1、 Bilateral Cochlear Implantation雙側人工(rngng)耳蝸植入 sarah shu20140515第一頁，共二十頁。內容(nirng)：雙側人工耳蝸植入的歷史(lsh)雙側人工耳蝸植入國內外現狀雙側人工耳蝸植入效果數據雙側人工耳蝸植入注意事項當前植入雙側人工耳蝸的有利因素雙側案例第二頁，共二十頁。雙側人工耳蝸植入雙側人工雙側人工(rngng)(rngng)耳蝸植入歷耳蝸植入歷史史- Auditory system has the potential to process and integrate the additional information provi

2、ded by two different devices. (Balkany et al., 1988; Pijl, 1991; Green et al., 1992; van Hoesel et al.,1993). 聽覺中樞可以處理和整合雙側不同設備傳來的信號。-1996年，德國維爾茨堡ENT首次為重建(zhn jin)雙側聽覺，給成人植入雙側耳蝸。-1998年，上述機構基于同樣目的，給兒童植入雙側耳蝸。第三頁，共二十頁。二、雙側人工耳蝸二、雙側人工耳蝸(r w)(r w)植入國內外現狀植入國內外現狀國際：截止2007年12月，全球雙側人工耳蝸植入數量8000，占當時總植入數量的5%。具估

3、計目前全球人工耳蝸植入數量350,000例，雙側植入數量已超過10000。截止2007年12月，雙側植入者中，兒童所占比例62%，成人38%。72%的雙側植入為分期植入，28%為同期植入。同期植入的患者中，58%小于3歲。雙側植入的小齡化趨勢：以美國(mi u)為例，2007年前，50%的雙側植入者為3-10歲，2007年后，雙側植入小齡化趨勢更明顯，3歲以下兒童比例越來越大。第四頁，共二十頁。二、雙側人工耳蝸二、雙側人工耳蝸(r w)(r w)植入國內外現狀植入國內外現狀國內：截止目前，國內雙側人工耳蝸植入約300例，僅占總數(zngsh)1%左右，雙側植入者中98%為兒童 。近兩年增長趨勢

4、明顯。第五頁，共二十頁。- 言語(yny)識別- 聲源定位- 音樂欣賞- 綜合素質三、雙側人工三、雙側人工(rngng)(rngng)耳蝸植入效果數據耳蝸植入效果數據第六頁，共二十頁。言語識別提升：安靜言語識別提升：安靜(njng)(njng)環境下（兒童）環境下（兒童）安靜環境下雙側耳蝸(r w)的言語識別率提高15%。Khn-Inacker, H., Shehata-Dieler, W., Mller, J., Helms, J. (2004). Bilateral cochlear implants: a way to optimize Khn-Inacker, H., Shehata-

5、Dieler, W., Mller, J., Helms, J. (2004). Bilateral cochlear implants: a way to optimize auditory perception abilities in deaf children. auditory perception abilities in deaf children. Speech discrimination in quite (monosyllabic words) 安靜(njng)環境下的單音節詞辨別率Speech discrimination score (%)言語識別百分比第七頁，共二十

6、頁。言語識別言語識別(shbi)(shbi)提升：噪音環境下（兒童）提升：噪音環境下（兒童）噪音環境下雙側耳蝸(r w)的言語識別率提高20-30%。Khn-Inacker, H., Shehata-Dieler, W., Mller, J., Helms, J. (2004). Bilateral cochlear implants: a way to optimize auditory Khn-Inacker, H., Shehata-Dieler, W., Mller, J., Helms, J. (2004). Bilateral cochlear implants: a way to

7、 optimize auditory perception abilities in deaf children. perception abilities in deaf children. 第八頁，共二十頁。言語識別提升：安靜言語識別提升：安靜(njng)(njng)環境下（成人）環境下（成人）安靜環境下雙側耳蝸的言語(yny)識別率提高18%。Buss, E., Pillsbury, H., Buchman, C., Pillsbury, C., Clark, M., Haynes, D., Labadie, R., Amberg, S., Roland, Buss, E., Pills

8、bury, 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., P., Kruger, P., Novak, M., Wirth, J., Black, J., Peters, R., Lake, J., Wackym, P., Firszt, J., Wils

9、on, B., Lawson, D., Schatzer, R., DHaese, P., Barco, A. (2008). Multicenter U.S. Bilateral MED-EL Cochlear 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. Implantation Study: Speech P

10、erception over the First Year of Use. Percent correct, 正確率（%）Test interval, 測試時間點Worse unilateral, 使用(shyng)較差一側耳蝸Better unilateral，使用較好一側耳蝸Bilateral,使用雙側耳蝸第九頁，共二十頁。言語識別言語識別(shbi)(shbi)提升：噪音環境下（成人）提升：噪音環境下（成人）噪音環境(hunjng)下雙側耳蝸的言語識別率提高25-30%。Speech Understanding in Quiet and Noise in Bilateral Users

11、of the MED-EL COMBI 40/40 Cochlear Implant SystemSpeech Understanding in Quiet and Noise in Bilateral Users of the MED-EL COMBI 40/40 Cochlear Implant SystemJ. Mller, F. SchJ. Mller, F. Schn, and J. Helmsn, and J. Helms第十頁，共二十頁。聲源定位聲源定位(dngwi)(dngwi)提升：兒童提升：兒童雙側植入后，聲源定位(dngwi)誤差從單側的45降低到4.7。Schleich

12、, P., Nopp, P., Anderson, I. (2007). Development of localization abilities in bilaterally implanted children.第十一頁，共二十頁。聲源聲源(shn yun)(shn yun)定位提升：成人定位提升：成人單側植入的聲源(shn yun)定位誤差平均為46，雙側植入平均降低到16.9。Localization in Bilateral Users of MED-EL COMBI 40/40 Cochlear ImplantsLocalization in Bilateral Users of

13、 MED-EL COMBI 40/40 Cochlear ImplantsP. Nopp, P. Schleich, and P. DHaeseP. Nopp, P. Schleich, and P. DHaese第十二頁，共二十頁。音樂欣賞提升音樂欣賞提升(tshng)(tshng)：雙側植入的樂器識別比單側平均高出18.8%。比正常(zhngchng)聽力的樂器識別率僅低7.7%Comparison of Music Perception in Bilateral and Unilateral Cochlear Implant Users and Normal-Hearing Subjec

14、ts K . Veekmans a, b L. Ressel c 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, gJ. Mueller d M. Vischer f S.J. Brockmeier e, g第十三頁，共二十頁。單雙側聽覺智力和綜合能力單雙側聽覺智力和綜合能力(

15、nngl)(nngl)對比對比- 如果只有一側聽力：- 35%以上的兒童，至少留級一年。- 60%以上的兒童，在學習上需要額外( wi)的輔助。 Lee, D., Gmez-MarLee, D., Gmez-Marn, O., Lee, H. (1998). n, O., Lee, H. (1998). Prevalence of unilateral hearing Prevalence of unilateral hearing loss in children: the National loss in children: the National Health and Nutritio

16、n Examination Health and Nutrition Examination Survey II and the Hispanic Health Survey II and the Hispanic Health and Nutrition Examination Survey. and Nutrition Examination Survey. Ear Hear, 19(4), 329-32.Ear Hear, 19(4), 329-32.第十四頁，共二十頁。對雙側人工耳蝸對雙側人工耳蝸(r w)(r w)植入植入效果效果的共識的共識- 不論兒童或成人，雙側植入CI的效果都比

17、單側植入更好。- 除聽覺相關的客觀數據優勢外，雙側人工耳蝸植入還對患者的言語、情感、認知產生積極影響，提高生活(shnghu)質量。具有良好的投入/獲益比。 Balkany et al. (2008). Balkany et al. (2008). William House William House Cochlear Implant Study Group. Position Cochlear Implant Study Group. Position Statement on Bilateral Cochlear Statement on Bilateral Cochlear Impla

18、ntation. Otology & NeurotologyImplantation. Otology & NeurotologyBichey & Miyamoto. (2008). Bichey & Miyamoto. (2008). Outcomes in bilateral cochlear Outcomes in bilateral cochlear implantation. implantation. OtolaryngologyHead and Neck OtolaryngologyHead and Neck Surgery Surgery 第十五

19、頁，共二十頁。四、雙側人工四、雙側人工(rngng)(rngng)耳蝸植入注意事項耳蝸植入注意事項植入時植入時機機 兒童：研究發現，3.5歲前是較小兒童聽覺中樞(zhngsh)快速發育的敏感期。3.5歲前完成雙側耳蝸植入（分期或同期），能充分利用聽覺中樞發育的可塑性。成人語后聾：無明顯年齡傾向。Sharma, A., Gilley, P., Martin, K., Roland, P., Bauer, P., Dorman, M. (2007). Simultaneous versus sequential bilateral Sharma, A., Gilley, P., Martin, K

20、., Roland, P., Bauer, P., Dorman, M. (2007). Simultaneous versus sequential bilateral implantation in young children: Effects on central auditory system development and plasticity. implantation in young children: Effects on central auditory system development and plasticity. -Bilateral implantation

21、before the age of 3.5 years takes advantage of the plasticity in the developing central auditory nervous system. Bilateral implantation before the age of 3.5 years takes advantage of the plasticity in the developing central auditory nervous system. 第十六頁，共二十頁。雙側人工耳蝸雙側人工耳蝸(r w)(r w)植入注意事項植入注意事項手術手術兒童雙側植入手術注意事項兒童雙側植入手術注意事項針對嬰幼兒病例，術前應進行全面的麻醉評估(pn )。術中積