双侧人工耳蜗植入课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,11/7/2009,#,Headline,Textmasterformat bearbeiten,Zweite Ebene,Dritte Ebene,Vierte Ebene,Fnfte Ebene,Headline,Textmasterformat bearbeiten,Zweite Ebene,Dritte Ebene,Vierte Ebene,Fnfte Ebene,*,Headline,Textmasterformat bearbeiten,Zweite Ebene,Dritte Ebene,Vierte Ebene,Fnfte Ebene,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Bilateral Cochlear Implantation,双侧人工耳蜗植入,sarah shu20140515,内容：,双侧人工耳蜗植入的历史,双侧人工耳蜗植入国内外现状,双侧人工耳蜗植入效果数据,双侧人工耳蜗植入注意事项,当前植入双侧人工耳蜗的有利因素,双侧案例,双侧人工耳蜗植入历史,Auditory system has the potential to process and integrate the additional information provided by two different devices. (Balkany et al., 1988; Pijl, 1991; Green et al., 1992; van Hoesel et al.,1993),.,听觉中枢可以处理和整合双侧不同设备传来的信号。,1996,年，德国维尔茨堡,ENT,首次为重建双侧听觉，给成人植入双侧耳蜗。,1998,年，上述机构基于同样目的，给儿童植入双侧耳蜗。,二、双侧人工耳蜗植入国内外现状,国际：,截止,2007,年,12,月，全球双侧人工耳蜗植入数量,8000,，占当时总植入数量的,5%,。具估计目前全球人工耳蜗植入数量,350,000,例，双侧植入数量已超过,10000,。,截止,2007,年,12,月，双侧植入者中，儿童所占比例,62%,，成人,38%,。,72%,的双侧植入为分期植入，,28%,为同期植入。,同期植入的患者中，,58%,小于,3,岁。,双侧植入的小龄化趋势：以美国为例，,2007,年前，,50%,的双侧植入者为,3-10,岁，,2007,年后，双侧植入小龄化趋势更明显，,3,岁以下儿童比例越来越大。,二、双侧人工耳蜗植入国内外现状,国内：,截止目前，国内双侧人工耳蜗植入约,300,例，仅占总数,1%,左右，双侧植入者中,98%,为儿童,。,近两年增长趋势明显。,言语识别,声源定位,音乐欣赏,综合素质,三、双侧人工耳蜗植入效果数据,言语识别提升：安静环境下（儿童）,安静环境下双侧耳蜗的言语识别率提高,15%,。,Khn-Inacker, H., Shehata-Dieler, W., Mller, J., Helms, J. (2004). Bilateral cochlear implants: a way to optimize auditory perception abilities in deaf children.,Speech discrimination in quite (monosyllabic words),安静环境下的单音节词辨别率,Speech discrimination score (%),言语识别百分比,言语识别提升：噪音环境下（儿童）,噪音环境下双侧耳蜗的言语识别率提高,20-30%,。,Khn-Inacker, H., Shehata-Dieler, W., Mller, J., Helms, J. (2004). Bilateral cochlear implants: a way to optimize auditory perception abilities in deaf children.,言语识别提升：安静环境下（成人）,安静环境下双侧耳蜗的言语识别率提高,18%,。,Buss, E., Pillsbury, H., Buchman, C., Pillsbury, C., Clark, M., Haynes, D., Labadie, R., Amberg, S., Roland, P., Kruger, P., Novak, M., Wirth, J., Black, J., Peters, R., Lake, J., Wackym, P., Firszt, J., Wilson, B., Lawson, D., Schatzer, R., DHaese, P., Barco, A. (2008). Multicenter U.S. Bilateral MED-EL Cochlear Implantation Study: Speech Perception over the First Year of Use.,Percent correct,正确率（,%,）,Test interval,测试时间点,Worse unilateral,使用较差一侧耳蜗,Better unilateral,，使用较好一侧耳蜗,Bilateral,使用双侧耳蜗,言语识别提升：噪音环境下（成人）,噪音环境下双侧耳蜗的言语识别率提高,25-30%,。,Speech Understanding in Quiet and Noise in Bilateral Users of the MED-EL COMBI 40/40 Cochlear Implant System,J. Mller, F. Schn, and J. Helms,声源定位提升：儿童,双侧植入后，声源定位误差从单侧的,45,降低到,4.7,。,Schleich, P., Nopp, P., Anderson, I.,(2007). Development of localization abilities in bilaterally implanted children.,声源定位提升：成人,单侧植入的声源定位误差平均为,46,，双侧植入平均降低到,16.9,。,Localization in Bilateral Users of MED-EL COMBI 40/40 Cochlear Implants,P. Nopp, P. Schleich, and P. DHaese,音乐欣赏提升：,双侧植入的乐器识别比单侧平均高出,18.8%,。,比正常听力的乐器识别率仅低,7.7%,Comparison of Music Perception in Bilateral and Unilateral Cochlear Implant Users and Normal-Hearing Subjects K . Veekmans a, b L. Ressel c J. Mueller d M. Vischer f S.J. Brockmeier e, g,单双侧听觉智力和综合能力对比,如果只有一侧听力：,35%,以上的儿童，至少留级一年。,60%,以上的儿童，在学习上需要额外的辅助,。,Lee, D., Gmez-Marn, O., Lee, H. (1998). Prevalence of unilateral hearing loss in children: the National Health and Nutrition Examination Survey II and the Hispanic Health and Nutrition Examination Survey. Ear Hear, 19(4), 329-32.,对双侧人工耳蜗植入,效果,的共识,不论儿童或成人，双侧植入,CI,的效果都比单侧植入更好。,除听觉相关的客观数据优势外，双侧人工耳蜗植入还对患者的,言语、情感、认知,产生积极影响，提高生活质量。具有良好的投入,/,获益比。,Balkany et al. (2008). William House Cochlear Implant Study Group. Position Statement on Bilateral Cochlear Implantation. Otology & Neurotology,Bichey & Miyamoto. (2008). Outcomes in bilateral cochlear implantation. OtolaryngologyHead and Neck Surgery,四、双侧人工耳蜗植入注意事项,植入时机,儿童：研究发现，,3.5,岁前是较小儿童听觉中枢快速发育的敏感期。,3.5,岁前完成双侧耳蜗植入（分期或同期），能充分利用听觉中枢发育的可塑性。,成人语后聋：无明显年龄倾向。,Sharma, A., Gilley, P., Martin, K., Roland, P., Bauer, P., Dorman, M. (2007). Simultaneous versus sequential bilateral implantation in young children: Effects on central auditory system development and plasticity.,Bilateral implantation before the age of 3.5 years takes advantage of the plasticity in the developing central auditory nervous system.,双侧人工耳蜗植入注意事项,手术,儿童双侧植入手术注意事项,针对婴幼儿病例，术前应进行全面的麻醉评估。,术中积极止血，降低出血量。,以足够显露术区为限，使用小切口，控制乳突开放的范围，降低对佩戴体外机的影响。,尽可能选择小的植入体，普通植入体则需深磨植入体骨床，减小术后双侧颞部凸起。,植入第二侧时，不能使用单极电凝。,在双侧耳蜗植入手术中使用无创方案的必要性,单侧植入耳蜗的病例，另一侧可在未来使用新技术治疗。,只有使用无创植入方案，双侧植入耳蜗的病例，才能有余地使用新技术,五、当前人工耳蜗双侧植入的优势,1,、最新植入体的微型化,满足患者对外观要求,2,、电极,/,手术无创化,保护耳蜗结构，,不影响未来新技术应用,3,、体外设备一体化，利于双侧佩戴,4,、编码策略唯一支持,ITD,和,ILD,：精确声源定位,无须磨骨床，更小切口，,操作简便，缩短手术及麻醉时间，,更佳的固定，长期稳定，不扭转,六、双侧病例效果展示：,1,、病史信息：,李,先天性感音神经性耳聋，,6,个月时确诊，植入时年龄,12,个月，开机时间,13,个月，目前年龄：,3,岁。,2,、目前康复情况（视频）：,