双侧先天性外中耳畸形患者骨锚式助听器效果分析

摘要

Objective To evaluate the efficacy and satisfaction of bone-anchored hearing aids (BAHA) in patients with outer and middle ear deformities.Methods Seven patients with bilateral microtia and aural atresia,and three patients with unilateral microtia and bilateral middle ear malformation were fitted with soft-band BAHA for a few months,followed by receiving unilateral BAHA implantation.Mean pure-tone thresholds and speech audiometry tests results were compared among patients without hearing aid,with softband BAHA, and with implanted BAHA. Scores from the BAHA users' questionnaires and Glasgow children's benefit inventory (GCBI) were used to measure patient satisfaction and subjective health benefit.Results The mean pure-tone thresholds of the patients were ( 64.8 ± 5.9 ) dBHL for those without hearing aid,(30.2 ± 3.7) dBHL for those with soft-band BAHA,and (20.3 ± 3.9 ) dBHL for those with implanted BAHA.The average decline in pure-tone threshold was (36.2 ± 8.0)dBHL for those with soft-band BAHA,and an additional decline of (12.2 ± 3.4)dBHL was achieved with implanted BAHA.The average gains in speech discrimination scores (SDS) were ( 3.00 ± 1.07 ) ％ for those without hearing aids and ( 89.39 ± 5.83) ％ for those with implanted BAHA in sound field of 45dBHL.SDS were(57.55 ± 10.30) ％ for those without hearing aids and (91.19 ± 4.16)％ for those with implanted BAHA in sound field of 65 dBHL.The average gains in SDS were ( 88.21 ± 6.86) ％ and ( 38.04 ± 7.56) ％ tested with 45dBHL and 65dBHL respectively.Sound reception thresholds (SRT) without hearing aids were (63.1 ± 5.9 )dBHL and (24.7 ± 3.5 )dBHL for those with implanted BAHA.The average gains in SRT was(39.6 ± 6.2)dBHL.The BAHA application questionnaire demonstrated excellent patient satisfaction.The general benefit score was 35.59 ± 14.35.Conclusion BAHA remains one of the most reliable methods of auditory rehabilitation and improves quality of life for patients with ear deformities.%目的 评估双侧先天性外中耳畸形患者应用骨锚式助听器(bone-anchored hearing aid,BAHA)后的听力效果及满意度.方法 双侧先天性耳廓畸形合并外耳道闭锁患者7例,单侧耳廓畸形伴双侧中耳畸形3例,佩戴软带BAHA后单侧植入BAHA钛植入体.分别测试患者在声场中裸耳与应用软带BAHA、植入式BAHA后的平均听阈、言语识别率及言语识别阈.以BAHA应用情况调查问卷和儿童格拉斯格受益列表(Glasgow children's benefit inventory,GCBI)分析患者应用BAHA后的生活质量提高程度和满意度.结果 患者裸耳平均听阈为(64.8 ±5.9)dBHL,佩戴软带BAHA后平均听阈降至(30.2±3.7) dBHL,佩戴植入式BAHA后平均听阈为(20.3±3.9) dBHL,三者两两比较,差异均具有统计学意义(P值均＜0.05).佩戴软带BAHA后患者听阈较裸耳平均下降(36.1±8.0)dB;植入式BAHA听阈较软带BAHA平均下降(12.2 ±3.4)dB.在45dBHL和65dBHL给声强度下,裸耳言语识别率分别为(3.00±1.07)％和(57.55 ±10.30)％,植入BAHA后言语识别率提高至(89.39±5.83)％和(91.19 ±4.16)％,二者差异具有统计学意义(P值均＜0.05).裸耳平均言语识别阈为(63.1±5.9) dBHL,佩戴植入式BAHA后为(24.7±3.5) dBHL,二者差异具有统计学意义(P＜0.05).BAHA应用情况调查问卷显示患者应用软带BAHA和植入式BAHA均获得满意效果,GCBI平均受益分数为(35.59 ±14.35)分.结论 对于双侧先天性外中耳畸形患者,应用BAHA可显著改善其听力及生活质量,患者满意度较高.