1Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; and 2Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Ear Hear. 2017 Nov/Dec;38(6):663-671. doi: 10.1097/AUD.0000000000000445.
The cochlear implant (CI) has been shown to be associated with better hearing, cognitive abilities, and functional independence. There is variability however in how much benefit each recipient derives from his or her CI. This study's primary objective is to determine the effects of individual and environmental characteristics on CI outcomes.
Seventy-six adults who developed postlingual severe to profound hearing loss and received their first unilateral CI at 65 years and older were eligible for the study. Fifty-five patients were asked to participate and the 33 (60%) with complete data were classified as "group 1." The remaining patients were placed in "group 2." Primary outcomes included changes in quality of life and open-set speech perception scores. Independent variables included age, health status, trait emotional intelligence (EI), comfort with technology, and living arrangements. Survey outcomes and audiological measurements were collected prospectively at 12 months after surgery, whereas preoperative data were collected retrospectively. Comparisons between groups 1 and 2 were made. Wilcoxon signed rank test, Spearman correlations, Mann-Whitney tests, Chi-square tests, and linear regressions were performed only on group 1 data.
Having a CI was associated with improved quality of life and speech perception. Familiarity with electronic tablets was associated with increased 12-month postoperative AzBio gains when adjusted for preoperative AzBio scores (adjusted p = 0.019), but only marginally significant when a family-wise error correction was applied (p = 0.057). Furthermore, patients who lived with other people scored at least 20 points higher on the AzBio sentences than those who lived alone (adjusted p = 0.046). Finally, consultation with an auditory rehabilitation therapist was associated with higher self-reported quality of life (p = 0.035).
This study suggests that in a cohort of older patients cochlear implantation is associated with a meaningful increase in both quality of life and speech perception. Furthermore, it suggests the potential importance of adjunct support and services, including the tailoring of CI rehabilitation sessions depending on the patient's familiarity with technology and living situation. Investment in rehabilitation and other services is associated with improvements in quality of life and may mitigate clinical, individual and social risk factors for poor communication outcome.
耳蜗植入物（CI）已被证明与更好的听力、认知能力和功能独立性相关。然而，每个接受者从 CI 中获得的益处存在差异。本研究的主要目的是确定个体和环境特征对 CI 结果的影响。
76 名成年人因后天性重度至极重度听力损失，在 65 岁及以上时接受单侧首例 CI，符合研究条件。55 名患者被要求参与，其中 33 名（60%）完成全部数据的患者被分类为“组 1”。其余患者被归入“组 2”。主要结果包括生活质量和开放式言语感知评分的变化。自变量包括年龄、健康状况、特质情绪智力（EI）、对技术的舒适度和居住安排。术后 12 个月前瞻性收集调查结果和听力学测量值，而术前数据则回顾性收集。比较组 1 和组 2。仅对组 1 数据进行 Wilcoxon 符号秩检验、Spearman 相关分析、Mann-Whitney 检验、卡方检验和线性回归。
植入 CI 与生活质量和言语感知的改善相关。使用电子平板电脑的熟悉程度与调整术前 AzBio 评分后的 12 个月术后 AzBio 增益相关（调整后 p = 0.019），但在应用全错误率校正时仅为边缘显著（p = 0.057）。此外，与独居者相比，与他人同住的患者在 AzBio 句子上的得分至少高出 20 分（调整后 p = 0.046）。最后，与听觉康复治疗师咨询与更高的自我报告生活质量相关（p = 0.035）。
本研究表明，在一组老年患者中，耳蜗植入物与生活质量和言语感知的显著提高相关。此外，它表明辅助支持和服务的潜在重要性，包括根据患者对技术和生活环境的熟悉程度调整 CI 康复课程。对康复和其他服务的投资与生活质量的提高相关，并可能减轻沟通结果不良的临床、个体和社会风险因素。
