Koklear implant ameliyatı olanlarda intraop nöral yanıt eşiği alınan ve alınmayan hastaların postop 6.ay ve 1.yıl ölçülen en rahat ses düzeyleri açısından karşılaştırılması
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Tarih
2024
Yazarlar
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Cilt Başlığı
Yayıncı
Dicle Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Koklear implant cihazında, her elektrot doğrudan elektrik akımı geldiğinde işitsel siniri uyarır.Mutlaka bir işitme duyusunu tetikler. İşitsel bir duyumu tetiklemek için gerekli elektrik akımı her birey ve her stimülasyon kanalı için farklıdır. Bu nedenle, konuşma işlemcisi ayrı ayrı ayarlanmalıdır.Her kullanıcı için her stimülasyon kanalıyla birlikte ve bu işleme programlama veya haritalama denir. Koklear implant kullanıcılarının ameliyat sonrası cihaz ayarının yapılması, günümüzde zor bir sorun olmaya devam ediyor.Özellikle doğuştan sağır çocuklar için. İntraoperatif Nöral yanıt seviyeleri ilk aşamada bir rehber olarak kullanılabilir. Bu İntraoperatif Nöral yanıt seviyeleri, erken psikofiziksel testlerde kullanılacak stimülasyon seviyeleri ile ilişkilendirilebilir. Koklear implant postoperatif süreçte nesnel ölçülerin kullanılması, özellikle bebekler ve küçük çocuklar için haritalama sürecinin başlangıcına temel teşkil eden belirli değerler sağladıkları için en rahat ses seviyesi büyük ölçüde katkıda bulunmuştur.Hastanın koklear implattan ne kadar fayda görebileceği de bu yöntemle tespit edilebilir. Gereç ve Yöntem: Ocak 2014-Ocak 2022 yılları arasında Dicle Üniversitesi Kulak Burun Boğaz kliniğinde 0-6 yaş arası koklear implant ameliyatı olan hastalar retrospektif olarak incelendi. Koklear implant ameliyatı sırasında Nöral yanıt eşiği hiç alamadığımız 50 hasta (Çalışma grubu);ameliyat sırasında Nöral yanıt eşiklerini tamamen aldığımız 50 hasta kontrol grubu olarak belirlendi. Nöral yanıt eşiği alınan ve alınmayan hastaların postop 6.ay ve 1.yılda ölçülen en rahat ses seviyeleri karşılaştırılmıştır. Bulgular: NRT(+) ve NRT(-) gruplarda 6. ve 12. Aylarda ölçülen mcl değerlerine cinsiyetin etkisi değerlendirildiğinde;sadece NRT(+) grupta 12.Aydaki mcl değerinin erkeklerde kadınlardan istatistiksel olarak anlamlı şekilde yüksek olduğu bulundu. (p=0.010) NRT(+) ve NRT(-) gruplarda 6. ve 12.aylardaki mcl değerlerinin ameliyat metoduna gore değişimi değerlendirildiğinde;sadece NRT(+) grupta kokleostomi yapılan grupta (ort=247.50±31.82) yuvarlak pencere müdahalesi yapılan gruba(ort=181.94±35.94) gore mcl değerinin istatistiksel açıdan anlamlı şekilde daha yüksek olduğu izlendi.(p=0.042) NRT (-) grupta 6. Ve 12. ayda bakılan mcl değerleri karşılaştırıldığında 12.ayda bakılan mcl değerinin (ort= 213.70±74.63) 6. ayda bakılan (ort=201.96±67.60) mcl değerinden istatistiksel olarak anlamlı şekilde yüksek olduğu bulundu.(p<0.001) NRT (+) grupta 6. Ve 12. Ayda bakılan mcl değerleri karşılaştırıldığında 12.ayda bakılan mcl değerinin (ort=199.12±41.71) 6. ayda bakılan (ort=184.56±37.79) mcl değerinden istatistiksel olarak anlamlı şekilde yüksek olduğu bulundu. (p<0.001) Sonuç: Koklear implantasyon cerrahisi sonrası özellikle pediatrik yaş grubu hastalarda elektrofizyolojik parametrelerle takip çok önemlidir. Bu parametrelerde tespit edilen anomalilikler hastanın daha yakın takibe alınmasını sağlar.Koklear implant ameliyatı sırasında ölçülen impedans ve stapes refleks eşiklerinin NRT alınıp alınmamasından daha değerli olduğunu literatüre uygun olarak kendi çalışmamızda farketttik.
Objective: In the cochlear implant device, each electrode directly stimulates the auditory nerve when electric current comes in. It definitely triggers a sense of hearing. The electrical current required to trigger an auditory sensation is different for each individual and each stimulation channel. Therefore, the speech processor must be set individually, with each stimulation channel for each user, and this process is called programming or mapping. Post-operative device adjustment of cochlear implant users remains a difficult challenge today, especially for congenitally deaf children. Intraoperative Neural response levels can be used as a guide in the initial phase. These Intraoperative Neural response levels can be correlated with stimulation levels to be used in early psychophysical testing. The use of objective measurements in the cochlear implant postoperative period has greatly contributed to the most comfortable sound level, especially for infants and young children, as they provide certain values that form the basis for the beginning of the mapping process. Material and Method: Between January 2014 and January 2022, patients aged 0-6 years who had cochlear implant surgery in the Otorhinolaryngology clinic of Dicle University will be retrospectively examined. 50 patients (Study group) for whom we did not get the Neural response threshold at all during the cochlear implant surgery, and 50 patients whose Neural response thresholds were completely received during the surgery will be determined as the control group. The most comfortable sound levels of patients with and without a neural response threshold were compared at the 6th month and 1st year postoperatively. Results: When the effect of gender on the mcl values measured in the 6th and 12th months in the NRT(+) and NRT(-) groups was evaluated, it was found that the mcl value at the 12th month was statistically significantly higher in males than in females only in the NRT(+) group. (p=0.010) When the change in mcl values at 6th and 12th months in NRT(+) and NRT(-) groups was evaluated according to the surgical method, it was observed that mcl values were statistically significantly higher in the NRT(+) group only in the cochleostomy group (mean=247.50±31.82) compared to the group that underwent round window intervention (mean=181.94±35.94) in the NRT(+) group at 12 and 12.months (p=0.042). mcl value (mean= 213.70±74.63) was found to be statistically significantly higher than the mcl value measured at 6 months (mean=201.96±67.60). (p<0.001) When the mcl values measured at the 6th and 12th months in the NRT (+) group were compared, it was found that the mcl value at the 12th month (mean= 199.12±41.71) was statistically significantly higher than the mcl value at the 6th month (mean=184.56±37.79). (p<0.001) Conclusion: Especially pediatric age group after cochlear implantation surgery It is very important to follow up with electrophysiological parameters in patients. In these parameters detected anomalies enable the patient to be followed up more closely. In accordance with the literature, we realized in our own study that the impedance and stapes reflex thresholds measured during cochlear implant surgery are more valuable than whether NRT is taken or not.
Objective: In the cochlear implant device, each electrode directly stimulates the auditory nerve when electric current comes in. It definitely triggers a sense of hearing. The electrical current required to trigger an auditory sensation is different for each individual and each stimulation channel. Therefore, the speech processor must be set individually, with each stimulation channel for each user, and this process is called programming or mapping. Post-operative device adjustment of cochlear implant users remains a difficult challenge today, especially for congenitally deaf children. Intraoperative Neural response levels can be used as a guide in the initial phase. These Intraoperative Neural response levels can be correlated with stimulation levels to be used in early psychophysical testing. The use of objective measurements in the cochlear implant postoperative period has greatly contributed to the most comfortable sound level, especially for infants and young children, as they provide certain values that form the basis for the beginning of the mapping process. Material and Method: Between January 2014 and January 2022, patients aged 0-6 years who had cochlear implant surgery in the Otorhinolaryngology clinic of Dicle University will be retrospectively examined. 50 patients (Study group) for whom we did not get the Neural response threshold at all during the cochlear implant surgery, and 50 patients whose Neural response thresholds were completely received during the surgery will be determined as the control group. The most comfortable sound levels of patients with and without a neural response threshold were compared at the 6th month and 1st year postoperatively. Results: When the effect of gender on the mcl values measured in the 6th and 12th months in the NRT(+) and NRT(-) groups was evaluated, it was found that the mcl value at the 12th month was statistically significantly higher in males than in females only in the NRT(+) group. (p=0.010) When the change in mcl values at 6th and 12th months in NRT(+) and NRT(-) groups was evaluated according to the surgical method, it was observed that mcl values were statistically significantly higher in the NRT(+) group only in the cochleostomy group (mean=247.50±31.82) compared to the group that underwent round window intervention (mean=181.94±35.94) in the NRT(+) group at 12 and 12.months (p=0.042). mcl value (mean= 213.70±74.63) was found to be statistically significantly higher than the mcl value measured at 6 months (mean=201.96±67.60). (p<0.001) When the mcl values measured at the 6th and 12th months in the NRT (+) group were compared, it was found that the mcl value at the 12th month (mean= 199.12±41.71) was statistically significantly higher than the mcl value at the 6th month (mean=184.56±37.79). (p<0.001) Conclusion: Especially pediatric age group after cochlear implantation surgery It is very important to follow up with electrophysiological parameters in patients. In these parameters detected anomalies enable the patient to be followed up more closely. In accordance with the literature, we realized in our own study that the impedance and stapes reflex thresholds measured during cochlear implant surgery are more valuable than whether NRT is taken or not.
Açıklama
Anahtar Kelimeler
Koklear implant, Nöral yanıt eşiği, En rahat ses düzeyi, Elektrofizyolojik parametre, Cochlear implant, Neural response threshold, Most comfortable sound level, Electrophysiological parameter
Kaynak
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Scopus Q Değeri
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Künye
Esen, D. (2024). Koklear implant ameliyatı olanlarda intraop nöral yanıt eşiği alınan ve alınmayan hastaların postop 6.ay ve 1.yıl ölçülen en rahat ses düzeyleri açısından karşılaştırılması. Yayımlanmamış uzmanlık tezi, Dicle Üniversitesi, Diyarbakır.
