Fitzpatrick E M, Johnson E, Durieux-Smith A
Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1082-7. doi: 10.1016/j.ijporl.2011.05.018. Epub 2011 Jun 23.
Early access to sound through early cochlear implantation has been widely advocated for children who do not derive sufficient benefit from acoustic amplification. Early identification through newborn hearing screening should lead to earlier intervention including earlier cochlear implantation when appropriate. Despite earlier diagnosis and the trend towards early implantation, many children are still implanted well into their preschool years. The purpose of this study was to examine the factors that affected late cochlear implantation in children with early onset permanent sensorineural hearing loss.
Data were examined for 43 children with cochlear implants who were part of a group of 71 children with hearing loss enrolled in a Canadian outcomes study. Eighteen (41.9%) of the 43 children were identified through newborn screening and 25 (58.1%) through medical referral to audiology. Medical chart data were examined to determine age of hearing loss diagnosis, age at cochlear implant candidacy, and age at cochlear implantation. Detailed reviews were conducted to identify the factors that resulted in implantation more than 12 months after hearing loss confirmation.
The median age of diagnosis of hearing loss for all 43 children was 9.0 (IQR: 5.1, 15.8) months and a median of 9.1 (IQR: 5.6, 26.8) months elapsed between diagnosis and unilateral cochlear implantation. The median age at identification for the screened groups was 3.3 months (IQR: 1.4, 7.1) but age at implantation (median 15.8 months: IQR: 5.6, 37.1) was highly variable. Eighteen of 43 children (41.9%) received a cochlear implant more than 12 months after initial hearing loss diagnosis. For many children, diagnosis of hearing loss was not equivalent to the determination of cochlear implant candidacy. Detailed reviews of audiologic profiles and study data indicated that late implantation could be accounted for primarily by progressive hearing loss (11 children), complex medical conditions (4 children) and other miscellaneous factors (3 children).
This study suggests that a substantial number of children will continue to receive cochlear implants well beyond their first birthday primarily due to progressive hearing loss. In addition, other medical conditions may contribute to delayed decisions in pediatric cochlear implantation.
对于无法从声音放大中充分获益的儿童，通过早期人工耳蜗植入尽早获得听力已得到广泛提倡。通过新生儿听力筛查进行早期识别应能实现更早的干预，包括在适当情况下更早进行人工耳蜗植入。尽管诊断有所提前且有早期植入的趋势，但许多儿童仍在学龄前才接受植入。本研究的目的是探讨影响早发性永久性感音神经性听力损失儿童延迟人工耳蜗植入的因素。
对43名接受人工耳蜗植入的儿童的数据进行了检查，这些儿童是参与一项加拿大结局研究的71名听力损失儿童群体的一部分。43名儿童中有18名（41.9%）通过新生儿筛查被识别，25名（58.1%）通过医学转诊至听力学部门被识别。检查病历数据以确定听力损失诊断年龄、人工耳蜗植入候选年龄和人工耳蜗植入年龄。进行详细审查以确定导致在听力损失确诊后12个月以上才进行植入的因素。
所有43名儿童听力损失的诊断中位年龄为9.0（四分位间距：5.1，15.8）个月，从诊断到单侧人工耳蜗植入的中位时间为9.1（四分位间距：5.6，26.8）个月。筛查组的识别中位年龄为3.3个月（四分位间距：1.4，7.1），但植入年龄（中位15.8个月：四分位间距：5.6，37.1）差异很大。43名儿童中有18名（41.9%）在首次听力损失诊断后12个月以上接受了人工耳蜗植入。对许多儿童来说，听力损失的诊断并不等同于确定人工耳蜗植入候选资格。对听力学资料和研究数据的详细审查表明，延迟植入主要可归因于进行性听力损失（11名儿童）、复杂的医疗状况（4名儿童）和其他杂项因素（3名儿童）。
本研究表明，相当数量的儿童在一岁生日后很久仍将继续接受人工耳蜗植入，主要原因是进行性听力损失。此外，其他医疗状况可能导致小儿人工耳蜗植入决策延迟。
