Sparreboom Marloes, Snik Ad F M, Mylanus Emmanuel A M
Radboud University Nijmegen Medical Centre, Department of Otorhinolaryngology, Head and Neck Surgery, Hearing and Implants, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands.
Arch Otolaryngol Head Neck Surg. 2012 Feb;138(2):134-41. doi: 10.1001/archoto.2011.229. Epub 2012 Jan 16.
To assess the effect of sequential bilateral cochlear implantation in children on their quality of life (QoL).
Prospective cohort-control study.
Tertiary academic referral center.
Thirty children with prelingual deafness underwent sequential bilateral cochlear implantation (mean age at first implant, 1.8 years; mean age at second implant, 5.3 years). Nine children with a unilateral cochlear implant were also included in the study. All children had prelingual deafness, had good implant performance, and had no benefit from a contralateral conventional hearing aid. The groups were matched on duration of unilateral implant use, chronological age, and degree of bilateral hearing loss.
Sequential bilateral cochlear implantation.
Quality of life was assessed before surgery of the second implant and after 12 and 24 months of bilateral implant use. In the children with a unilateral cochlear implant, QoL was assessed over time and was compared with the study group after 12 and 24 months. Six questionnaires were used to measure QoL: overall health status using a visual analog scale; the Health Utilities Index Mark 3 (HUI3); the Pediatric Quality of Life Inventory (PedsQL); the Glasgow Children's Benefit Inventory (GCBI); the Speech, Spatial, and Qualities of Hearing Scale (SSQ); and the Nijmegen Cochlear Implant Questionnaire (NCIQ).
Results showed no significant gain in generic QoL measures associated with sequential bilateral cochlear implantation (P > .05). The nonsignificant effect yielded on the HUI3 could be attributed to the ceiling effect and the lack of resolution in the hearing domain obtained in cochlear implant recipients. The gain in QoL of +0.04 may, therefore, be underestimated. In contrast, the 3 disease-specific questionnaires showed a significant improvement in QoL (P < .05). Results also showed that, unlike the children with a unilateral implant, QoL measures continued to improve with longer durations of bilateral implant use. Within the study group, the age at second implantation had no influence on the gain in QoL (P > .05).
Sequential bilateral cochlear implantation in children is associated with an improvement in QoL, although this is predominantly reflected in the disease-related aspects of QoL and not necessarily in generic QoL.
评估儿童序贯双侧人工耳蜗植入对其生活质量（QoL）的影响。
前瞻性队列对照研究。
三级学术转诊中心。
30名语前聋儿童接受了序贯双侧人工耳蜗植入（首次植入时的平均年龄为1.8岁；第二次植入时的平均年龄为5.3岁）。9名单侧人工耳蜗植入儿童也纳入本研究。所有儿童均为语前聋，人工耳蜗植入效果良好，且对侧传统助听器未带来益处。两组在单侧植入使用时长、实际年龄和双侧听力损失程度方面进行了匹配。
序贯双侧人工耳蜗植入。
在第二次植入手术前以及双侧植入使用12个月和24个月后评估生活质量。对于单侧人工耳蜗植入儿童，随时间评估其生活质量，并在12个月和24个月后与研究组进行比较。使用6份问卷来测量生活质量：使用视觉模拟量表评估总体健康状况；健康效用指数Mark 3（HUI3）；儿童生活质量量表（PedsQL）；格拉斯哥儿童受益量表（GCBI）；言语、空间和听力质量量表（SSQ）；以及奈梅亨人工耳蜗植入问卷（NCIQ）。
结果显示，与序贯双侧人工耳蜗植入相关的一般生活质量指标无显著提高（P > 0.05）。HUI3产生的不显著效果可能归因于天花板效应以及人工耳蜗植入受者在听力领域缺乏分辨率。因此，生活质量提高0.04可能被低估。相比之下，3份疾病特异性问卷显示生活质量有显著改善（P < 0.05）。结果还表明，与单侧植入儿童不同，双侧植入使用时间越长，生活质量指标持续改善。在研究组内，第二次植入时的年龄对生活质量的提高没有影响（P > 0.05）。
儿童序贯双侧人工耳蜗植入与生活质量的改善相关，尽管这主要体现在生活质量的疾病相关方面，而不一定体现在一般生活质量方面。
