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目的 探讨在人工耳蜗植入术中能快速、准确地判断人工耳蜗装置的完好性和患者客观听觉反应的监测方法。方法 在 40例患儿人工耳蜗植入术中先测定电极阻抗 ,然后使用神经反应遥测技术 (neuralresponsetelemetry,NRT)监测 6个电极的电诱发听神经复合动作电位 (electricallyevokedauditorynervecompoundactionpotentials,ECAP)。结果 患儿所有电极阻抗正常 ,ECAP的检出率分别为 97 5 %(39例 / 40例 )和 92 1%(2 2 1个电极 / 2 40个电极 )。其中 33例内耳无畸形的患儿所有198个测试电极中有 195个电极测出清晰的ECAP波形 (98 5 %)。 7例内耳Mondini畸形患者共 42个测试电极中有 2 6个电极测得ECAP波形 (6 1 9%) ,两组之间差异有极显著性。靠近耳蜗底回 (高频区 )的电极比靠近蜗尖 (低频区 )的电极具有较高的ECAP反应阈值和较高的ECAP饱和阈值。结论 NRT技术可以简便、快速和准确地判断患者的听神经反应 ,可望成为术中常规监测方法 ,内耳Mondini畸形是影响ECAP检出的重要因素。
Objective To investigate the method of monitoring the integrity of auditory cochlear devices and objective auditory responses in cochlear implants. Methods Electrode impedance was measured in 40 children with cochlear implants. Electro-induced auditory neuropoerative potentials (ECAP) were then measured at 6 electrodes using neural response telemetry (NRT). Results The impedance of all the electrodes in children was normal. The detection rate of ECAP was 97.5% (39 cases / 40 cases) and 92.1% (221 cases / 240 electrodes) respectively. Among them, 195 of the 198 test electrodes in 33 children without deformity of the inner ear detected a clear ECAP waveform (98.5%). The ECAP waveforms (6 1 9%) were detected in 26 of 42 test electrodes in 7 patients with Mondini deformity in the inner ear. There was a significant difference between the two groups. The electrode near the bottom of the cochlea (high frequency region) has a higher ECAP response threshold and a higher ECAP saturation threshold than the electrode near the tip (low frequency region). Conclusion NRT can judge the auditory nerve response of patients easily, rapidly and accurately, and it is expected to be the routine monitoring method. Mondini malformation of the inner ear is an important factor affecting the detection of ECAP.