Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
Ear Hear. 2018 Sep/Oct;39(5):1008-1014. doi: 10.1097/AUD.0000000000000568.
This study determined the relationship between preoperative phoneme and word scores and the gain in speech perception after cochlear implantation in a large cohort of patients. The authors aimed to define evidence-based selection criteria for cochlear implantations in adults with postlingual deafness.
This retrospective study included 364 adults with postlingual deafness who received a cochlear implant between 2000 and 2013 at the Leiden University Medical Center. The gain in speech perception observed postimplantation was compared with preoperative-aided/binaural speech perception scores, measured at 65 dB SPL in quiet. Patients who showed preoperative phoneme scores on monosyllabic words above 50% were also tested for speech perception in the presence of speech-shaped background noise, at a +5 dB signal to noise ratio.
Speech perception in quiet improved after implantation in all except 7 patients. Average scores in quiet continued to improve, up to approximately 1 year after implantation. When participants were divided into five groups, based on preoperative speech perception scores, all groups showed gains in speech perception, except for the group with aided preoperative phoneme scores above 80%. However, all patients who were tested preoperatively with the addition of background noise showed improvements in speech perception in noise after the cochlear implantation.
Although the decision to implant should consider individual ear differences and other factors that might apply to a particular case, based on our data, all patients with preoperative scores of either 80% (phonemes correct) or 60% (words correct) and lower in an optimal-aided situation are potential candidates for a cochlear implant, provided that their preoperative speech perception score decreases below 50% (phonemes correct) or 20% (words correct), when background noise is added at a +5 dB signal to noise ratio.
本研究旨在确定术前音位和单词得分与人工耳蜗植入后言语感知增益之间的关系，研究对象为一大组后天性聋的成年患者。作者旨在为后天性聋的成年患者人工耳蜗植入术制定基于循证的选择标准。
这是一项回顾性研究，共纳入了 364 名后天性聋成年患者，他们于 2000 年至 2013 年期间在莱顿大学医学中心接受了人工耳蜗植入术。将术后观察到的言语感知增益与术前助听听阈下安静环境中的单音节词和双音节词的言语感知得分进行比较。术前单音节词音位得分高于 50%的患者，还在+5 dB 信噪比的言语噪声环境下进行言语感知测试。
除 7 名患者外，所有患者植入后安静环境中的言语感知能力均有提高。平均得分在植入后持续提高，约 1 年后达到稳定。根据术前言语感知得分将患者分为五组，除术前助听音位得分高于 80%的组外，其余各组均有言语感知增益。然而，所有术前在加入背景噪声的情况下接受测试的患者，在人工耳蜗植入后在噪声环境中的言语感知能力均有提高。
尽管植入决策应考虑个体耳差异和其他可能适用于特定病例的因素，但根据我们的数据，所有术前在最佳助听情况下得分分别为 80%（音位正确）或 60%（单词正确）及更低的患者，只要其术前言语感知得分在加入+5 dB 信噪比的背景噪声后下降至 50%（音位正确）或 20%（单词正确）以下，均为人工耳蜗植入的潜在候选者。
