Santa Maria Peter Luke, Gluth Michael Brian, Yuan Yongqing, Atlas Marcus David, Blevins Nikolas H
*Department of Otolaryngology, Head and Neck Surgery, Stanford University Hospital and Clinics, Stanford, California; and †Section of Otolaryngology-Head and Neck Surgery, University of Chicago Medical Center, Chicago, Illinois, U.S.A.; ‡Ear Sciences Centre, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia; §Department of Statistics, Stanford University, Stanford, California, U.S.A.; and ∥Ear Science Institute Australia, Perth, Western Australia, Australia.
Otol Neurotol. 2014 Dec;35(10):e256-69. doi: 10.1097/MAO.0000000000000561.
To examine the results of hearing preservation in cochlear implantation surgery to identify surgical technical factors, electrode array design factors, and steroid usage, which predicts greater low-frequency hearing preservation.
A thorough search of Medline and Pubmed of English studies from January 1, 1995, to January 1, 2013, was performed using the key words "electric and acoustic hearing" or "hybrid cochlear implant" or "EAS cochlear implant" or "partial deafness cochlear implant" or "bimodal hearing cochlear implant" or "hearing preservation cochlear implant."
The meta-analysis was conducted according to the PRISMA statement. Only articles in English were included. Studies were included if hearing preservation was the primary end point. A final number of 24 studies met the inclusion criteria.
Patient populations were analyzed as intention to treat. Data were extracted from raw audiograms where possible. Data were excluded if not all explanatory variables were present or if variable values were ambiguous.
The weighted least-squares regression method was used to determine the predictive power of each explanatory variable across all studies.
In this meta-analysis, the following are associated with better hearing preservation: cochleostomy over the round window approach, posterior tympanotomy over the suprameatal approach, a slow electrode array insertion technique over insertion of less than 30 seconds, a soft tissue cochleostomy seal over a fibrin glue only seal and the use of postoperative systemic steroids. Longer electrode arrays, topical steroid use, and lubricant use for electrode array insertion did not give an advantage.
研究人工耳蜗植入手术中听力保留的结果，以确定手术技术因素、电极阵列设计因素和类固醇使用情况，这些因素可预测更好的低频听力保留。
使用关键词“电声联合听力”或“混合式人工耳蜗”或“电声联合刺激人工耳蜗”或“部分性聋人工耳蜗”或“双耳双模人工耳蜗”或“听力保留人工耳蜗”，对1995年1月1日至2013年1月1日期间的英文研究进行了全面检索。
根据系统评价和Meta分析的首选报告项目（PRISMA）声明进行Meta分析。仅纳入英文文章。如果听力保留是主要终点，则纳入研究。最终有24项研究符合纳入标准。
对患者群体按意向性分析。尽可能从原始听力图中提取数据。如果并非所有解释变量都存在或变量值不明确，则排除数据。
采用加权最小二乘回归方法确定所有研究中每个解释变量的预测能力。
在这项Meta分析中，以下因素与更好的听力保留相关：圆窗入路优于经鼓窦入路的耳蜗造瘘术，后鼓室切开术优于耳道上入路，电极阵列缓慢插入技术优于插入时间少于30秒，软组织耳蜗造瘘密封优于仅用纤维蛋白胶密封，以及术后全身使用类固醇。更长的电极阵列、局部使用类固醇和在电极阵列插入时使用润滑剂并无优势。
