双侧人工耳蜗植入.ppt

Bilateral Cochlear Implantation 双侧人工耳蜗植入 sarah shu20140515 内容：一双侧人工耳蜗植入的历史 二双侧人工耳蜗植入国内外现状 三双侧人工耳蜗植入效果数据 四双侧人工耳蜗植入注意事项 五当前植入双侧人工耳蜗的有利因素 六双侧案例 一一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;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%。KhnKhn-Inacker,H.,ShehataInacker,H.,Shehata-Dieler,W.,Mller,J.,Helms,J.(2004).Bilateral cochlear implants:a way to 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 deaf 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%。KhnKhn-InackerInacker,H.,H.,ShehataShehata-DielerDieler,W.,W.,MllerMller,J.,Helms,J.(2004).Bilateral cochlear,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.,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,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 MEDMED-EL Cochlear Implantation Study:Speech Perception over the First Year of Use.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 Quiet and Noise in Bilateral Users of the MEDSpeech Understanding in Quiet and Noise in Bilateral Users of the MED-EL COMBI 40/40 Cochlear EL COMBI 40/40 Cochlear Implant SystemImplant System J.J.MllerMller,F.,F.SchSch n n,and J.Helms,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。Schleich,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 MEDLocalization in Bilateral Users of MED-EL COMBI 40/40 Cochlear ImplantsEL COMBI 40/40 Cochlear Implants P.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 NormalComparison of Music Perception in Bilateral and Unilateral Cochlear Implant Users and Normal-Hearing 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.,Lee,D.,GmezGmez-MarnMarn,O.,Lee,H.,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 Health and Nutrition Hispanic Health and Nutrition Examination Survey.Ear Hear,Examination Survey.Ear Hear,19(4),32919(4),329-32.32.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).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&NeurotologyNeurotology BicheyBichey&Miyamoto.(2008).Outcomes in&Miyamoto.(2008).Outcomes in bilateral cochlear implantation.bilateral cochlear implantation.OtolaryngologyOtolaryngologyHead and Neck Surgery Head 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.,Martin,K.,Roland,P.,Bauer,P.,Dorman,M.(2007).Simultaneous versus Sharma,A.,Gilley,P.,Martin,K.,Roland,P.,Bauer,P.,Dorman,M.(2007).Simultaneou