30%。Speech Understanding in
10、Quiet and Noise in Bilateral Users of the MED-EL COMBI 40/40 Cochlear Speech Understanding in Quiet and Noise in Bilateral Users of the MED-EL COMBI 40/40 Cochlear Implant SystemImplant SystemJ. Mller, F. SchJ. Mller, F. Schn, and J. Helmsn, and J. Helms声源定位提升:儿童声源定位提升:儿童双侧植入后,声源定位误差从单侧的45降低到4.7。Sch
11、leich, P., Nopp, P., Anderson, I. (2007). Development of localization abilities in bilaterally implanted children.声源定位提升:成人声源定位提升:成人单侧植入的声源定位误差平均为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 MED-EL COMBI 40/40 Cochlear Imp
12、lantsP. Nopp, P. Schleich, and P. DHaeseP. Nopp, P. Schleich, and P. DHaese音乐欣赏提升:音乐欣赏提升:双侧植入的乐器识别比单侧平均高出18.8%。比正常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 Comparison of Music Perception in Bilateral and Unilateral Cochlear Imp
13、lant Users and Normal-Hearing Subjects K . Veekmans a, b L. Ressel c J. Mueller d M. Vischer f S.J. Subjects K . Veekmans a, b L. Ressel c J. Mueller d M. Vischer f S.J. Brockmeier e, gBrockmeier e, g单双侧听觉智力和综合能力对比单双侧听觉智力和综合能力对比-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,在学习上需要额外的辅助。 Lee, D., Gmez-Marn, O.
14、, Lee, H. Lee, D., Gmez-Marn, O., Lee, H. (1998). Prevalence of unilateral (1998). Prevalence of unilateral hearing loss in children: the hearing loss in children: the National Health and Nutrition National Health and Nutrition Examination Survey II and the Examination Survey II and the Hispanic Hea
15、lth and Nutrition Hispanic Health and Nutrition Examination Survey. Ear Hear, Examination Survey. Ear Hear, 19(4), 329-32.19(4), 329-32.对双侧人工耳蜗植入对双侧人工耳蜗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,提高生活质量。具有良好的投入/获益比。 Balkany et al. (2008). Balkany et al. (2008).
16、William House William House Cochlear Implant Study Group. Cochlear Implant Study Group. Position Statement on Bilateral Position Statement on Bilateral Cochlear Implantation. Otology & Cochlear Implantation. Otology & NeurotologyNeurotologyBichey & Miyamoto. (2008). Outcomes in Bichey & Miyamoto. (2
17、008). Outcomes in bilateral cochlear implantation. bilateral cochlear implantation. OtolaryngologyHead and Neck Surgery OtolaryngologyHead and Neck Surgery 四、双侧人工耳蜗植入注意事项四、双侧人工耳蜗植入注意事项植入时机植入时机儿童:研究发现,3.5岁前是较小儿童听觉中枢快速发育的敏感期。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., Ma
18、rtin, K., Roland, P., Bauer, P., Dorman, M. (2007). Simultaneous versus Sharma, A., Gilley, P., Martin, K., Roland, P., Bauer, P., Dorman, M. (2007). Simultaneous versus sequential bilateral implantation in young children: Effects on central auditory system development and sequential bilateral impla
19、ntation in young children: Effects on central auditory system development and plasticity. plasticity. -Bilateral implantation before the age of 3.5 years takes advantage of the plasticity in the developing Bilateral implantation before the age of 3.5 years takes advantage of the plasticity in the de
20、veloping central auditory nervous system. central auditory nervous system. 双侧人工耳蜗植入注意事项双侧人工耳蜗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。术中积极止血,降低出血量。以足够显露术区为限,使用小切口,控制乳突开放的范围,降低对佩戴体外机的影响。尽可能选择小的植入体,普通植入体则需深磨植入体骨床,减小术后双侧颞部凸起。植入第二侧时,不能使用单极电凝。在双侧耳蜗植入手术中使用无创方案的必要性在双侧耳蜗植入手术中使用无创方案的必要性单侧植入耳蜗的病
21、例,另一侧可在未来使用新技术治疗。只有使用无创植入方案,双侧植入耳蜗的病例,才能有余地使用新技术五、当前人工耳蜗双侧植入的优势五、当前人工耳蜗双侧植入的优势1、最新植入体的微型化,满足患者对外观要求2、电极/手术无创化 保护耳蜗结构, 不影响未来新技术应用3、体外设备一体化,利于双侧佩戴4、编码策略唯一支持ITD和ILD:精确声源定位l无须磨骨床,更小切口,l操作简便,缩短手术及麻醉时间,l更佳的固定,长期稳定,不扭转六、双侧病例效果展示:六、双侧病例效果展示:1、病史信息:李,先天性感音神经性耳聋,6个月时确诊,植入时年龄12个月,开机时间13个月,目前年龄:3岁。2、目前康复情况(视频):