National Hearing Implant and Research Centre, Beaumont Hospital, Dublin 9, Ireland.
Neural Engineering, Trinity Centre for Biomedical Engineering, Trinity College, The University of Dublin, Dublin 2, Ireland.
Clin Otolaryngol. 2020 Jul;45(4):459-465. doi: 10.1111/coa.13523. Epub 2020 Mar 24.
It is well established that sequential bilateral implantation offers functional benefits in speech in noise and sound localisation, although it can be challenging to get long-term unilateral users to adapt to the second implant. The aim of this study was to investigate programming differences between the two cochlear implants that can impact on performance outcomes.
Cohort Study.
Sixteen older children who received sequential implants in Ireland and with at least one-year experience with their sequential implant were included in this study. Children were categorised into two groups according to the time interval between the two implants: short if the time between the two implants was less than eight years and long if more than eight years.
Dynamic ranges and current levels were compared for both implants. Functional outcome measures included sentence discrimination in quiet and in noise and sound localisation.
Results show that for the children with long inter-implant delays, the dynamic range of their second implant was on average 34% less than the dynamic range of their first implant. This difference was driven by smaller comfort levels in the second implant compared to the first. Children with longer inter-implant delays also show lower speech discrimination scores with their second implant compared to children with shorter delays, in addition to no bilateral advantage in speech in noise, that is their performance in unilateral mode does not differ from the performance in bilateral mode. Finally, children with longer delays demonstrate poor performance in sound localisation compared to the children with shorter delays.
Sequentially implanted older children show limited functional benefits from the second implant. The observed functional benefits are determined both by a short inter-implant delay and by having balanced dynamic ranges between the two implants.
已有研究证实，序贯双侧植入在噪声环境中的言语感知和声音定位方面具有显著的功能优势，尽管让长期使用单侧植入的患者适应第二侧植入可能具有挑战性。本研究旨在探究可能影响患者术后表现的双侧植入之间的编程差异。
队列研究。
16 名在爱尔兰接受序贯双侧植入的大龄儿童，且至少有一年的双侧植入使用经验。根据两次植入之间的时间间隔，将这些儿童分为两组：间隔时间小于 8 年的为短期组，间隔时间大于 8 年的为长期组。
对双侧植入的动态范围和电流水平进行比较。采用安静和噪声环境下的句子辨别测试以及声音定位测试对患者的功能结果进行评估。
结果表明，对于两次植入间隔时间较长的儿童，他们第二侧植入的动态范围平均比第一侧植入的动态范围小 34%。这一差异主要是由于第二侧植入的舒适度比第一侧植入低。与间隔时间较短的儿童相比，间隔时间较长的儿童在使用第二侧植入时，言语辨别得分较低，且在噪声环境下的言语感知能力也没有双侧优势，即他们在单侧模式下的表现与双侧模式下的表现没有差异。此外，间隔时间较长的儿童在声音定位方面的表现明显差于间隔时间较短的儿童。
序贯双侧植入的大龄儿童患者仅能从第二侧植入中获得有限的功能优势。观察到的功能优势不仅取决于较短的两次植入间隔时间，还取决于双侧植入之间平衡的动态范围。
