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基于患者相关特征的成人人工耳蜗植入效果影响因素——一项回顾性研究

Factors that influence outcomes in cochlear implantation in adults, based on patient-related characteristics - a retrospective study.

作者信息

Kraaijenga V J C, Smit A L, Stegeman I, Smilde J J M, van Zanten G A, Grolman W

机构信息

Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.

Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.

出版信息

Clin Otolaryngol. 2016 Oct;41(5):585-92. doi: 10.1111/coa.12571. Epub 2016 Feb 11.

Abstract

OBJECTIVE

Outcomes in speech perception following cochlear implantation in adults vary widely. Many studies have been carried out to identify and quantify factors that influence outcomes. This study adds a new dimension to pre-existing literature.

DESIGN

Single-centre retrospective cohort study.

SETTING

University Medical Center Utrecht, the Netherlands.

PARTICIPANTS

A total of 428 adults with bilateral severe-to-profound sensorineural hearing loss, unilaterally implanted between February 1988 and March 2014.

MAIN OUTCOME MEASURES

Univariable and multivariable linear regression analyses were carried out to identify factors that may influence outcome after cochlear implantation. Consonant-vowel-consonant word scores were recorded pre- and post-implant and were used as outcome measure in two groups of patients (prelingually and postlingually deafened adults). As an added dimension, multiple imputation was implemented and evaluated to tackle 4% (17/407) missing data.

RESULTS

For postlinguals, pre-implant speech perception score and age at onset of deafness are positive predictors and meningitis and otosclerosis as cause of deafness are negative predictors of post-implant speech perception. This model accounted for 26% of variance. For prelinguals, pre-implant speech perception score is the only strong positive predictor (β 0.524; P < 0.001). This model accounted for 31% of variance. Age at implantation was not a significant predictor in either group.

CONCLUSIONS

Speech perception is predicted by pre-implant speech perception, age at onset of deafness and aetiology (meningitis and otosclerosis) for postlinguals and solely pre-implant speech perception for prelinguals. Age at implantation is of lesser importance in predicting speech perception outcome post-implant. Multiple imputation is a useful statistical technique when analysing incomplete data sets.

摘要

目的

成人人工耳蜗植入后的言语感知结果差异很大。已经开展了许多研究来识别和量化影响结果的因素。本研究为现有文献增添了新的维度。

设计

单中心回顾性队列研究。

地点

荷兰乌得勒支大学医学中心。

参与者

共有428例双侧重度至极重度感音神经性听力损失的成人,于1988年2月至2014年3月期间接受单侧植入。

主要结局指标

进行单变量和多变量线性回归分析,以识别可能影响人工耳蜗植入后结果的因素。在两组患者(语前聋和语后聋成人)中,记录植入前后的辅音-元音-辅音单词得分,并将其用作结局指标。作为一个新增维度,实施并评估多重填补法以处理4%(17/407)的缺失数据。

结果

对于语后聋患者,植入前言语感知得分和耳聋发病年龄是植入后言语感知的阳性预测因素,而脑膜炎和耳硬化症作为耳聋病因是植入后言语感知的阴性预测因素。该模型解释了26%的方差。对于语前聋患者,植入前言语感知得分是唯一强有力的阳性预测因素(β 0.524;P < 0.001)。该模型解释了31%的方差。植入年龄在两组中均不是显著的预测因素。

结论

对于语后聋患者,植入前言语感知、耳聋发病年龄和病因(脑膜炎和耳硬化症)可预测言语感知,而对于语前聋患者,仅植入前言语感知可预测言语感知。植入年龄在预测植入后言语感知结果方面重要性较低。在分析不完整数据集时,多重填补法是一种有用的统计技术。

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