雙側(cè)人工耳蝸植入

1、 Bilateral Cochlear Implantation雙側(cè)人工耳蝸植入 sarah shu20140515內(nèi)容：一雙側(cè)人工耳蝸植入的歷史二雙側(cè)人工耳蝸植入國(guó)內(nèi)外現(xiàn)狀三雙側(cè)人工耳蝸植入效果數(shù)據(jù)四雙側(cè)人工耳蝸植入注意事項(xiàng)五當(dāng)前植入雙側(cè)人工耳蝸的有利因素六雙側(cè)案例一一雙側(cè)人工耳蝸植入歷史雙側(cè)人工耳蝸植入歷史- Auditory system has the potential to process and integrate the additional information provided by two different devices. (Balkany et al., 1988

2、; Pijl, 1991; Green et al., 1992; van Hoesel et al.,1993). 聽(tīng)覺(jué)中樞可以處理和整合雙側(cè)不同設(shè)備傳來(lái)的信號(hào)。- 1996年，德國(guó)維爾茨堡ENT首次為重建雙側(cè)聽(tīng)覺(jué)，給成人植入雙側(cè)耳蝸。- 1998年，上述機(jī)構(gòu)基于同樣目的，給兒童植入雙側(cè)耳蝸。二、雙側(cè)人工耳蝸植入國(guó)內(nèi)外現(xiàn)狀二、雙側(cè)人工耳蝸植入國(guó)內(nèi)外現(xiàn)狀國(guó)際：截止2007年12月，全球雙側(cè)人工耳蝸植入數(shù)量8000，占當(dāng)時(shí)總植入數(shù)量的5%。具估計(jì)目前全球人工耳蝸植入數(shù)量350,000例，雙側(cè)植入數(shù)量已超過(guò)10000。截止2007年12月，雙側(cè)植入者中，兒童所占比例62%，成人38%。72%的雙側(cè)

3、植入為分期植入，28%為同期植入。同期植入的患者中，58%小于3歲。雙側(cè)植入的小齡化趨勢(shì)：以美國(guó)為例，2007年前，50%的雙側(cè)植入者為3-10歲，2007年后，雙側(cè)植入小齡化趨勢(shì)更明顯，3歲以下兒童比例越來(lái)越大。二、雙側(cè)人工耳蝸植入國(guó)內(nèi)外現(xiàn)狀二、雙側(cè)人工耳蝸植入國(guó)內(nèi)外現(xiàn)狀國(guó)內(nèi)：截止目前，國(guó)內(nèi)雙側(cè)人工耳蝸植入約300例，僅占總數(shù)1%左右，雙側(cè)植入者中98%為兒童 。近兩年增長(zhǎng)趨勢(shì)明顯。- 言語(yǔ)識(shí)別- 聲源定位- 音樂(lè)欣賞- 綜合素質(zhì)三、雙側(cè)人工耳蝸植入效果數(shù)據(jù)三、雙側(cè)人工耳蝸植入效果數(shù)據(jù)言語(yǔ)識(shí)別提升：安靜環(huán)境下（兒童）言語(yǔ)識(shí)別提升：安靜環(huán)境下（兒童）安靜環(huán)境下雙側(cè)耳蝸的言語(yǔ)識(shí)別率提高15%。K

4、hn-Inacker, H., Shehata-Dieler, W., Mller, J., Helms, J. (2004). Bilateral cochlear implants: a way to Khn-Inacker, H., Shehata-Dieler, W., Mller, J., Helms, J. (2004). Bilateral cochlear implants: a way to optimize auditory perception abilities in deaf children. optimize auditory perception abiliti

5、es in deaf children. Speech discrimination in quite (monosyllabic words) 安靜環(huán)境下的單音節(jié)詞辨別率Speech discrimination score (%)言語(yǔ)識(shí)別百分比言語(yǔ)識(shí)別提升：噪音環(huán)境下（兒童）言語(yǔ)識(shí)別提升：噪音環(huán)境下（兒童）噪音環(huán)境下雙側(cè)耳蝸的言語(yǔ)識(shí)別率提高20-30%。Khn-InackerKhn-Inacker, H., , H., Shehata-DielerShehata-Dieler, W., , W., MllerMller, J., Helms, J. (2004). Bilateral co

6、chlear , J., Helms, J. (2004). Bilateral cochlear implants: a way to optimize auditory perception abilities in deaf children. implants: a way to optimize auditory perception abilities in deaf children. 言語(yǔ)識(shí)別提升：安靜環(huán)境下（成人）言語(yǔ)識(shí)別提升：安靜環(huán)境下（成人）安靜環(huán)境下雙側(cè)耳蝸的言語(yǔ)識(shí)別率提高18%。Buss, E., Pillsbury, H., Buchman, C., Pillsbu

7、ry, C., Clark, M., Haynes, D., Labadie, R., Amberg, 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., S., Roland, P., Kruger, P., Novak, M., Wirth, J., Black,

8、 J., Peters, R., Lake, J., Wackym, P., Firszt, J., Wilson, B., Lawson, D., Schatzer, R., DHaese, P., Barco, A. (2008). Multicenter U.S. Firszt, J., Wilson, B., Lawson, D., Schatzer, R., DHaese, P., Barco, A. (2008). Multicenter U.S. Bilateral MED-EL Cochlear Implantation Study: Speech Perception ove

9、r the First Year of Use. Bilateral MED-EL Cochlear Implantation Study: Speech Perception over the First Year of Use. Percent correct, 正確率（%）Test interval, 測(cè)試時(shí)間點(diǎn)Worse unilateral, 使用較差一側(cè)耳蝸Better unilateral，使用較好一側(cè)耳蝸Bilateral,使用雙側(cè)耳蝸言語(yǔ)識(shí)別提升：噪音環(huán)境下（成人）言語(yǔ)識(shí)別提升：噪音環(huán)境下（成人）噪音環(huán)境下雙側(cè)耳蝸的言語(yǔ)識(shí)別率提高25-30%。Speech Understan

10、ding in Quiet and Noise in Bilateral Users of the MED-EL COMBI 40/40 Cochlear Speech Understanding in Quiet and Noise in Bilateral Users of the MED-EL COMBI 40/40 Cochlear Implant SystemImplant SystemJ. J. MllerMller, F. , F. SchSchn n, and J. Helms, and J. Helms聲源定位提升：兒童聲源定位提升：兒童雙側(cè)植入后，聲源定位誤差從單側(cè)的45降

11、低到4.7。Schleich, P., Nopp, P., Anderson, I. (2007). Development of localization abilities in bilaterally implanted children.聲源定位提升：成人聲源定位提升：成人單側(cè)植入的聲源定位誤差平均為46，雙側(cè)植入平均降低到16.9。Localization in Bilateral Users of MED-EL COMBI 40/40 Cochlear ImplantsLocalization in Bilateral Users of MED-EL COMBI 40/40 Coc

12、hlear ImplantsP. Nopp, P. Schleich, and P. DHaeseP. Nopp, P. Schleich, and P. DHaese音樂(lè)欣賞提升：音樂(lè)欣賞提升：雙側(cè)植入的樂(lè)器識(shí)別比單側(cè)平均高出18.8%。比正常聽(tīng)力的樂(lè)器識(shí)別率僅低7.7%Comparison of Music Perception in Bilateral and Unilateral Cochlear Implant Users and Normal-Hearing Comparison of Music Perception in Bilateral and Unilateral Coc

13、hlear Implant Users and Normal-Hearing Subjects K . Veekmans a, b L. Ressel c J. Mueller d M. Vischer f S.J. Subjects K . Veekmans a, b L. Ressel c J. Mueller d M. Vischer f S.J. Brockmeier e, gBrockmeier e, g單雙側(cè)聽(tīng)覺(jué)智力和綜合能力對(duì)比單雙側(cè)聽(tīng)覺(jué)智力和綜合能力對(duì)比- 如果只有一側(cè)聽(tīng)力：- 35%以上的兒童，至少留級(jí)一年。- 60%以上的兒童，在學(xué)習(xí)上需要額外的輔助。 Lee, D., L

14、ee, D., Gmez-MarnGmez-Marn, O., Lee, H. , O., Lee, H. (1998). Prevalence of (1998). Prevalence of unilateral hearing loss in unilateral hearing loss in children: the National Health children: the National Health and Nutrition Examination and Nutrition Examination Survey II and the Hispanic Survey II

15、 and the Hispanic Health and Nutrition Health and Nutrition Examination Survey. Ear Hear, Examination Survey. Ear Hear, 19(4), 329-32.19(4), 329-32.對(duì)雙側(cè)人工耳蝸植入對(duì)雙側(cè)人工耳蝸植入效果效果的共識(shí)的共識(shí)- 不論兒童或成人，雙側(cè)植入CI的效果都比單側(cè)植入更好。- 除聽(tīng)覺(jué)相關(guān)的客觀數(shù)據(jù)優(yōu)勢(shì)外，雙側(cè)人工耳蝸植入還對(duì)患者的言語(yǔ)、情感、認(rèn)知產(chǎn)生積極影響，提高生活質(zhì)量。具有良好的投入/獲益比。 Balkany et al. (2008). Balkany e

16、t al. (2008). William House William House Cochlear Implant Study Group. Cochlear Implant Study Group. Position Statement on Bilateral Position Statement on Bilateral Cochlear Implantation. Otology & Cochlear Implantation. Otology & NeurotologyNeurotology BicheyBichey & Miyamoto. (2008).

17、Outcomes in & Miyamoto. (2008). Outcomes in bilateral cochlear implantation. bilateral cochlear implantation. OtolaryngologyHead and Neck Surgery OtolaryngologyHead and Neck Surgery 四、雙側(cè)人工耳蝸植入注意事項(xiàng)四、雙側(cè)人工耳蝸植入注意事項(xiàng)植入時(shí)機(jī)植入時(shí)機(jī) 兒童：研究發(fā)現(xiàn)，3.5歲前是較小兒童聽(tīng)覺(jué)中樞快速發(fā)育的敏感期。3.5歲前完成雙側(cè)耳蝸植入（分期或同期），能充分利用聽(tīng)覺(jué)中樞發(fā)育的可塑性。 成人語(yǔ)后聾：無(wú)明

18、顯年齡傾向。Sharma, A., Gilley, P., Martin, K., Roland, P., Bauer, P., Dorman, M. (2007). Simultaneous versus 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 sequential bilateral implantation in young children: Effects on central auditory system development and plasticity. and plasticity. -Bilateral implantation before the age of 3.5 years takes advantage of the plasticity in the developing Bilateral implantation before the age of 3.5 years takes adva