The value of threshold of neural response telemetry on the prediction of behavioral audiometry threshold after cochlear implantation patients
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摘要: 目的 通过分析正常耳蜗形态与内耳畸形的人工耳蜗植入儿童主观行为测试法阈值和神经反应遥测(NRT)阈值的规律及相关性，探讨利用NRT阈值指导术后调机的价值。方法 对30例正常耳蜗形态(耳蜗正常组)和12例内耳畸形(内耳畸形组)的人工耳蜗植入儿童分别选取1、6、11、16、22号电极进行NRT测试和主观行为测试，并选取代表高频的1号电极、中频的11号电极、低频的22号电极分析NRT阈值与T值、C值的相关关系。结果 耳蜗正常组与内耳畸形组的NRT阈值平均值均大于T值，靠近且略小于C值。内耳畸形组的T值、C值和NRT阈值的平均值均略大于耳蜗正常组。耳蜗正常组与内耳畸形组的高、中、低频段NRT阈值与C值、T值显著相关。与正常耳蜗组相比，内耳畸形组在高、中、低频段两组的NRT阈值与T值的回归系数b相差20.90%、3.02%、9.68%，k相差13.01%、3.92%、5.28%；两组的NRT阈值与C值的回归系数b相差15.74%、2.51%、0.53%，k相差14.44%、0.24%、4.09%，可见在高频段两组植入者的NRT阈值与T值、C值的相关关系有明显区别，而在低、中频段较为相近。结论 NRT阈值与主观行为测试阈值显著相关，所得到的线性回归方程可用于指导人工耳蜗调机，特别是针对内耳畸形儿童的高频段T值与C值，应采用与正常耳蜗儿童不同的回归方程进行预估，以获得更为准确的T值与C值。Abstract: Objective To explore the feasibility of using the threshold of neural response telemetry(NRT) to guide postoperative machine adjustment by analyzing the regularity and correlation between the threshold of subjective behavior test and NRT in cochlear implant patients with normal cochlear morphology and inner ear malformation.Methods Thirty cochlear implant patients with normal cochlear morphology and 12 cochlear implant patients with inner ear malformation were selected for NRT test and subjective behavior test, respectively. Electrode 1 representing high frequency, electrode 11 representing medium frequency and electrode 22 representing low frequency were selected to analyze the correlation between NRT threshold and T value and C value.Results The mean NRT threshold values of the cochlear normal group and the inner ear malformation group were both greater than T value, close to and slightly smaller than C value. The T value, C value and NRT threshold of the inner ear malformation group were slightly higher than those of the cochlear normal group. The NRT thresholds of high, middle and low frequency bands were significantly correlated with C and T values in the normal cochlear group and the inner ear malformation group. Compared with the normal cochlear group, the regression coefficientsBof NRT threshold and T value in the high, medium and low frequency groups were 20.90%, 3.02%, 9.68%, and theKcoefficients were 13.01%, 3.92%, 5.28%. The regression coefficients B of NRT threshold and C value of the two groups were 15.74%, 2.51%, 0.53%, andKwere 14.44%, 0.24%, 4.09%, respectively. It can be seen that the correlation between NRT threshold and T value and C value of the two groups was significantly different in the high frequency band, but similar in the low and middle frequency band.Conclusion The NRT threshold is significantly correlated with the threshold of subjective behavior test. The linear regression equation obtained can be used to guide the cochlear implant tuning machine, especially for the high frequency band T and C values of patients with inner ear malformation implantation. Different regression equations should be used to estimate the T and C values of patients with normal cochlea, so as to obtain more accurate T and C values.
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表 1 正常耳蜗患者组T值、C值与NRT阈值的测试结果
X±S，n=30，CL 电极 1号 6号 11号 16号 22号 T值 135.17±18.51 138.01±15.68 140.67±14.93 135.83±15.87 124.47±18.58 C值 171.77±29.34 175.57±29.52 182.77±24.92 169.20±27.37 159.33±19.45 NRT阈值 169.97±18.26 172.87±15.93 175.47±14.37 167.37±19.32 158.27±26.55 
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表 2 内耳畸形患者组T值、C值与NRT阈值的测试结果
X±S，n=12，CL 电极 1号 6号 11号 16号 22号 T值 135.63±20.53 142.50±16.39 147.51±11.46 138.75±13.64 132.50±19.53 C值 173.88±22.07 185.13±20.46 200.01±19.21 180.88±21.73 169.13±21.78 NRT阈值 170.50±11.26 179.13±19.70 185.13±13.12 177.25±14.94 166.25±16.14
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表 3 正常耳蜗患者组T值、C值与NRT阈值的相关关系
高频 中频 低频 r P r P r P T值 0.84 < 0.001 0.74 < 0.001 0.79 < 0.001 C值 0.84 < 0.001 0.73 < 0.001 0.74 < 0.001
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表 4 内耳畸形患者组T值、C值与NRT阈值的相关关系
高频 中频 低频 r P r P r P T值 0.609 0.018 0.758 0.002 0.686 0.007 C值 0.540 0.035 0.592 0.021 0.577 0.025
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表 5 正常耳蜗患者T值、C值与NRT阈值的回归系数
高频 中频 低频 b k b k b k T值 44.08 0.53 60.13 0.44 36.41 0.56 C值 80.17 0.52 98.59 0.42 73.96 0.54 注：NRT阈值与T值回归方程为T=bT+kT×NRT；NRT阈值与C值回归方程为C=bC+kC×NRT。
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表 6 内耳畸形患者T值、C值与NRT阈值的回归系数
高频 中频 低频 b k b k b k T值 55.72 0.47 58.37 0.46 33.12 0.59 C值 95.15 0.46 101.12 0.42 73.57 0.56 注：NRT阈值与T值回归方程为T=bT+kT×NRT；NRT阈值与C值回归方程为C=bC+kC×NRT。
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