目的：探讨糖皮质激素不同使用方法对儿童人工耳蜗植入者术后早期电极阻抗的影响。方法回顾性收集于我院行澳大利亚Nucleus 24CA型多导人工耳蜗植入儿童患者资料，根据糖皮质激素使用方法纳入经鼓室圆窗给药组（A组）及经鼓室圆窗联合全身静脉给药组（B组）；以各组22个电极相对于耳蜗内位置分为高频段（3-6）、中频段（10-13）及低频段（17-20）3个亚组，检测各组术中、开机（术后1月）、术后3月及术后6月电极阻抗值，并进行统计学分析。结果两组22个电极阻抗平均值均在术中较低，开机时最高，术后6个月达最低值；开机、术后3月及术后6月两组电极阻抗值比较差异有统计学意义（P＜0.05）；在各亚组间比较中，两组在术中不同频段比较无统计学差异（P＞0.05），开机时两组间各频段电阻抗值比较差异有统计学意义（P＜0.05），B组各频段电极阻抗值小于A组，且两组开机与术中电阻抗差值均在高频段较大；术后3月及6月两组高频段比较仍具统计学差异（P＜0.05），而低频段无明显差别（P＞0.05）。结论经鼓室圆窗联合全身静脉给药途径在降低术后电极阻抗效果方面优于局部单独使用，在高频段尤为明显，提示糖皮质激素联合应用更有利于降低耳蜗植入后电极周围纤维化组织形成。%Objective The objective of this study was to investigate short-term effects of steroids on electrode impedance in children after cochlear implantation. Methods Children who received Nucleus 24 Contour (Australia) cochlear implants in our hospital were divided into two groups based on the method of corticosteroids administration, i.e. transtympanic (group A) or combined transtympanic and intravenous ad-ministration (group B). For evaluation of impedance development along the electrode array (total 22) in differ-ent areas of cochlea, the measured values for Contacts 3 to 6 were pooled to represent high frequency region, Contacts 10-13 for middle frequency region and Contacts 17-20 for low frequency region. Electrode imped-ance values were measured during the operation, and at 1 month (the initial stimulation), 3 months and 6 months after surgery. Results In both groups, average electrode impedance values were low during the opera-tion, peaked at the initial stimulation, and reached the lowest after 6 months. The impedance values were sig-nificantly different between the two groups at the initial stimulation and at 3 and 6 months after surgery (P<0.05). In different cochlea regions, electrode impedance values were not significantly different between the two groups during the operation (P>0.05). Impedance in group B was lower than group A in all frequencies regions at the initial stimulation (P<0.05). The greatest increase in impedance was found in high frequency re- gions in both groups. At 3 and 6 months after implantation, impedance values in high frequency regions re-mained statistically different between the two groups (P<0.05), but not in low frequency regions (P>0.05). Conclusions Combined transtympanic and intravenous steroids administration appears better than exclusive local administration in reducing electrode impedance, especially for high frequency regions, suggesting that the former is more effective to reduce fibrosis and tissue formation around the electrode.
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