优化耳蜗神经发育不全的人工耳蜗植入效果：EMPES方案（早期植入、蜗轴贴近与早期开机）
Optimizing Cochlear Implant Outcomes in Cochlear Nerve Aplasia: The EMPES Protocol (Early Implantation, Modiolar Proximity, and Early Switch-On).
文献信息
| PMID | 42872457 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Suji Jeong |
| 作者单位 | Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam. |
| 期刊 | Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology |
| SCI 分区 | Q2 |
| IF | 1.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 评估EMPES[早期植入、蜗轴贴近（MP）与早期开机]方案在双侧耳蜗神经（CN）发育不全中的疗效。
研究设计： 回顾性队列研究。
地点： 三级转诊中心。
患者： 46例（86耳）双侧CN发育不全儿童于2011年至2024年间在2个三级中心接受人工耳蜗植入（CI）。
干预： 为进行电生理比较，CI使用CI24RE-CA电极且不后拉（常规植入）或使用纤细蜗轴电极并后拉（更好的MP）。为进行言语结果比较，常规方案组包括常规植入且随访≥12个月的病例，EMPES方案组包括更好的MP组中在12个月前植入并随访≥12个月的病例。
主要结局指标： 机制终点：术中ECAP阳性；功能终点：纵向听觉能力分类（CAP）评分至48个月。
结果： 更好的MP组显示更高的术中ECAP阳性率，并转化为更好的术后结果。EMPES方案在至12个月时的听觉表现方面显示出明显优势[CAP评分3.00（2.00至4.00）对比1.50（1.00至2.25）；P=0.010]，1年时反应差者（CAP<2）显著更少，并且在36个月内维持了更窄的中位CAP评分变异性，表明与常规方案相比听觉进展更稳定。未观察到基于MRI的CN发育不全严重程度与ECAP阳性或听力学结果之间存在明确关联。
结论： EMPES方案在关键语言期改善术后听力学结果，推荐用于双侧CN发育不全，以促进语言发育并可能减少对听觉脑干植入的需求。
英文摘要
OBJECTIVE: To evaluate the efficacy of EMPES [Early implantation, Modiolar Proximity (MP), and Early Switch-on] approach in bilateral cochlear nerve (CN) aplasia.
STUDY DESIGN: Retrospective cohort study.
SETTING: Tertiary referral center.
PATIENTS: Forty-six children (86 ears) with bilateral CN aplasia underwent cochlear implantation (CI) between 2011 and 2024 at 2 tertiary centers.
INTERVENTION: For electrophysiological comparison, CI was performed using CI24RE-CA electrodes without pull-back (conventional implantation) or a slim modiolar electrode with pull-back (better MP). For speech outcome comparison, the conventional approach group comprised conventional implantation cases with ≥12-month follow-up, and the EMPES approach group comprised those in the better MP group implanted before 12 months and followed for ≥12 months.
MAIN OUTCOME MEASURES: Mechanistic endpoint, intraoperative ECAP positivity; functional endpoint: longitudinal Categories of Auditory Performance (CAP) scores up to 48 months.
RESULTS: The better MP group showed higher intraoperative ECAP positivity, which translated into better postoperative outcomes. The EMPES approach demonstrated clear superiority in auditory performance up to 12 months [CAP score 3.00 (2.00 to 4.00) vs. 1.50 (1.00 to 2.25); P=0.010], with significantly fewer poor responders (CAP<2) at 1 year, and maintained narrower variability in median CAP scores through 36 months, indicating more stable auditory progress compared with the conventional approach. No clear association was observed between MRI-based CN aplasia severity and either ECAP positivity or audiological outcomes.
CONCLUSIONS: The EMPES approach improves postoperative audiological outcomes during critical language periods and is recommended for bilateral CN aplasia to enhance language development and potentially reduce the need for auditory brainstem implantation.