Wong Daniel Jun Yi, Moran Michelle, O'Leary Stephen John
*The Royal Victorian Eye and Ear Hospital†Department of Otolaryngology‡Department of Audiology and Speech Pathology, University of Melbourne§The HEARing Co-operative Research Centre, Melbourne, Victoria, Australia.
Otol Neurotol. 2016 Jan;37(1):46-51. doi: 10.1097/MAO.0000000000000920.
To evaluate the outcomes after cochlear implantation (CI) in the elderly population, with a particular emphasis on perioperative complications, dizziness, and speech perception outcomes.
A retrospective cohort study of elderly cochlear implant patients.
Tertiary referral center (Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital, Melbourne).
All patients aged 75 and above at the time of first cochlear implant (N = 150). Comparison was made between groups aged 85+ to 80-84, and 75-79.
All patients received Nucleus devices (either CI512 or CI24RE(CA)).
Speech recognition scores both pre- and postimplantation, symptomatic dizziness and effects upon independent living after surgery, and the incidence of perioperative medical and surgical complications. Complications were classified as major (intrinsic device failure, device migration, extracochlear insertion, meningitis, surgical site infection requiring reoperation, wound breakdown, permanent facial nerve paralysis) and minor (tinnitus, transient facial nerve palsy, facial nerve stimulation, taste disturbance, delayed wound healing).
All three cohorts had poor preoperative speech perception. There was significant improvement in postoperative word scores at 3 and 12 months across all groups. There was no statistically significant difference between the three cohorts in terms of speech recognition outcomes at 3 and 12 months. After surgery, more than 20% of patients at all ages experienced transient imbalance, although the incidence did not differ significantly between age groups (p = 0.71). In total, there were 13 major complications in 7 patients (4.7%), and 28 minor complications in 25 patients (16.7%).
Postoperative disequilibrium was commonly observed in this elderly population, yet patients still benefited with improved speech perception after cochlear implantation. Elderly patients can benefit from cochlear implantation, and age should not be a limitation for CI surgery. Cochlear implantation can be done safely and provides significant patient benefits.
评估老年人群人工耳蜗植入（CI）后的效果，特别关注围手术期并发症、头晕及言语感知效果。
对老年人工耳蜗植入患者进行回顾性队列研究。
三级转诊中心（墨尔本皇家维多利亚眼耳医院人工耳蜗诊所）。
首次人工耳蜗植入时年龄在75岁及以上的所有患者（N = 150）。将85岁及以上组、80 - 84岁组和75 - 79岁组进行比较。
所有患者均接受Nucleus设备（CI512或CI24RE(CA)）。
植入前后的言语识别分数、症状性头晕及手术对独立生活的影响，以及围手术期内科和外科并发症的发生率。并发症分为严重（内置设备故障、设备移位、耳蜗外插入、脑膜炎、需要再次手术的手术部位感染、伤口裂开、永久性面神经麻痹）和轻微（耳鸣、短暂性面神经麻痹、面神经刺激、味觉障碍、伤口愈合延迟）。
所有三个队列术前言语感知能力均较差。所有组在术后3个月和12个月时单词分数均有显著提高。三个队列在术后3个月和12个月时的言语识别结果无统计学显著差异。术后，各年龄段超过20% 的患者经历过短暂性失衡，尽管各年龄组的发生率无显著差异（p = 0.71）。共有7例患者出现13例严重并发症（4.7%），25例患者出现28例轻微并发症（16.7%）。
在该老年人群中术后失衡较为常见，但人工耳蜗植入后患者的言语感知仍有改善。老年患者可从人工耳蜗植入中获益，年龄不应成为CI手术的限制因素。人工耳蜗植入可以安全进行，并给患者带来显著益处。
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