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目的:观察Med-EL Combi 40+人工耳蜗植入后电极阻抗、检测阈值(THR)、最大舒适阈(MCL)、动态范围的变化规律,分析其内在联系,探讨其对术后调机的指导意义。方法:回顾性分析连续的20例植入MedEL Combi 40+人工耳蜗患儿,对术中、术后1、3、6、12、24、36个月的电极阻抗值,以及对应时间点的THR、MCL值、动态范围进行分析,探讨其变化规律及相关性。结果:总体而言,各电极阻抗值术中检测最低,术后1个月时电阻较术中有明显升高(P<0.01),术后3个月时电阻略有下降(P<0.01),随后蜗顶组和中间组电极电阻基本趋于平稳,但蜗底的电极电阻呈逐年升高。各电极通道THR值基本随术后时间延长逐渐增高(P<0.05),MCL值术后早期呈显著上升(P<0.05),但第2年起趋于平稳。蜗底组电极的动态范围术后早期呈上升,但1年后出现下降趋势。各组电极电荷量术后3个月升高显著(P<0.05),术后1年起趋于稳定(P>0.05)。电极电阻与动态范围的相关性较THR值、MCL值高,且呈负相关。术后3个月、6个月时的电极电阻与术后3年时的动态范围呈强负相关,均以蜗顶组最明显(r=-0.618,r=-0.636,均P<0.01)。结论:电极电阻的变化规律会因电极的位置不同而异,测定电极阻抗值能有效评估人工耳蜗刺激电极状态;术后电极THR、MCL值与电极电阻的关联性小,可能受众多因素影响所致,但电极的动态范围与电阻呈负相关;术后3个月或6个月时的电极电阻具有预测动态范围大小的意义。
OBJECTIVE: To observe the changes of electrode impedance, threshold of detection (THR), maximum comfort threshold (MCL) and dynamic range of Med-EL Combi 40+ cochlear implants after implantation, to analyze its internal relations and to explore its guidance on postoperative regulators significance. Methods: A retrospective analysis of 20 consecutive children with Medel Combi 40+ implanted cochlear implants, intraoperative, postoperative 1, 3, 6, 12, 24, 36 months of the electrode impedance values, and the corresponding time point THR , MCL value, dynamic range analysis, to explore its variation and correlation. Results: In general, the impedance of each electrode was the lowest during operation, the resistance was significantly increased at 1 month after operation (P <0.01), and decreased slightly at 3 months after operation (P <0.01) , Then the electrode resistance of the pinnacle group and the middle group basically stabilized, but the electrode resistance at the bottom of the snail increased year by year. The THR value of each electrode channel gradually increased with the extension of postoperative time (P <0.05). The MCL value increased significantly in early postoperative period (P <0.05), but stabilized in the second year. The dynamic range of the electrode at the bottom of the cochlear group increased in the early postoperative period, but decreased after one year. Electrode charge of each group increased significantly 3 months after operation (P <0.05), and stabilized from 1 year after operation (P> 0.05). Electrode resistance and dynamic range of relevance than the THR value, MCL value is high, and was negatively correlated. The electrode resistance at 3 months and 6 months postoperatively was strongly negatively correlated with the dynamic range at 3 years postoperatively, which were the most significant (P <0.01) . CONCLUSION: The variation of electrode resistance varies with the location of electrode. The determination of electrode impedance can effectively evaluate the state of cochlear stimulation electrode. The postoperative relationship between electrode THR and MCL and electrode resistance may be affected by many factors However, the dynamic range of the electrode is negatively correlated with the resistance. The electrode resistance at 3 months or 6 months after the operation has the meaning of predicting the dynamic range.