四种助听装置对双侧先天性中外耳畸形患者效果的比较

摘要

Objective To compare efficacy of BAHA(softband and implant),VSB implant,bone bridge(BB)im-plant and bone conduction hearing aid (BCHA) in patients with bilateral congenital deformation of middle and outer ears. Methods Improvement of average air conduction pure tone thresholds or conditioned reflex audiometry (sound field)thresholds at 0.5-4kHz and speech recognition scores at 65 dB SPL in quiet and noisy settings were compared among four types of hearing aiding devices in 28 cases,including BAHA softband(n=6),BAHA implant(n=3),VSB (n=5),BB (n=2) and BCHA(n=12). Results The average improvement of air conduction threshold was 29.8 dB for BAHA softband(from 61.3 dB HL to 31.5 dB HL),41.8 dB for BAHA implant(from 63 dB HL to 21.2 dB HL),45.5 dB for VSB(from 69.3 dB HL to 23.8 dB HL),36.9 dB for BB(from 66.9 dB to 30 dB HL),and 31.1 dB for BCHA (from 63.6 dB HL to 32.5 dB HL),respectively.Sentence recognition score was 11-31% without aiding,but improved to 89.5-93.5% when aided with BAHA softband, bone bridge and BAHA implant and to 96-100% when aided with VSB.Conclusion All these aiding devices are effective solutions for hearing in patients with bilateral congenital defor-mation of middle and outer ears.BAHA softband seems to be similarly effective as BCHA at all frequencies,but espe-cially at 0.5 and 1 kHz(up to 30 dB HL).BAHA implant can further improve hearing threshold to normal levels at 2 kHz and VSB is especially good at high frequency (2 kHz) but less so at 1 kHz(down to 50 dB HL).BB shows an as-cending curve with thresholds ranging from 20 to 40 dB HL.Sentence recognition scores are better with BAHA implant and VSB than with BAHA softband and BB.These aiding devices need to be selected based on an individual patient's development status,hearing levels and socioeconomic situations.%目的 比较BAHA(软带与植入式佩带)、振动声桥(VSB)、骨桥(BB)与骨导助听器(BCHA)对双侧先天性中外耳畸形患者听力改善的效果,为听力解决方案的选择提供参考.方法 比较四种助听装置(5组),包括软带BAHA(6例)、植入式BAHA(3例)、VSB植入(5例)、BB植入(2例)及骨导助听器(12例),共28例患者助听前后交流情况、0.5kHz-4kHz纯音测听或条件反射测听(声场)平均气导阈值改善情况及安静和噪声环境下65dBSPL言语识别率.结果 助听后均能完成日常交流.平均气导阈值改善分别为29.8dB(61.3dB/31.5dB)、41.8dB(63dB/21.2dB)、45.5dB(69.3dB/23.8dB),36.9dB(66.9dB/30dB),31.1dB(63.6dB/32.5dB).句子识别率,助听前11-31%,助听后软带BAHA和植入骨桥89.5-93.5%,植入式BAHA和VSB 96-100%.结论 四种助听装置(5组)均能使患者获得明显的听力改善.软带BAHA与骨导助听器类似,听力曲线呈弓形,在0.5k、1 kHz最佳,30dB左右,植入BAHA在2kHz进一步改善达正常水平,植入VSB在高频(2kHz左右)效果好,但低频1kHz以下不理想;而BB听力曲线呈上升型,阈值在20-40 dB水平.助听后句子识别率植入式BAHA和VSB较软带BAHA和植入骨桥好.同时还要结合患者的发育状况、听力水平、经济能力来选择助听方案.