一例具有大量残余听力的儿童人工耳蜗植入后高频听力的长期保留：病例报告

文献信息

中文摘要

背景/目的： 具有大量残余听力的儿童行人工耳蜗植入（CI）仍因听力损失风险而具有挑战性。部分耳聋治疗和听力保留传统上关注功能上有用的低频听力，而高频范围内的残余听力在既有分类中尚未被专门涉及。儿童CI后保留大量高频残余听力的长期数据仍然有限。我们报告一例儿童病例，展示CI后高频残余听力保留5年。方法：一名14岁双侧感音神经性听力损失女孩接受了左侧CI，经圆窗插入MED-EL FLEX 28电极。在术前及术后1、12、24和60个月评估纯音阈值。使用Skarzynski分类评估听力保留，并在植入前和24个月时评估言语感知。结果：术前，2000-8000 Hz气导阈值≤70 dB HL。总体听力保留在1、12和24个月时为完全保留，在60个月时为部分保留。重要的是，2000-8000 Hz的听力保留在整个60个月随访期间保持完全，S值分别为90.7%、76.7%、79.1%和76.7%。在24个月时，与术前助听状态相比，植入耳的词识别在安静环境中提高35个百分点，在噪声中提高70个百分点。结论：本病例展示了一名术前听力特征不典型的青少年在CI后大量高频残余听力保留5年。这些发现提示，对于常规助听器功能获益不足的特定大量残余听力患者，可考虑人工耳蜗植入。然而，不能从单一病例得出关于人工耳蜗植入适应证的更广泛结论。

英文摘要

Background/Objectives: Cochlear implantation (CI) in children with substantial residual hearing remains challenging because of the risk of hearing loss. Partial deafness treatment and hearing preservation have traditionally focused on functionally useful low-frequency hearing, while residual hearing in the high-frequency range has not been specifically addressed in established classifications. Long-term data on preservation of substantial high-frequency residual hearing after CI in children remain limited. We present a pediatric case demonstrating 5-year preservation of high-frequency residual hearing after CI. Methods: A 14-year-old girl with bilateral sensorineural hearing loss underwent left CI with a MED-EL FLEX 28 electrode inserted through the round window. Pure-tone thresholds were assessed preoperatively and at 1, 12, 24, and 60 months postoperatively. Hearing preservation was evaluated using the Skarzynski classification, and speech perception was assessed before implantation and at 24 months. Results: Preoperatively, air-conduction thresholds were ≤70 dB HL at 2000-8000 Hz. Overall hearing preservation was complete at 1, 12, and 24 months and partial at 60 months. Importantly, hearing preservation at 2000-8000 Hz remained complete throughout the 60-month follow-up, with S-values of 90.7%, 76.7%, 79.1%, and 76.7%, respectively. At 24 months, word recognition in the implanted ear improved by 35 percentage points in quiet and 70 percentage points in noise compared with the preoperative aided condition. Conclusions: This case demonstrates 5-year preservation of substantial high-frequency residual hearing after CI in an adolescent with an atypical preoperative hearing profile. These findings suggest that cochlear implantation may be considered in selected patients with substantial residual hearing when conventional hearing aids provide insufficient functional benefit. However, broader conclusions regarding cochlear implant candidacy cannot be drawn from a single case.