공동강 내이 기형 아동의 인공와우이식 후 장기 추적 결과 1예

김리석,허민정,이미영,김동환 대한이비인후과학회 2002 대한이비인후과학회지 두경부외과학 Vol.45 No.4

Encouraging results have been reported in implanted patients with cochlear malformations, but relevant information about results in the comon cavity is not enough. This case study is to report postimplantation performance in a boy with comon gical asessments using CT and MRI revealed bilateral comon cavity deformities. Twelve electrodes were inserted premedi-tatedly, and eleven electrodes were active in his pseudomonopolar mode map. A wide pulse width needed to be used because the T level was high, and facial twitching was present at the higher C level. Speech perception and speech-language evaluations were conducted at pre and postoperative 6-month intervals for up to 4 years. He showed limited sound response and could not ESP tests (low version) at 1 postoperative year and achieved the score of 80% for NU-CHIPS at 2 years after implantation. His open-set word recognition ability has shown continuous improvement over time. PBK score was 80% on phonemes and 50% on words at 2 years, Comon Phrases score was 90% at 3 years following implantation. He also developed age appropriate language skills after 3 years of implantation. This report demonstrates that this child could remarkably benefit from cochlear implant even with severe cochlear malformation. (Korean J Otolaryngol 2002;45:399-403)

청각신경병증 3예

김리석,정성욱,이승환,허승덕 대한이비인후과학회 2003 대한이비인후과학회지 두경부외과학 Vol.46 No.10

Auditory neuropathy is a hearing disorder characterized by an absent or severely abnormal auditory brainstem response, with preservation of the cochlear microphonics and otoacoustic emisions. This sugests that outer hair cell (OHC) function is normal tones and impaired word discrimination out of proportion to pure tone loss. Hearing aid alone is of little or no benefit in patients with auditory neuropathy. Visual support via cued spech or signed language can be a fail-safe method for insuring language de-velopment. Recently, there are some reports that cochlear implantation is highly sucesful in patients with auditory neuropathy. We report three cases (two children and one woman) with auditory neuropathy. Each patient was tested with cochlear microph-ear microphonics or otoacoustic emisions with absent auditory brainstem response. Two of them had evidence of a peripheral neuropathy. We should be aware of auditory neuropathy and implications for its management, which differs from treatment of sensorineural hearing loss. Auditory neuropathy also raises a concern about the risk of false-negative findings when newborn hearing screening is restricted to otoacoustic emissions. (Korean J Otolaryngol 2003 ;46 :874-881)

시표추적 및 시운동성 안진검사

김리석 釜算慶南耳鼻咽喉科學會 1992 임상이비인후과 Vol.3 No.1

신생아 청력장애의 선별검사와 의의

김리석 대한소아청소년과학회 2007 Clinical and Experimental Pediatrics (CEP) Vol.50 No.1

Hearing loss in newborns is the most frequently occurring birth defect. If hearing impaired children are not identified and managed early, it is difficult for many of them to acquire the fundamental language, social and cognitive skills that provide the foundation for later schooling and success in society. All newborns, both high and low risk, should be screened for hearing loss in the birth hospital prior discharge (Universal Newborn Heaing Screening, UNHS). Objective physiologic measures must be used to detect newborns and very young infants with hearing loss. Recent technological developments have produced screening methods and both evoked otoacoustic emission (EOAE) and auditory brainstem response (ABR) have been successfully implemented for UNHS. Audiologic evaluation should be carried out before 3 months of age and infants with confirmed hearing loss should receive intervention before 6 months of age. All infants who pass newborn hearing screening but who have risk indicators for other auditory disorders and/or speech and language delay receive ongoing audiologic surveillance and monitoring for communication development. Infants with sensorineural hearing loss are managed with hearing aids and receive auditory and speech-language rehabilitation therapies. Cochlear implants can be an outstanding option for certain children aged 12 months and older with severe to profound hearing loss who show limited benefit from conventional amplifications.

인공와우이식에서 전기자극 등골근반사의 임상적의의

김리석,안영민,이승환,김동환 대한이비인후과학회 2000 대한이비인후과학회지 두경부외과학 Vol.43 No.10

Usher 증후군 1예

김리석,한치성,오영준,김동환,허장원 대한이비인후과학회 2001 대한이비인후과학회지 두경부외과학 Vol.44 No.10

청성뇌간반응과 청성지속반응을 이용한 영유아의 청력역치 예측

김리석,정성욱 대한이비인후과학회 2011 대한이비인후과학회지 두경부외과학 Vol.54 No.9

Between one and three of every 1,000 neonates have sensorineural hearing loss (SNHL). It is of utmost importance to minimize the duration of auditory deprivation between the onset of bilateral deafness and intervention using hearing devices such as hearing aids and cochlear implants for achieving the best speech percpetion ability. To fit amplification accurately for children with SNHL, hearing thresholds for frequencies in the range of human communication should be evaluated. However, infants and young children are difficult to test using conventional behavioral tests, and hearing thresholds of them can be predicted using auditory brainstem response (ABR) and auditory steady-state response (ASSR). ABR is best evoked by applying a click stimulus, which allows an estimate over a broad range of high frequencies. ABR elicited by tone burst stimulus provides frequency-specific audiometric information. However, it can be difficult to record and observe at near-threshold levels, especially at lower frequencies. ABR thresholds for click and tone burst stimuli are highly correlated with behavioral thresholds, and often give an idea of the shape of an audiogram. ASSR is an auditory evoked potential, elicited with modulated tones. It provides frequency-specific hearing thresholds across the audiometric frequencies, which are well correlated with behavioral thresholds. However, the accuracy of threshold prediction decreases directly with the decrease of degree of hearing loss, and hearing thresholds cannot be predicted for auditory neuropathy. ASSR is most useful for estimating auditory thresholds for patients with no evidence of auditory neuropathy by the click ABR and OAEs, and who have an ABR only at high intensities or no ABR at a maximum stimulus level. Even if hearing thresholds are predicted through ABR and ASSR, behavioral testing including behavioral observation audiometry, visual reinforcement audiometry, or play audiometry should be employed repeatedly to verify the predicted thresholds, becasue the thresholds of ABR and ASSR are not true measure of hearing acuity but just responses generated at the brainstem.

뇌간유발반응

김리석,허승덕 釜算慶南耳鼻咽喉科學會 1996 임상이비인후과 Vol.7 No.2

와우갑각 전기자극 뇌간유발반응에 관한 연구

김리석,강명구,안영민,허승덕,이현,김상렬 대한청각학회 2000 Journal of Audiology & Otology Vol.4 No.1

인공와우이식 아동의 Open-Set Speech Perception의 발달

김리석,이미영,허민정,오영준 대한이비인후과학회 2004 대한이비인후과학회지 두경부외과학 Vol.47 No.1

Background and Objectives:The aims of this study were 1) to assess the development of open-set speech perception in pre-lingualy deaf children who had multichannel cochlear implants implanted and 2) to document the outcomes according to age at implantation and the device type. Subjects and Method:received a Nucleus 22 or Nucleus 24 multichannel cochlear implants and who had been followed-up for a period of 1-4 years at Dong-A University Hospital. They had no other disabilities. Open-set speech perception was evaluated pre-operatively, postope-ratively for 6 months and then on a yearly basis using the following assesment materials:Phonetically Balanced Kindergarten monosyllabic word lists, bisyllabic word lists, and Glendonald Auditory Screning Procedure(GASP) sentence subtest. Paired t-diferences in the mean scores between two groups divided by age at implantation and the device type. Results:Open-set speech perception for all subjects was improved to mean 84% for monosylabic phonemes and 89% and 88% for bisyllabic phonemes and everyday sentences respectively at 4 years postimplantation. Open-set speech perception ability was better for children who received implantation before 5 years of age than those who did it after 5 years of age at 3 years interval and 4 years interval. Conclusion:The prelingualy deaf children in our study showed significant open-set speech perception abilities at the time of the last postoperative evaluation. Rapid improvement was noted in open-set spech perception for the children who had Nucleus 24M implanted before 5 years of age. In order to maximize the effects of access to auditory stimuli provided by the cochlear implant on the development of open-set speech perception, a structured postoperative schedule of programing and rehabili-tation is recomended in addition to the optimal educational environment.