Saroul N, Akkari M, Pavier Y, Gilain L, Mom T
Department of Otorhinolaryngology, Head and Neck Surgery, Université Clermont-I, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
Audiol Neurootol. 2014;19(2):85-90. doi: 10.1159/000354272. Epub 2013 Dec 21.
The aim of our study was to identify clinical criteria for optimizing rehabilitation of patients with unilateral deafness using the Baha device. We made a retrospective study of 102 patients with unilateral deafness requesting auditory rehabilitation over a period of 5 years. All subjects underwent a series of stereo audiometric tests, with and without Baha worn on a headband, and were then referred to a hearing care specialist for a real life trial of 15 days. The Glasgow Health Status Inventory (GHSI) questionnaire was administered. Patients refusing the implantation were retrospectively submitted to a questionnaire specifically designed to ask the reasons for refusal. We measured stereo audiometric test results, age, aetiology of deafness, duration of auditory deprivation on the rehabilitated ear, and GHSI score. At the conclusion of testing, the implantation rate was 29%. During preoperative testing, the improvement in understanding of speech-in-noise was 22 ± 11% for patients agreeing to the implantation versus 13 ± 11% for patients refusing the implantation. Age, aetiology of deafness and duration of auditory deprivation had no influence on the implantation decision. Speech-in-noise testing and aided stereo audiometric gain were the only two measures showing statistically significant differences between the groups agreeing to and refusing the implantation. There were multiple reasons for refusal of the implantation. Among these, the four principal reasons were: absence of perceived benefit during stereo audiometric testing (59%), requirement for surgery (35%), cost of the solution (44%), and aesthetics (41%). Hence, no other criteria except the preoperative improvement in understanding of speech-in-noise and the aided gain from Baha worn on a headband were found to be predictive of the patient's acceptance of surgical implantation of a bone-anchored implant/abutment for Baha. Speech-in-noise testing with and without Baha worn on a headband has a role to play in deciding on the implantation of a bone-anchored hearing solution.
我们研究的目的是确定使用骨锚式助听器（Baha）优化单侧耳聋患者康复治疗的临床标准。我们对102例单侧耳聋患者进行了为期5年的回顾性研究，这些患者均要求进行听觉康复治疗。所有受试者均接受了一系列立体声听力测试，测试时分别佩戴和不佩戴头带式Baha，然后被转介给听力保健专家进行为期15天的实际试用。同时发放了格拉斯哥健康状况量表（GHSI）问卷。拒绝植入的患者则通过一份专门设计的问卷进行回顾性调查，以询问其拒绝的原因。我们测量了立体声听力测试结果、年龄、耳聋病因、康复耳的听觉剥夺持续时间以及GHSI评分。测试结束时，植入率为29%。在术前测试中，同意植入的患者在噪声环境下言语理解能力的改善为22±11%，而拒绝植入的患者为13±11%。年龄、耳聋病因和听觉剥夺持续时间对植入决定没有影响。噪声环境下言语测试和佩戴Baha时的辅助立体声听力增益是仅有的两项在同意和拒绝植入的两组之间显示出统计学显著差异的指标。拒绝植入有多种原因。其中，四个主要原因是：在立体声听力测试中未感知到益处（59%）、需要手术（35%）、解决方案成本（44%）以及美观问题（41%）。因此，除了术前在噪声环境下言语理解能力的改善以及佩戴头带式Baha时的辅助增益外，未发现其他标准可预测患者是否接受骨锚式植入体/骨锚式助听器（Baha）基台的手术植入。佩戴和不佩戴头带式Baha进行的噪声环境下言语测试在决定是否植入骨锚式听力解决方案方面具有重要作用。
