唯一听力耳听神经瘤患者人工耳蜗植入疗效分析

摘要

Objective To discuss the method as well as effect of hearing restoration for patients with acoustic neuroma (AN) in the only hearing ear.Methods A retrospective study was conducted in three patients with AN in the only hearing ear.Ipsilateral cochlear implantation (CI) was performed in case 1 and contralateral CI was performed in case 2 without tumor resection.In case 3,CI was performed 6 months after tumor removal by the retrosigmoid approach.Dynamic changes in the audiological tests was recorded regularly.Results In case 1 and case 2,no matter which side CI was performed,pure tone average (PTA) was improved clearly,and speech discrimination score (SDS) was slightly increased.In case 3,heating loss was observed after tumor removal.Simultaneous bilateral CI after 12 months was performed in this case.PTA on both sides was largely lower than that before CI,and SDS was slightly improved.With bilateral CI,SDS was improved,especially in noise,compared with unilateral CI on either side.Conclusions For patients with AN in the only hearing ear,CI can significantly improve PTA,and SDS can be slightly increased.Bilateral CI should improve the outcome of hearing restoration compared with unilateral CI.%目的 探讨唯一听力耳听神经瘤患者人工耳蜗植入的康复效果.方法 收集3例唯一听力耳发生听神经瘤的典型病例,对其病史、听力状况、诊疗策略及人工耳蜗康复效果进行回顾性分析.病例1及病例2均未行听神经瘤切除术,前者于肿瘤侧带瘤植入人工耳蜗,后者在肿瘤对侧植人人工耳蜗.病例3患者经乙状窦后径路行唯一听力耳听神经瘤切除术,术后6个月双侧同期植人人工耳蜗.患者植入后定期听力学随访,记录并比较纯音听阈和言语识别率.结果 病例1及病例2中,无论在肿瘤侧或是肿瘤对侧单侧人工耳蜗植入,术后语言频率气导平均听阈显著改善,言语识别率较术前略有提高.病例3听神经瘤切除后,术侧听力明显下降;同期双侧人工耳蜗植入后随访12个月,双耳语言频率助听听阈较术前听阈明显下降,言语识别率较术前略有提高;同时使用双侧人工耳蜗较仅使用任一单侧人工耳蜗时,言语识别率有所提高,噪声下提高更为明显.结论 唯一听力耳听神经瘤患者植入人工耳蜗可显著改善纯音听阈,言语识别能力略有提高.双侧人工耳蜗植入的听力康复效果优于单侧植入.