目的 分析大前庭水管综合征（enlarged vestibular aqueduct，LVAS）成年患者人工耳蜗植入（cochlear implantation，CI）手术疗效。 方法 回顾2019年1月~2021年12月本院32例人工耳蜗手术患者临床资料，根据是否患有LVAS，分为LVAS组（16例）和对照组（16例），分别在术前和术后12月、18月进行听阈和言语识别率测试、听觉行为分级（category of auditory performance-II，CAP-II）和言语可懂度分级评估（speech intelligibility rating，SIR）、自信心及满意度评分，对两组患者进行比较，并评价听觉言语情况与耳蜗植入时机的关系。 结果 两组患者电极均成功植入，术后均未发生面瘫、感染、电极脱出等并发症；术后12月，LVAS组与对照组语后聋患者的声场助听听阈（P=0.554）、言语识别率（P=0.425）、CAP-II评分（P=0.288）、SIR评分（P=0.105）、自信心评分（P=0.301）、满意度评分（P=0.618）无统计学差异（P>0.05）；术后18月，LVAS组与对照组语后聋患者的声场助听听阈（P=0.682）、言语识别率（P=0.501）、CAP-II评分（P=0.555）、SIR评分（P=0.192）、自信心评分（P=0.631）、满意度评分（P=0.618）无统计学差异（P>0.05）；两组患者术后1年CAP-II评分、满意度评分与耳聋时间具有负相关关系（P<0.05）；LVAS组CAP-II评分与耳聋发生年龄具有正相关关系（P<0.05），两组评分均与植入年龄、助听器佩戴时间无明显相关性（P>0.05）。 结论 成年重度以上LVAS患者接受人工耳蜗植入手术可以获得与内耳结构发育正常的其他患者近似的听觉言语康复效果，人工耳蜗植入术可作为伴有重度以上感音神经性聋的成年LVAS患者听觉康复的主要治疗手段。
Abstract
Objective To assess the efficacy of cochlear implantation (CI) in adult patients with enlarged vestibular aqueduct syndrome (LVAS). Methods A retrospective analysis was conducted on clinical data from 32 patients who underwent cochlear implant surgery between January 2019 and December 2021. Patients were categorized into the LVAS group (16 cases) and the control group (16 cases) based on the presence of LVAS. Audiometric testing, speech recognition rate assessment, category of auditory performance-II (CAP-II), speech intelligibility rating (SIR), self-confidence, and satisfaction scores were compared between the two groups before surgery and at 12 and 18 months post-cochlear implantation. The relationship between the auditory-oral conditions of the two groups and the timing of cochlear implantation were evaluated. Results Successful electrode implantation was achieved in both groups, and no postoperative complications such as facial paralysis, infection, or electrode displacement were observed. At 12 months postoperatively, there were no significant differences between the postlingual deaf patients of LVAS group and the control group in aided audiometric thresholds (P=0.554), speech recognition rates (P=0.425), CAP-II scores (P=0.288), SIR scores (P=0.105), self-confidence scores (P=0.301), and satisfaction scores (P=0.618) (P>0.05). Similarly, at 18 months postoperatively, there were no significant differences in the mentioned parameters between the two groups (P>0.05) in aided audiometric thresholds (P=0.682), speech recognition rates (P=0.501), CAP-II scores (P=0.555), SIR scores (P=0.192), self-confidence scores (P=0.631), and satisfaction scores (P=0.618). CAP-II scores and satisfaction scores in both groups were negatively correlated with the duration of deafness at one year postoperatively (P<0.05). The CAP-II scores of LVAS group showed a positive correlation with the age of onset of hearing loss (P<0.05), while there was no significant correlation with the age of implantation and hearing aid wearing time in either group (P>0.05). Conclusions Cochlear implantation in adult patients with severe or profound LVAS can yield auditory-oral rehabilitation outcomes comparable to those of adult patients with normal inner ear development. Cochlear implantation serves as a primary means for auditory rehabilitation in adult LVAS patients with severe or profound sensorineural hearing loss.
关键词
大前庭水管综合征 /
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人工耳蜗植入术 /
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听觉康复 /
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成人
Key words
Large vestibular aqueduct syndrome /
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Cochlear implantation /
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Auditory rehabilitation /
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Adults
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