目的 探讨共同腔畸形(common cavity deformity,CCD)患者使用定制电极经乳突缝状迷路切开入路(transmastoid slotted labyrinthotomy approach,TSLA)行人工耳蜗植入(cochlear implantation,CI),术后长期听觉及言语功能发展规律.方法 本研究共纳入了首都医科大学附属北京同仁医院36例CCD经TSLA径路植入定制电极的单侧CI患儿及61例同年龄段内耳结构无异常的单侧CI患儿.由同一组经过统一规范化培训的专业人员使用听觉行为分级标准(Categories of Auditory Performance,CAP)量表、言语可懂度分级标准(Speech Intelligibility Rating,SIR)量表、婴幼儿有意义听觉整合量表(Infant-Toddler Meaningful Auditory Integration Scale,IT-MAIS)/有意义听觉整合量表(Meaningful Auditory Integration Scale,MAIS)、有意义使用言语量表(Meaningful Use of Speech Scale,MUSS)评估所有受试者听觉和言语能力.分别CI术前及开机后分别在1、3、6、12、18、24、36、48、60、72、84个月时进行评估.结果 广义估计方程分析结果提示,本研究受试者术前及术后听觉言语康复效果组别、时间及其交互效应均有统计学意义(P＜0.05).CCD组患儿CAP得分在术前和术后开机1、3、6、12、18个月之间差异均有统计学意义(P＜0.05),在开机24、36、48、60个月间差异均无统计学意义(P＞0.05);IT-MAIS/MAIS得分百分比在开机1、3、6、12、24个月间差异有统计学意义(P＜0.05),在开机24、36、48、60个月间差异均无统计学意义(P＞0.05);SIR得分在术前、开机1、3个月间差异均无统计学意义(P＞0.05),在开机6、12、18个月间差异有统计学意义(P＜0.05),在开机18、24、36、48、60个月间差异均无统计学意义(P＞0.05);MUSS得分百分比在术前、开机1、3个月间差异均无统计学意义(P＞0.05),在开机3、6、12、18个月间差异有统计学意义(P＜0.05),在开机24、36、48、60个月间差异均无统计学意义(P＞0.05).CCD组患儿CI术后CAP得分及IT-MAIS/MAIS得分百分比在开机后1、3、6、12、18、24、36、48及60个月均显著低于对照组(P＜0.05),SIR得分及MUSS得分百分比在开机后3、6、12、18、24、36、48及60个月均显著低于对照组(P＜005).结论 经TSLA径路配合定制电极的CI可以有效帮助CCD患儿获得长期听觉言语收益,但较内耳结构无异常患儿CI术后听觉言语功能发育迟缓.CCD患儿CI术后听觉功能发育呈现开机2年内快速增长的趋势,在两年后呈缓慢增长趋势;其言语能力发育在开机后6个月至18个月内呈快速增长趋势,在18个月至7年内呈现缓慢增长趋势.
Long-term outcomes after cochlear implantation with customized electrodes via transmastoid slotted labyrinthotomy approach in patients with common cavity deformity
Objective To investigate the long-term development of auditory and speech function after cochlear implantation(CI)using the transmastoid slotted labyrinthotomy approach(TSLA)with customized electrodes in patients with common cavity deformity(CCD).Methods Thirty-six children with CCD,all of whom underwent unilateral CI,were included in this study,and 61 children match on age who underwent unilateral CI but with normal inner ear structure were selected as a control group from Beijing Tongren Hospital,Capital Medical University.The auditory and speech performance of all subjects were assessed by the professionals staff with uniform standardized training using the following assessment tools:Categories of Auditory Performance(CAP),Speech Intelligibility Rating(SIR),Infant-Toddler Meaningful Auditory Integration Scale/Meaningful Auditory Integration Scale(IT-MAIS/MAIS),and Meaningful Use of Speech Scale(MUSS).Assessments were performed at pre-surgery and 1,3,6,12,18,24,36,48,60,72,and 84 months after CI switch-on.Results The generalized estimating equation analysis suggested that the preoperative and postoperative auditory speech rehabilitation effects of the subjects in this study were statistically significant in terms of group,time,and their interaction effects(P＜0.05).The differences in CAP scores of the CCD group were statistically significant among preoperative and postoperative 1,3,6,12,and 18 months after switch-on(P＜0.05),while the increase stabilized among 24,36,48,and 60 months(P＞0.05).The percentages of IT-MAIS/MAIS scores were significantly different among preoperative and postoperative 1,3,6,12,and 24 months after switch-on(P＜0.05),with no significant difference among 24,36,48,and 60 months(P＞0.05).SIR scores were not significantly different among preoperative and 1,3 months after switch-on(P＞0.05),but significantly different among 6,12,and 18 months after switch-on(P＜0.05),again it showed no significantly difference among 18,24,36,48,and 60 months after switch-on(P＞0.05).The percentages of MUSS score was not significantly different among preoperative and 1,3 months after switch-on(P＞0.05),among 3,6,12,and 18 months after switch-on(P＜0.05),and among 24,36,48,and 60 months after switch-on(P＞0.05).Compared with the control group,CCD group had significantly lower CAP scores and percentage of IT-MAIS/MAIS scores from 1 to 60 months after switch-on(P＜0.05),and significantly lower SIR scores and percentage of MUSS scores from 3 to 60 months after switch-on(P＜0.05).Conclusions CI via the TSLA with customized electrodes can be effective in achieving long-term auditory and speech benefits in CCD children,but the development of auditory speech function is delayed after CI compared with that of children without structural abnormality of the inner ear.The development of auditory performance in children with CCD after CI shows a trend of rapid growth within 2 years of switch-on,and then a trend of slow growth after 2 years.The development of their speech ability shows a trend of rapid growth from 6 months to 18 months after switch-on,and then a trend of slow growth from 18 months to 7 years.
common cavity deformitytransmastoid slotted labyrinthotomy approachcochlear implantationauditory and speech rehabilitation outcomes
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