Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.
Otol Neurotol. 2019 Jul;40(6):745-753. doi: 10.1097/MAO.0000000000002225.
To determine the extent to which bilateral cochlear implantation increases patient-reported benefit as compared with unilateral implantation and no implantation.
PubMed, Scopus, CINAHL, and Cochrane databases searches were performed using the keywords ("Cochlear Implant" or "Cochlear Implantation") and ("bilateral").
Studies assessing hearing/CI-specific (CI) and general-health-related (HR) quality of life (QOL) in adult patients after bilateral cochlear implantation were included.
Of the 31 articles meeting criteria, usable QOL data were available for 16 articles (n = 355 bilateral CI recipients).
Standardized mean difference (Δ) for each measure and weighted effects were determined. Meta-analysis was performed for all QOL measures and also independently for hearing/CI-specific QOL and HRQOL.
When measured using hearing/CI-specific QOL instruments, patients reported very large improvements in QOL comparing before cochlear implantation to bilateral CI (Δ=2.07 [1.76-2.38]) and medium improvements comparing unilateral CI to bilateral CI (Δ=0.51 [0.32- 0.71]). Utilization of parallel versus crossover study design did not impact QOL outcomes (χ = 0.512, p = 0.47). No detectable improvements were observed in either CI transition when using HRQOL instruments (no CI to bilateral CI: Δ=0.40 [-0.02 to 0.81]; unilateral CI to bilateral CI: Δ=0.22 [-0.02 to 0.46]).The universal nature of HRQOL instruments may render them insensitive to the medium to large QOL improvements reported by patients using hearing/CI-specific QOL instruments. Given that HRQOL instruments are used to determine the economic benefit of health interventions, these measurement differences suggest that the health economic value of bilateral cochlear implantation has been underestimated.
比较双侧人工耳蜗植入与单侧植入和不植入相比，增加患者报告获益的程度。
使用关键词（“耳蜗植入”或“耳蜗植入术”）和（“双侧”）在 PubMed、Scopus、CINAHL 和 Cochrane 数据库中进行了搜索。
纳入评估成人双侧人工耳蜗植入后听力/人工耳蜗特定（CI）和一般健康相关（HR）生活质量（QOL）的研究。
符合标准的 31 篇文章中，有 16 篇文章（n=355 例双侧 CI 接受者）有可用的 QOL 数据。
确定了每项措施的标准化平均差异（Δ）和加权效应。对所有 QOL 措施进行了荟萃分析，也对听力/CI 特定 QOL 和 HRQOL 进行了独立分析。
使用听力/CI 特定 QOL 工具测量时，与植入前相比，患者报告双侧人工耳蜗植入后 QOL 有非常大的改善（Δ=2.07 [1.76-2.38]），与单侧人工耳蜗植入相比，有中等程度的改善（Δ=0.51 [0.32-0.71]）。使用平行设计与交叉设计对 QOL 结果没有影响（χ²=0.512，p=0.47）。使用 HRQOL 工具时，在任何 CI 过渡中都没有观察到可察觉的改善（无 CI 至双侧 CI：Δ=0.40 [-0.02 至 0.81]；单侧 CI 至双侧 CI：Δ=0.22 [-0.02 至 0.46]）。HRQOL 工具的普遍性可能使它们对患者使用听力/CI 特定 QOL 工具报告的中等至大的 QOL 改善不敏感。鉴于 HRQOL 工具用于确定健康干预措施的经济效益，这些测量差异表明，双侧耳蜗植入的健康经济效益被低估了。
