A long term effect on speech recognition in the patients with simultaneous bilateral cochlear implants / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate an effect on speech recognition after bilateral cochlear implants(CI) simultaneously.@*Methods@#Nine subjects who underwent bilateral CI operation simultaneously in Peking Union Hospital in 2007 were assigned as bilateral group, another 9 subjects with unilateral CI were chosen as unilateral group according to the age, gender, duration of deafness. Hearing threshold, speech recognition of phrases, disyllabic words, single word in quiet and noise environment were calculated, respectively. Three different sound source positions were set up to simulate the three effects of binaural hearing (head shadow, binaural redundancy and binaural squelch) in noise environment. The speech signal intensity was 70 dBSPL, the signal to noise ratio (SNR) was 0 dB, + 4 dB, + 8 dB, and the speech recognition of phrases were examined in bilateral CI group. All the data was analyzed by SPSS 19.0 software.@*Results@#In quiet environment, the average aid-hearing threshold was significantly reduced as (7.2±3.0)dB in bilateral CI group compared to unilateral CI group(P<0.05). However, the speech recognition of phrases, disyllabic words, and single word in quiet and noise environment did not show significant differences between bilateral CI and unilateral CI groups (P>0.05). In the testing under noise environment, the speech recognition of bilateral CI group was significantly higher than that of unilateral CI group (P<0.05). In the estimation of noise environment (SNR=+ 8), the phrase test and speech recognition of head shadow model in bilateral groups were significantly better than that of unilateral group (P<0.01). Further, bilateral CI group showed statistical significances in binaural redundancy and binaural squelch models(P<0.01), there was statistically significant were also found difference between two groups (P<0.01); Bilateral CI group did not reveal significant difference compared with unbilateral CI group in binaural squelch model(P>0.05). Under different signal-to-noise ratio (SNR=+ 8, + 4) noise environment, all the three given models in bilateral CI group show higher signal-to-noise ratio, higher speech recognition rate (Independent-Samples t test, P<0.01). In addition, head shadow model presented negative influences on speech recognition rate compared with binaural redundancy and binaural squelch model by SNR(P<0.05). SNR influences on binaural redundancy and binaural squelch model were almost identical, F=0.371, P=0.549.@*Conclusion@#The subjects who underwent simultaneous bilateral cochlear implantation could significantly reduce aid-hearing threshold, and greatly improve the speech recognition of phrases, disyllabic words, and single word under noise environment.

Cochlear implant operation to summarize and postoperative outcome / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The aim of this study was to evaluate the clinical features of cochlear reimplantation. To review our experience of cochlear reimplant surgery.@*METHOD@#Retrospective analysis of all 25 cochlear reimplant surgeries between 2002 and 2012. Causes of revision operations, number of electrode channels inserted, surgical findings and postoperative speech performances were analyzed.@*RESULT@#Causes of reimplantation were eight hard failures; eight poor implanted electrodes position, four poor outcome, three skin flap infection lead to implant device exposure, one postoperative symptoms of facial nerve stimulation, one postoperative temporal bone lesions. All cochlear reimplantations were successfully performed in our hospital, audiologic performances were stable or improved following reimplantation in most of cases.@*CONCLUSION@#Cochlear implant surgeons should have a good knowledge of how to diagnose cochlear implant failures and how to deal with medical complications related to cochlear implantation. Medical and audiologic outcomes are generally excellent. Cochlear reimplantation appears to be a safe and effective.

Cochlear implantation in patients with cochlear ossification / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate cochlear implantation surgical techniques and postoperative results in patients with cochlear ossification.@*METHOD@#Twenty-nine cochlear ossification patients with cochlear implantation in our department were retrospectively studied during 1997-2011. Preoperative imaging and electrophysiological assessment were done to classify the cochlear ossification of all the patients. Categories of auditory performance and speech intelligibility rating were detected to assess the outcome of cochlear implant postoperatively.@*RESULT@#Among 29 cases with cochlear ossification, 19 cases were grade II, 4 cases were grade I, 4 cases were grade III, and 2 cases were apical turn ossification. Among 23 patients with cochlear ossification grade I and II, 17 cases were totally cochlear array insertion, and 6 cases were partial cochlear array insertion. Patients with cochlear ossification grade III were all partial cochlear array insertion. Most patients achieved good hearing and language ability after cochlear implantation.@*CONCLUSION@#Cochlear implantation can be successfully performed on the basis of systematic preoperative assessment and some patients can achieve good postoperative results in patients with cochlear ossification. Intraoperative electrical stimulation of the auditory evoked response provides a good method to assess the residual spiral nerve function.

Cochlear implantation in patients with auditory neuropathy assisted by intra-operative EABR and the therapeutic effect evaluation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the pathological position of auditory neuropathy and investigate the hearing and speech rehabilitation results of cochlear implantation in patients with auditory neuropathy.@*METHOD@#In our hospital, among the patients received cochlear implantation, 8 cases with auditory neuropathy were selected, and 8 cases of non-auditory neuropathy patients with profound deafness were selected as matched control group with the background close to the study group. The preoperative hearing data of these two groups were retrospectively analyzed. During operation, the homemade stimulation electrodes were inserted to test the electric evoked auditory brainstem response(EABR) for assessing the auditory pathway; EABR and neural response telemetry(NRT) were tested after implantation, and T, C value were acquired 1 month later. CAP, SIR and speech recognition rate were used to assess hearing and speech rehabilitation effect 12 months after booting.@*RESULT@#Intra-operative EABR wave can be derived in 8 cases of auditory neuropathy, but the wave pattern exhibited variations compared with normal wave. It needed increased stimulation or adjusted parameters, with variable V latency. After cochlear implantation, the waveforms of NRT and EABR were similar between the two groups, and the post-operative V waveform was close to the intra-operative EABR. 8 pairs of patients can present listening response after booting. There was no statistically significant difference in T, C value, CAP (6.50 +/- 0.94 and 6.90 +/- 0.77) and speech recognition rate (85.00% +/- 11.66% and 89.50% +/- 9.02%) between the auditory neuropathy group and the control group 1 year after booting.@*CONCLUSION@#Pre-operative EABR can be used as an effective tool to assess the auditory pathway of auditory neuropathy patients, improving the pre-operative examination and helping with selecting the suitable cochlear implant patient. Cochlear implantation can help patients with auditory neuropathy to improve hearing and speech.

Evaluation of intra-operative EABR characteristics and rehabilitation effects of cochlear implantation in patients with internal auditory canal stenosis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the intra-operative electrical evoked auditory brain stem response (EABR) characteristics and the hearing and speech rehabilitation effects of cochlear implantation (CI) in patients with internal auditory canal stenosis (IACS).@*METHOD@#A retrospective study was performed on 16 patients with IACS (IACS group) matched with 16 implanted without IACS (control group), who received multi- channel CI because of pre-lingual sensorineural hearing loss. The integrity and functional status of the auditory pathway were assessed by EABR, recording waveforms, thresholds and dynamic ranges intra-operation before CI. Interviewed the implanted parents or teachers, asking them to rate the implanted hearing and speech ability according to Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR). Paired T test was performed to compare scores of CAP and SIR between before and 1 year after CI, while Spearman test was performed to compare correlation between EABR grades and post-operative CAP scores.@*RESULT@#Among the IACS group, 2 cases weren't recorded typical EABR waveforms and without auditory response 1 year after a successful CI. The EABR waveforms in the IACS group were poorer than that in the control group, their EABR thresholds higher than the control group, and their EABR dynamic ranges less than the control group. The hearing and speech rehabilitation after CI showed that the results of CAP and SIR values (3.47 +/- 1.09 and 1.62 +/- 0.50) scored significantly lower than the control group (5.06 +/- 0.79 and 2.59 +/- 0.58) (P < 0.05), but significantly increased compared with pre-operation. Intra-operative EABR grades and post-operative CAP scores showed significant correlation (r = 0.78 , P < 0.05).@*CONCLUSION@#Intra-operative EABR can accurately monitor the integrity and functional status of the auditory pathway, be of important clinical value in predicting whether patients can acquire auditory responses with the aid of CI. CI can help patients with IACS to improve the ability of hearing and speech with EABR to screen out compatible implanted.

Cochlear implant patients underwent successful MRI examination after local bandaging: a case report / 临床耳鼻咽喉头颈外科杂志

A female patient, now 6 years old, received cochlear implant in the right ear at the age of 2 (February, 2006). In August 16, 2010, a cervical spine MRI examination was required due to the cervical spine injury in order to confirm the diagnosis. Considering the cochlea coil may interfere with the MRI examination results, a local bandaging around the ear was given to isolate cochlear magnetic field. The results of cervical spine MRI examinations showed no obvious disturbance, which suggests that we could further explore this method clinically.

The assessment of cochlear implantation assisted by EABR in patients with common cavity deformity / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the hearing and speech rehabilitation results of cochlear implantation in patients with common cavity deformity.@*METHOD@#A retrospective study was performed on 19 patients with common cavity deformity who received multi-channel cochlear implantation from 1995 to 2010 in Peking Union Hospital, with assisted evaluation of auditory nerve pathways by intraoperative electrical evoked auditory brain stem response (EABR); matched with 19 implantees with no deformity. Paired T test was performed to compare T values, dynamic range; Rank-sum test was performed to compare scores of categories of auditory performance (CAP) and speech intelligibility rating (SIR).@*RESULT@#The T value of common cavity inner ear malformation group (172.59 +/- 14.57) was significantly higher than that of the control group (139.63 +/- 19.45) (P 0.05); hearing and speech rehabilitation after implantation showed that the results of CAP and SIR values (5.50 +/- 0.94 and 3.00 +/- 0.82) scored significantly lower than the control group (6.90 +/- 0.77 and 3.90 +/- 0. 57) (P < 0.05), but significantly increased compared with that before. Some children appeared facial twitch at boot time caused by electrical stimulation of the facial nerve (surface pumping rate of 31.58%).@*CONCLUSION@#Common cavity is a kind of severe inner ear malformations, but to perform a comprehensive preoperative evaluation, select the appropriate surgical technique, employ personalized postoperative booting, transfer machines and long-term auditory intensive language training, the children can get varying degrees of language and hearing recovery according to the severity of deformity. On the whole, the rehabilitation outcome was significantly worse in patient with deformity than its counterpart without deformity.

Study for cochlear microphonic potential test in patients with profound sensorineural hearing loss / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To report intraoperative round window cochlear microphonic potential test (CM) in patients with profound sensorineural deafness.@*METHOD@#Intraoperative round window CM test were performed on 40 cases with profound sensorineural deafness during cochlear implantation surgery under general anesthesia in the standard operating room. CM were compared with their reliable preoperation distortion product otoacoustic emission (DPOAE).@*RESULT@#The CM were found in 40 patients. The rate at 0.5, 1.0, 2.0, 4.0. kHz was respectively 90%, 97.5%, 100%, 92.5%. The preoperation DPOAE were found in some frequency in 9 cases. The rate at 0.5, 1.0, 2.0, 4.0 kHz was respectively was 2.5%, 2.5%, 17.5%, 2.5%.@*CONCLUSION@#The elicited rate of CM was obviously higher than the one of DPOAE in the same patient with profound sensorineural deafness. The intraoperative round window CM may objectively and accurately estimate the part of cochlear function in patients with profound sensorineural deafness.

The research of cochlear implantation with other assident particular diseases / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To Respectively analyze extremely SNHL patients who received cochlear implants with other particular diseases, mainly introducing pre-/intra-/postoperative clinical experiences.@*METHOD@#Eight out of one thousand and three hundred patients who received cochlear implants in PUMC hospital were diagnosed with other assident particular diseases besides SNHL, which included hypopotassaemia, hemophilia, idiopathic thrombocytopenic purpura (ITP), favism, abnormal blood coagulation factor, abnormally high alkaline phosphatase. We would introduce pre-/intra-/postoperative clinical experiences by turns.@*RESULT@#All of the surgery were performed without any complication, and there were no remote complications.@*CONCLUSION@#SNHL patients with other assident particular diseases could accept cochlear implantation with carefully preparations before and during operation.

The Outcomes Measures of the Cochlear Implantation in Patients with Waardenburg Syndrome / 听力学及言语疾病杂志

Objective To measure the outcomes of the cochlear implantation for patients with Warrensburg syndrome in comparison with non-syndromic patients with sensorineural hearing loss. Methods 16 of 1 300 Waardenburg syndrome patients who received cochlear implants at PUMC hospital were reviewed in this papers. The authors will discuss the effects between Warrensburg syndrome and non- syndromic patients with sensorineural hearing loss by means of the Parents Evaluation of Aural-Oral Performance of Children (PEACH). Results There were no statistical difference in quiet, in noise, in overall results and in conversation on the phone between Warrensburg syndrome and non-syndromic patients. There was statistical difference between in quiet and in noise in every group. Conclusion The auditory perception and speech recognition between Warrensburg syndrome and non-syndromic patients with sensorineural hearing loss is same, and the results in quiet is better than that in noise.

The Pre-attentive Processes of Chinese Tones Transmitted by Cochlear Implant Users and Normal Hearing Subjects / 听力学及言语疾病杂志

Objective Event related potentials (ERP), especially mismatch negativity (MMN), as index, was utilized to study the processing of Chinese tones recognized by cochlear implant (CI) users and normal hearing subjects. Methods The auditory materials were Chinese words with four tones consisting of three different oddball blocks. The ERP and MMN of CI users and normal hearing subjects were recorded and analyzed in relation to the discrimination of those tones as tested. Results The ERP and MMN of CI users and normal hearing subjects were presented. The MMN of CI users includes two negative waves: the first negative wave (MMN1) occurred approxi-mately 100 ms, and the second wave (MMN2) at 300 ms. The MMN of normal hearing subjects includes two nega-tive waves too: the first negative wave (MMN1) occurred approximately 150 ms, and the second wave (MMN2) al-so at 300 ms. The MMN1 peak latency of CI users was obviously shorter than that of normal hearing subjects and the MMN2 peak latency of CI users shorter than that of normal hearing subjects too, but the difference of MMN2 peak latency between CI users and normal hearing subjects was not as significant as that of MMN1. Conclusion In the preattentive stage, CI users could process Chinese tones as normal hearing subjects, but compared with the pro-cessing of normal hearing subjects, there are some differences in the processing of CI users.

Analysis of the changes of Mandarin-tone recognition in pre-lingual deaf children of lower ages with cochlear implant / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the changing features of mandarin-tone recognition in lower prelingual children with cochlear implant after mapping.@*METHOD@#Twenty-nine children with CI were registered in this test, who were divided into two groups according to the age received the operation. They were group A whose ages were 3 to 4.5 years old, and group B whose ages were 5.0 to 6.5 years old. The time after first mapping was between 1.5 and -2.0 years. The test only included close-set phonetic recognition which was mainly used to evaluate Mandarin-tone recognition. The Phonetic Recognition List was used as the test material.@*RESULT@#The results showed that the percentages of correct recognition were same-single-syllable tones average (63.00+/-16.75)%; bi-syllable tones average (75. 60+/-11.18)%; single-character words average (72.38+/-11.39)% in A group children and respectively, (49.46+/-13.91)%; (64.71+/-9.64)%; (55.71+/-8.59)% in B group children. The recognition scores exceeded chance level in all results and they were better in A group. Statistical analysis(t test) showed significant difference between two groups.@*CONCLUSION@#The age is one of the most influence factors about Mandarin-tone recognition after implanting in pre-lingual children with CI. It is another important factor to influence studying Chinese after operation in the children.

HSV AMPLICON-MEDIATED NEUROTROPHIN-3 TRANSDUCTION PREVENTS MOUSE SPIRAL GANGLION NEURONS FROM DAMAGE / 解剖学报

Objective To determine whether NT 3 overexpression could abrogate DDP toxicity in vitro . Methods We constructed a herpes simplex virus(HSV) amplicon vector to transduce a c myc tagged version of rat NT 3. In the HSVnt 3myc vector, the chimeric neurotrophin cDNA was placed under the transcriptional control of the CMVIE promoter. The resultant vector was packaged utilizing the recently developed helper virus free method. Results Transduction of NT 3myc in cultured mouse cochlear explants at a multiplicity of infection(MOI) of 0 25 resulted in production of NT 3 up to 3?g/L over a 48 hours period. The mouse cochlear explants were transduced with HSVnt 3myc or HSVmiap(control vector expressing the reporter gene, murine intestinal alkaline phosphatase) for 48 hours and the exposed to cisplatin for 48 hours.The cochlear explants transduced with HSVnt 3myc had a significantly greater number of SGN survival than the control group. NT 3 powerfully enhanced the process length and the density of SGNs.Conclusion These data demonstrate that the neurotrophic cDNA transduction via HSV amplicon helper free virus system can attenuate the ototoxic action of DDP on organotypic culture. The potency of NT 3 in protecting spiral ganglion neurons from degenerating suggests that neurotrophins might be useful for the prevention or treatment of hearing disorders. [

Observation of the Spontaneous Discharge of Auditory Nerve Primary Fibers / 听力学及言语疾病杂志

Being fundamental preparation for the research of cochlear implants, study of tinnitus's mechanism and establishment of the animal model, the spontaneous discharge of single unit of auditory nerve primary fibers in normal cat was observed and analyzed. They include: Ⅰ, How to identify the spontaneous discharge potential in auditory nerve primary firbers. Ⅱ, The waveform of the spontaneous discharge potential in auditory never, Ⅲ, The discharge rate of spontaneous discharge in auditory nerve primary fibers. Ⅳ, The temporal feature of the spontaneous discharge. Ⅴ, The origin of the spontaneous discharge.