T9P chl Tai MOi Hpng Vi$f Nam - Volume (57-8). N''2 - March. 2012
6. Committee on Hearing and of results of treatment of conductive Equilibrium. Committee on hearing and hearing loss. Otolaryngol Heat! Neck equilibrium guidelines for the evaluation Surg. 1995 Sep;l 13(3): 186-7.
T 6 N G KtT PHAU THU^T CAY 6 C TAI DI$N T C T A I B $ N H VlfN
TAI Mill HQNG THANH P H O H O CHf MINH Tiri998 - 2011
Ll Trin Quang Minh*, Nguyin Thf Ngpc Dung*
Vd Quang Phic*, LlHupnh Mal*
Nguyin Thanh Vinh*, BSHSng Giang*
T 6 M TAT
Ky thu^t ciy ic tai difn tir Ik m^t ky thu^t tiln ti^n dugc phA bi^n r^ng rai tren th^
gi6i. Bfnh vifn Tai Miii Hpng TP. Ho Chi Minh da thyc hi$n c^y 6c tai difn tu don k6nh tit nam 1998 va da kenh tit nam 2000. D^n thing 6/ 2011 da c6 97 bfnh nhan dupe cay 6c tai di^n til vdi 8 bfnh nhSn dupe phlu thu§t ca 2 ben. Dp tuoi tu 21 thing t6i 52 tuoi, nam c6 48 trudng h(?p vd n& li 49. S6 trudng hgp diec trudc ng6n ng& dugc phau thuat la 91 va CO 6 tru&ng hgp di6c sau ngon ngiJ. Tai bien gom c6 lift m^t va chay djch nao tily phuc hoi t6t. Sy thinh cong ciia phau thuit bao gom: chpn Ivra bfnh nhan, danh gia CT Scan va MRI ky ludng, phau thuit vien c6 kinh nghifm, dupe dao t^o bii bin.
Ket qui phit tri€n ngdn ngi) khi quan, bfnh nhin diec sau ngdn ngO phyc hdi kha nang giao tiSp binh thudng sau 1 nim. B^nh nhin diec bam sinh c6 the dat k6t qua tir kha djn xuat sic sau tir 2-3 nim.
Tii' kh6a: dien eye oc tai SUMMARY
Cochlear implant is an advanced technique and applying worldwide. ENT Hospital of HCM City has been applying single channel cochlear implant since 1998 and multi-channel cochlear implant since 2000. Until June 2011, there has been 97 patients, in which, 8 patients with bilateral cochlear implants simultaneously. Range of age from 21 months old to 52 years old. There are 48 male cases and 49 female cases in this study. The number of prelingual deafness are 91 cases and 6 cases with postlingual deafness. Complications are facial paralysis and CFS leak which have good recovery.
The success of this operation consists: careful selection of candidates, accessment CT Scan and MRI preoperation, well- trained and experience surgeon. The result is veiy good. Postlingual implanted patients have influently communicating after 1 year. The congenital deaf children can reach the result from fair to excellent after 2-3 years.
Keywords: Cochlear implant (*) BJnh vi0n Tai MQi Hpng TP H i Chl Minh, Nh^n bii 11-5-2012, duyjt in 25-5-2012
20
Tgp chl Tai Mui Hgng Vl$t Nam -Volume (57-8). N°2 - March. 2012 l.Di^TVANDfe
6c tai di$n tii la mOt thiet bj vi mach di^n tii nh6 dugfc c^y ben trong 6c tai vk 1 bg phlin xii ly dm thanh ben ngo^i dugc chi dinh cho nhOng b$nh nhSn diec nSng. Am thanh dugc xii l^
thanh nhiing tin hi?u di$n d$c bi$t \k dugc truyen den nhthig di?n c\rc nam trong 6c tai. Nhiing tin hi$u cua di?n c\re kich thich cac sgi than kinh thinh gi6c d^
giii thong tin d6n nSo noi n6 dui^c phien dich thanh am thanh c6 nghTa.
Tren the git^i vi$c cay 6c tai d3 dugc th\ic hien tvr nhiing nSm 1980, sau do cdc nude trong khu vuc Asean d3 dp dung ky thuat nay.
Vao nam 1998, truong hgp cay 6c tai diu tien dugc thuc hien tai b|nh vi§n Tai Miii Hpng TP.HCM v6i su giup dd, huong dan cua Giao su W.House, Bdc sT Whitaker, Bac sT Bui Minh Due (Hoa Ky).
2. LICH SU"
Vao nam 1790 Alessandro Volta phdt hiSn ra viec kich thich dien len h?
thong thinh gidc tao ra kha ndng tiep nhan am thanh.
Vao nam 1950, Djoumo va Chales Eyries (Phap) lan dau tien thuc hi$n tien hanh kich thich true ti6p len than kinh thinh gidc voi 1 dien cue.
Sau do, nam 1957 Djoumo va Eyries (Phdp) va William House (Vi6n House- Los Angeles) bdo cdo cac truong hgp cay ghep thiet bi 6c tai dien tii don kenh.
Ddu nam 1970, Graeme Clark va c6ng su tiln hanh nghien cihi thiet hi 6e tai dien tu da kenh dau tien tr^n toan the gioi. Thilt bi nay dugic che tao b6fi Ingeborg va Erwin Hochmair, ngudi sang lap ra MED-EL sau nay.
Vdo thang 12/1984 FDA da ch^p nhan cho phep cly thilt bi 6c t^i di?n hi
da kSnh dugc sdn xuat tai Uc cho cdc ngudi ldn bj diec sdu tai My. Nam 1990, FDA cho ph6p ciy 6e tai d trd em 2 tuoi, d tr6 em 18 thdng tu6i vdo ndm 1998 vd tr6 em 12 thdng tu6i vdo nam 2002.
3. SO LirpC HQAT D Q N G C t A 6 C TAI DlfN TU"
1. Mgt microphone nhd thu nh§n dm thanh, dugc gan tryrc tiep vdo bO ph§n xii ly am thanh b6n ngodi vd dugc deo sau tai.
2. BO phdn xit ly dm thanh Id mOt mdy vi tinh nhd tiln hdnh Igc, phan tich vd s6 hda cdc tin hi^u dm thanh thdnh nhihig tin hi^u di^n.
3. Bg phan xur ly am thanh giii nhihig tin hieu dd dugc md hda tdi cu$n truyen dan, cuon truyen dan ndy thdt s\r la mgt anten van chuyen sdng tan so radio. Cuon truyen dan dugc dinh vdi bg phan tiep nhan trong d dudi da bdng nam cham.
4. Cuon truyen dan giii nhung tin hieu da dugc ma hda (giong nhu tin hieu radio) xuyen qua da tdi bg phan tiep nhan trong ciia thiet hi 6c tai di$n tii ndm dudi da. Bg phdn tiep nhdn trong ndy thuc chat la mgt anten tilp nhan sdng tan sd radio vd mgt may vi tinh nhd khdc, cdc tin hieu dd md hda duoc bien ddi thanh eac tin hi^u dien.
5. Bg phan tiep nhan trong chuySn cdc tin hi^u dien nay den ddy dien cue ndm ben trong 6c tai, tiiy loai, 6c tai di?n tii hi^n nay se cd tu 22- 24 di$n cvrc.
6. Moi di8n cue ndm dgc theo ddy di^n c\rc deu cd day ket noi vdi bO phdn tiep nhan trong, m5i di^n c\rc diu cd m0t chuong trinh rieng bi?t de chuyln ddi cac tin hi$u di$n d$c trung cho tiing loai dm thanh khdc nhau ed ve do ldn cung nhu tan s6.
Khi cdc dien cure tifip nhan mgt tin
T?p chl Tai Mui H(jng Vi$t Nann - Volume (57-8). N°2 - March. 2012 hieu difn, chung kich Ihich nhOng
sfi diy thin kinh 6c tai thich hgp trong dc tai d6 giri thdng tin v^ nio.
Ket qui li thdng tin v4 im thanh dudi dfing tin hi?u di^n thdng qua hf th6ng 6c tai da dugc giri len nao de giai ma.
4. K£T QUA NGHIEN ctru
- T6ng s6: 97 bfnh nhin.4.1. Tu6i 4.I.I. TuSi a&i
• B$nh nhin nhd tu6i nh4t: 21 thing.
- B$nh nhin Idn tu6i nhit: 52 tu6i.
' Chung tdi chia thinh 4 nhdm tuoi:
Tu6l
< 2 tuoi 2- 6 tudi 6-15lu6i
> 16 tuii
5^ tru»diig /T9P 3 31 60 13
nit'/.
3,1%
32,0%
61,5%
13,4%
4.1.2 Tudi khi phdu thu^t
- B^nh nhdn nhd tuoi nhit: 21 thdng.
- Chung tdi chia thdnh 4 nhdm tu6i:
Tu6l
< 2 tu6i 2- 5 tudi 6-16 tudi
> 16 tudi
So trxfimg /ipp 11 67 15 4
TltlV.
11,3%
69,1%
16,6%
4,1%
4.2. Gidi 6/d>
Nam NO
So tnfd/ng htj/p 48 49
TllfA 49,5%
50,6%
4.3. Dia phirons D/a phuxmg T/PHd Chl Minh Hi Ndi Mi6n Trung Cic tinh thinh khic
So tnfdng /ipp 31 20 13 33
Ttlt%
32,0%
20,6%
13,4%
34,0%
22
Tap chi Tai Mui Hpng Vi§t Nann - Volume (57-8). N''2 - March. 2012 4.4. NguySn nhin vi y& (6 nguy cff
a. Me:
- Dimg thu6c trong thing dau thai ky: Khdng nhd rd.
- 01 trudng h(;rp dieu trj Basedow - 01 trudng h<;rp dimg thu6c nam - 01 trudng h(pp hi cum - 01 trudng htfp s6t phit ban b. Con:
4.5. Phan loai di^c
Nhiem Streptococcus: 02 trudng Vigm ming nSo: 02 trudng hpp Viem tai gifra: 04 trudng hgp Hfp dgng mach phoi: 01 trudng - Da di tat: 01 trudng hgp.
B^i nio, di tit mit, tim : 01 trudng hgp.
Dj d^ng Mondini: 02 trudng hgp.
hgp
hgp.
PhSn lo9i Tn/dc ngdn ngd Sau ngfin ngd
S6 truing hgp 91
6
Tlli%
93,8%
6,2%
4.6. Thinh lire do PhSn lo?l fliec n^ng
€)iec siu
So tnrdng hgp 6 92
Ttlt%
5,2%
94,8%
4.7. Xet nghifm tien phau a. Khdm Idm sdng:
- Phdt hien nhimg benh ly phdi hgp - Loai bd nhihig 6 nhiem triing b. Xet nghiem thinh hpc:
Thinh luc dd NhT lugng d6 - Phdn xa bdn dap - Dien thinh gidc than ndo c. CTScan-MRI:
Phdt hien nhiing bdt thudng cua tai giira
- Khdo sat vi tri ciia day TK VII - Ddnh gia cau tnic ciia dc tai.
4.8. Cdc birdc tien hanh
a. Rach da sau tai theo hinh chCr U, C ngugc hay S.
b. Bdc Id CO thdi duong, boc taeh tao vat cdn ca thdi duong de che phu thiet bi trong cua 6c tai di$n tii.
c. Bdc 16 mat ngoai xuong chum, ldm ro cdc m6c gidi phlu: dudng thdi duong, gai Henle, viing sdng Chiphault, mdm chQm.
d. Bgc Ig thdnh sau dng tai ngodi.
V. Diing khoan xuong md vdo sao bdo d vung sdng Chipault, khoan hit cdc nhdm t€ bao xuong chilm.
f. Md ngach mdt (Md hdm nhT phia sau)
- Dd^ la thi quan trgng nhit phau thu^t eay 6c tai, nd phdi cho ph6p ta md
T?p chl Tai MQi Hong Vi#t Nam - Volume (57-8). N°2 - March, 2012 mgt cila so thdng tir hd m6 chflm phia
sau d6n hdm nhT mi khdng cin bdc tdch mang nhT.
- M6C giii phiu quan trpng li mdm ngang xuong de, dimg khoan mii nhd khoan phia trin cda gd xuong c6ng fallop, mui khoan hudng vk phia hdm nhi.
- Khi ngich mjt dugc md, ti6p tyc md ve phia dudi d6 thiy rd cira so trdn.
g. Md 6c tai: Ditng mQi khoan kim cuong md 1 l5 nhd khoing 1,2 - 1,4 mm d phia trudc cda cda s6 trdn, cich cda s6 niy khoing 1mm.
h. Dit di^n cue:
Khoan khuylt xuong (tgo giudng) d mit ngdai ban sg de dit thin difn c\rc.
4.9. 8£n phau thugt
Qi^n cvc bao gdm: 1 thin di?n cvc, 2 diy di^n eye: day hogt ddng, diy dit.
- Diy hgat ddng s5 dugc dua vio trong 6c tai qua cita s6 bing 1 dgng cv die bi$t, tdy logi di^n cvc, dd siu dao ddng tir 25 d6n 30mm.
- Diy dit dugc c6 djnh vio phia dudi c6t mgc xuomg'thii ducmg.
i. Khiu Igi v6t m6:
- Diing vgt eg thii duong d6 phO 18n thin di$n cvc.
- May da 2 ldp.
- Bing ip.
B6n phau thu$t Bdn (P)
Bdn (T) 2 Bdn
S6 tru^g hgp 67 22 8
Ttlf-i 6 9 , 1 % 22,6%
8,3%
4.10. ThM gian phau thu|it
Thdi gian phau thuat dao dgng tir Olgid 30 phiit din 02 gid.
- Thdi gian ndm vi?n 7- 10 ngdy.
4.11. Sdn sdc hau phau
Chyp Stenver de xdc djnh chdc chdn Id di^n c\ic dd d$t dung vdo 6c tai.
- Dung khdng sinh Cephalosporine III trong 7 npay + Cdc thudc gidm dau + ch6ng phu ne.
- cat chi sau 7 ngdy, neu khdng cd biln chiing thi cd thi cho b?nh nhan xult hien sau 10 ngay.
Ddn dd b?nh nhan tdi khdm thudng xuyen.
Sg ddt thiet bj ngodi sau 4 - 6 tuin, khi vet khau da vd da dau hoi phyc gan nhu blnh thudng.
4.12. Bien chihig
Bien chiing li^t mdt xay ra trong 02 tnrdng hpp, thu§c dO 2 (theo phan dO House-Brackmann), vd hdi ph\ic hodn todn sau 03 thdng.
Bien chiing rdch mdng ndo khi t^o khuyet xuong d$t bO phan tilp nhan trong: I trudng hgp.
Chdy djch ndo tiiy khi md dc tai: 1 hudng hgp (Dj d^ng Mondini)
Cd 5 trudng hgp cly l^i, trong dd 3 trudng hgrp di^n c^rc khong hoat dgng, 1 trudng hgp bj chin thuang tr\rc tilp ldm hu di$n c\rc, 1 trudng hgp vifim lo^t da phdi lly di^n C\TC ra.
24
Tgp chi Tai Mui Htjng Vi#t Nam -Volume (57-8). N''2 - March. 2012 4.13. Ket qua p h i u thuat
Ketqui Kdt qui tdt Kdt qui khi
So tnfimg hgip 93
4
Tlli%
96,9%
4 1%
4.14. Ket qua thinh hpc
- Chiing tdi x6p logi ket qui v^ mat thinh hgc thinh 4 nhdm:
Ketqui Xuit s i c Tdt Khi Tmng blnh
So tnrimg hgp 12 32 26 12
TtlfA 14.7%
39.0%
31.7%
14.6%
hgp.
- Chua ddnh gid dugc: 14 trudng - Khdng tdi khdm: 01 trudng hop.
5. BAN LUAN
1 v l gidi tinh khdng cd su khdc bi6t, nam va nii.
2. Ve dia phuong, thdnh pho Hd Chi Minh chilm im the hem vdi 31,96%
nhung Hd NOi vd cac tinh cung chilm ty le ddng kl do trong thdi gian qua, chi cd BV Tai Miii Hgng thuc hien phau thuat cay 6c tai dien tii d Viet nam.
3. Trong hiu hit cdc nghien cuu, cdc tdc gid chi bdo cao ve thong ke tudi cua benh nhdn tai thdi diem thdng ke.
Tuy nhien trong nghien cihi nay, chiing tdi thdng ke them mgt chi sd la do tu6i tai thdi dilm phau thuat.
Chi sd nay that su quan trgng vi cang ely sdm d liia tudi cdng nhd, ket qud phdt trien ngdn ngu cang t6t hon.
4. Thinh luc dd trudc phau thugt cho thiy da sd Id b?nh nhan diSc sau chilm 94,84 % vd tdt cd cdc benh nhan diu dugrc cho deo may trgr thinh
trudc mo. Trong 5 b^nh nhdn diec ndng, cdc benh nhan ndy deu Id dilc sau ngdn ngu vdi nhQ-ng b6nh l^
Viem mang nao vd diec dot nggt cd 2 ben.
5. Phau thuat duoc thuc hi$n da so d ben (P) vdi 69,07% vi nlu trudng hgp 2 ben gilng nhau, chiing tdi sS thuc hien phau thudt b^n tay thuan de benh nhdn dl ddng trong viec chdm sdc va thdo gdn b6 phan tiep nh|in ngoai (da sd benh nhdn thudn tay (P)).
Cdc trudng hgp cly b6n (T) thudng do dc tai ben (P) cdt hda hay vi6m xuong hay bat thudng gidi phau. Gdn day tren the gidi da thuc hien phau thuat 2 ben mgt liic, chiing tdi ciing cd 8 trudng hgp phau thuat 2 ben.
Benh nhdn dugc cay 2 ben se ed dinh hudng am thanh tdt hon vd ket qud huan luy?n nghe ndi cung se tot hon cdy 1 ben.
6. Kit qud phau thuat t6t dat 95,88% , khdng cd tai bien trong liie phau thuat, vlt md ldnh tdt vd b€iih nhdn xudt vi?n trong vdng 7 ngdy. 4 trudng hgp tai bien gdm 2 trudng hgp li^t mdt do ngdch m^t rat h^p, benh nhdn phuc hdi kh6ng di chiing.
Tap chi Tai Mui Hong Vi$t Nam - Volume (57-8). N°2 - March. 2012 1 trudng hgp rich ming nSo khi
khoan khuyet xuong dl djt bg phin tiep nh^n trong, chdng tdi tien hinh may lgi ming cirng. 1 trudng hgp chay djch nSo tiiy khi khoan md 6c lai d bfnh nhin cd dj dgng Mondini.
chung tdi van tien hinh dit difn cvc vi sau dd bit iSp bing md co.
7. Chung tdi cay lgi 5 trudng hgp, trong dd 3 trudng hgp difn cvc khdng hogt dgng, 1 tnrdng hgp bj chan thuang trvc ti6p lim hu di$n cvc, I trudng hgp vi3m lodt da phii lay di^n cvc ra vi 6 thing sau ciy lgi.
8. V6 k6t qui thinh hgc, chung tdi chia thinh 4 nhdm
K4tqui Xuit sic Tdl Khi Trung btnii
S6 truing hgp 12 32 26 12
Ttlf/, 14.7%
39,0%
31.7%
14,6%
Vi^c phdn lo^i d\ra Iren bdng ddnh gid s^r phdt trien ngdn ngit sau, mSi tiSu chuin dugc cham tdi da 5 diem
0
1
2
3
4 Thdi d$
d6i vin deo mdy Ti> chdl
Phan doi
Oeo khdng thudng xuydn
Deo thudng xuydn
Yfiuc^u deo mSy
Khd ndng nghe
Khdng nghe gl
Nghe ti^ng dOng rdt Idn
Nghe gigng n6\
Idn
Nghe gigng nbi thudng
Nghe gigng ndi nhd
Hiiu
KhSng hi^u
Phdn bi$t dugc git/a cd ti^ng ddng vd khdng H\k\s mdt sd ti^ng ddng
B4 ddng (hiSu 1 $6 tCr quen thudc) Bdmd (hi6u nhi^u tu)
Khd ndng ndi
cam
Phdt dm bi bd v6 nghia
Ndi tOng ti>
don ddc
Ndi tOng ti>
k^t hgp
Ndi cdu ngdn Giao ti^p
(Cdm)
Khdng giao tiSp vdi at
Ldp Igi cdc dmti^t
Vdi cha me
Vdi nhOng ngudi khdng chuyfin
0-4 Rdt k^m
5-9 Kdm
10-14 Trung blnh
15-19 Khd
20-24 Tdt
26
Tap chi Tai Mui Hpng Vi§t Nann - Volunne (57-8). N°2 - March. 2012 Cdn deo
mciy
Nghe giong thi thdm
Nghe di$n thoai rdt tdt
Xudt sdc 25 Xudt sdc
ndm. Doi vdi tre em diec bam sinh, ket qud phu thuOc vao nhieu yeu to nhung nhin chung sau 2-3 ndm luy?n tdp, b?nh nhan c6 thi dgt kit qud phdt triln ngdn ngtt tir khd din xudt sdc, phkn ldn cdc b&
dugc hudng d§n cd the hgi nhap vdo mdi trudng trudng hgc binh thudng.
TAI L i f u THAM K H A O
1 Arastoo Vossough. "Imaging evaluation of sensorineural hearing loss".
Applied Radiology. Volume 32, Nl, January, 2003.
2. Brandon Isaacson. "Indications for Cochlear Implants." Medscape reference, June 25,2010.
3. Cliff A Megerian."Cochlear Implant Surgery". Medscape reference, Mar 9,2011.
4. John K.Niparko. Cochlear Implants:
Principles and Practice. 2000.
5. Kileny, Paul. "A Comparison of Round-Window and Transtympanic Promontory Electric Stimulation in Cochlear Implant Candidates". Williams
&Wilkinsl992.
6. Marsot-Dupuch."Cochlear implant assessment: imaging issues". European Journal of Radiology, Vol. 40 (2) (2001) pp. 119- 132. June 25,2001
7. Michael A. Meccaa. "Complication of Cochlear Implantation Surgery"
American Journal of Neuroradiology AJNR 2003.
8. Peter Gibson. "Electrode Insertion Depth: Design Philosophy and Review of Research Literature". 1/2009.
Trong so 12 trudng hgp dgt kit qua xuat sdc, chung t6i luu y ddy Id nhihig trudng hgp cay sdm, diec sau ngdn ngii vd nhihig trudng hgp cha m?
rdt sieng ndng tgp luy?n cho tx6 vd phoi hop tdt vdi chuy6n vien thinh hgc. Cd trudng hop chdu 6 tudi va vao hgc ldp I binh thudng nhu nhihig ban cung trang lua.
Nhin chung, kit qud thinh hgc tir loai khd din xuat sdc chiem hon 85%
trudng hgp la rat dang khich 16 doi vdi nhimg benh nhan diec ndng vd sau.
Ngoai ra, 12 trudng hgp ket qud trung binh do chua dii thdi gian huan luy^n sau cdy (tir 2-3 ndm). Chiing tdi cGng cdn 14 benh nhan mdi phdu thuat trong ndm 2011 chua dii thdi gian hieu chinh mdy, do dd chua ddnh gid hoan chinh s6 benh nhdn nay.
6. KET LUAN
Ky thuat cay 6c tai dien tu la mgt phat minh to ldn dang ngdy cang dugc dp dung rgng rai tren the gidi vd Viet Nam, giiip ich rdt nhilu cho cdc benh nhan diSc nang vd di6c sau cd the tiep can voi the gidi am thanh vd giao tiep xd hgi.
Viec chgn lira benh nhan ky cdng vd nghien cuu CT Scan ciing nhu MRI giiip phdu thuat thdnh cdng, trong dd giai doan md ngach mat nhilu nguy ca gdy biln chiing va giai doan md dc tai khd thao tdc nhat.
v l mgt phdt triln ngdn ngii, ddi vdi ngudi ldn va tre em diec sau ngdn ngG, kit qud trd lai dugc khd ndng giao tilp binh thudng cho benh nhan sau 1
T9P chl Tai MDi Htjng V i | t Nam - Volume (57-8). N''2 - March. 2012 9. Richard T Ramsden, Hugh
Wheatley. "Developing surgical techniques in cochlear implantation"
Cochlear Implants International, 1(2), 67-81, 2000 © Whurr Publishers Ltd.
10. Robert J. Witte "Pediatric and Adult Cochlear Implantation".
RadioGraphics, September 2003.
11. Rolf Dieter Baltner; Azne Erenst.
"Rislc and Benefit of Deeply inserted Cochlear Implant electrode Arrays". 2006.
12. Thomas Lenarz. Cochlear Implantation, The Hannover Guideline".
2010.
13. Van de Heyning. " Cochlear Implants and Hearing Preservation." Vol 67,2010. Karger.
14. Ugo Fisch. Temporal bone dissection. The Zurich Guidelines" 2009.
Press.
15. Wikipedia. "Cochlear Implant".
William F.House.
16. NguySn T h | Bfch Thiiy, B& Hing Giang "So k^t c i c truimg hpp c4y 6c tai difn til da kinh t«i Bfnh Vifn Tai Mui Hpng tir nSm 2000 d^n 11/2008". Nfi san HOi nghj Khoa Hpc K^ Thu|it- BV Tai MOi Hpng TP HA C W Minh 12/2008, trang 13-20.
KtT QUA THiNH LV'C SAU PHAU THUAT CHINH HINH TAI GI&A B A N G SyN
Nguyin Hoang Hiiy * T 6 M TAT
D$t v^n d^: s\tn dupe su dung trong chinh hlnh tai gi&a v6i m\ic dich ban ch^ tii phdt benh tich 6 tai gii^a, d^c tinh cung ciia svn c6 tic dyng giim tii phit tlji co Vio mang nhT, tuy nhien cung c6 the inh hu6ng den truyen am cua ming nhi. Hifn nay chua CO nhieu nghien cihi ve thinh I\rc sau phau thu^t v i nht bing s\m. M^c tieu: dinh gii ket qua thinh l\rc sau phau thuit chinh hlnh tai gii^a bing syn. D&i tir^rng v i phmng p h i p nghien cihi: nghien ctru hoi cim ttin 22 bfnh nhin dupe phlu thi4t v i nhi bing sun tai Khoa Tai - Bfnh vifn Tai Mui Hpng tnmg uomg tir 1/2009 den 12/2010. Ti&i chuan lua chpn la nhihig bfnh nhin x^p nht, vifm tai giiia m^n tinh trSn bfnh nhan x ^ nhT, trfn bfnh nhan r6i l o ^ chirc ning v6i ho$c tii phit sau phau thu^t. Tat c i bfnh nhan co nghe kdm dan truyen hojc hon hpp thien ve dSn diiyen. So sinh nguBng nghe trung binh (PTA) v i khoing cich giiJa dudng khi v i duimg xuong (ABG) trudc v i sau phlu thu^t. Ket q u i : Kk qui phvc h6i giii phlu ming nhT t6t, kh6ng c6 tii phit xqi nhi hoic thung nhi. PTA sau mo dupe cii thifn b tit c i cic tin so tir 500Hz din 4000Hz.
68,2% ABG trudc m6 trong khoing 20 - 29 dB, 63,6% ABG sau mo trong khoing 0 - 19 dB. Ket lu|n: v i nhi bing syn cho ket qui tot v^ sire nghe v i giii phlu, phlu thu^
dirge lifi chpn cho cic trudng hpp xfp nhi, vifm tai giOa ph6i hpp x?p nM, viem tai giOa rdi lo?n chirc ning vdi, viim tai giOa tii phit sau phlu thujt.
Ti* idida: chinh hinh tai giiia bing syn, v i nhi bing s^m, ket qui thinh luc sau mh
' Khoa Tai - B$nh vi$n Tat MQi Hgng tmng uong NhSn bii 15-4-2012, duy^t in 25-4-2012
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