Black Jane, Hickson Louise, Black Bruce
School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Brisbane 4072, Australia.
Int J Pediatr Otorhinolaryngol. 2012 Sep;76(9):1317-26. doi: 10.1016/j.ijporl.2012.05.027. Epub 2012 Jun 27.
This work is a preliminary study that sought to investigate and develop a method for defining and evaluating "success" in paediatric cochlear implantation (PCI) and to apply a process by which a clinical team could optimally achieve this aim.
A pilot group of 25 profoundly deaf children who received a unilateral cochlear implant from 1995 to 2008 was used to develop the process. The cases displayed features that are commonly encountered in PCI. Individual case records were examined retrospectively for adverse factors that might impact on the implantation outcome with particular reference to the probability and severity of impact of each factor. Case prognosis was then rated on a 1-4 basis (1: excellent, 2: good, 3: fair, 4: poor). The subsequent outcomes were assessed using standardised speech (GFW, DEAP), language (PLS-4; CELF) and vocabulary (PPVT; EVT) assessments. Auditory performance outcomes were assessed using a new Categories of Auditory Performance Index (CAPI) that incorporated criteria, testing and scoring aspects. Family issues were also evaluated. Case outcomes were rated 1-4 as above and the prognoses and outcomes were then compared.
Accurate prognostication was seen in 14 cases, 5 had better outcomes than expected and 6 obtained poorer results. "Success", where the outcome equalled or exceeded the prognosis, occurred in 19 (76%) of cases. The successful group contained some "limited gains" cases where the results were nonetheless in line with expectations and parental satisfaction. The detrimental effect of delayed implantation was evident; Connexin 26 (GJB2) mutation had little influence. Poor general medical condition and adverse family situations commonly produced poorer outcomes.
Success in PCI is achieved when the outcome matches or exceeds the pre-operative expectations of the well-counselled family, without adverse side effects. The assessments achieved a good success rate, but further research is required to clearly identify potential problems and a skilled team is needed to evaluate their risk to the PCI outcome. Unforseen events may also intervene. Currently, differing outcome evaluation techniques impede comparison of studies, particularly in the speech and hearing domains. Rationalisation of these is recommended to facilitate future research.
本研究是一项初步研究，旨在探索和开发一种用于定义和评估小儿人工耳蜗植入（PCI）“成功”的方法，并应用一种临床团队能够最佳实现该目标的流程。
选取1995年至2008年期间接受单侧人工耳蜗植入的25名极重度聋儿组成试点组来开发该流程。这些病例展现出了PCI中常见的特征。对个体病例记录进行回顾性检查，以寻找可能影响植入结果的不利因素，尤其关注每个因素影响的可能性和严重程度。然后根据1 - 4级对病例预后进行评分（1：优秀，2：良好，3：中等，4：差）。使用标准化的言语（GFW、DEAP）、语言（PLS - 4；CELF）和词汇（PPVT；EVT）评估来评估后续结果。使用一种新的听觉表现类别指数（CAPI）来评估听觉表现结果，该指数纳入了标准、测试和评分方面。还对家庭问题进行了评估。病例结果按上述1 - 4级进行评分，然后比较预后和结果。
14例预后准确，5例结果好于预期，6例结果较差。结果等于或超过预后的“成功”病例有19例（76%）。成功组包括一些“获益有限”的病例，但其结果仍符合预期且家长满意。延迟植入的有害影响明显；连接蛋白26（GJB2）突变影响较小。一般健康状况差和不良家庭情况通常会导致较差的结果。
当结果与经过充分咨询的家庭的术前预期相符或超过预期且无不良副作用时，PCI即为成功。这些评估取得了较高的成功率，但需要进一步研究以明确识别潜在问题，并且需要一个专业团队来评估它们对PCI结果的风险。不可预见的事件也可能会干预。目前，不同的结果评估技术妨碍了研究之间的比较，尤其是在言语和听力领域。建议对这些技术进行合理化处理以促进未来的研究。
