Medical University of South Carolina, Charleston.
JAMA Otolaryngol Head Neck Surg. 2020 Jul 1;146(7):613-620. doi: 10.1001/jamaoto.2020.0662.
Multiple studies have evaluated associations between post-cochlear implant (CI) speech recognition outcomes and patient-related factors. Current literature often appears equivocal or contradictory, so little is known about the factors that contribute to successful speech recognition outcomes with CIs.
To use a meta-analysis to pool data from the extant literature and provide an objective summary of existing evidence on associations of patient-related factors and CI speech recognition outcomes.
A literature search was performed using PubMed, Scopus, and CINAHL databases in January 2019 using the following search terms: cochlear implant or cochlear implants or cochlear implantation and speech recognition or word recognition or sentence recognition. Studies of postlingually deafened adult CI recipients that reported word or sentence recognition scores were included.
Inclusion criteria were postlingual adult CI recipients 18 years or older with word or sentence recognition scores at minimum 6-month postimplantation. Studies that included patients undergoing revision or reimplantation surgery were excluded.
Following the Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) guidelines, 1809 unique articles underwent review by abstract, and 121 articles underwent full-text review, resulting in 13 articles of 1095 patients for a meta-analysis of correlations. Random-effects model was used when the heterogeneity test yielded a low P value (P < .05).
The planned primary outcome was the pooled correlation values between postimplant speech recognition scores and patient-related factors.
Of the 1095 patients included from the 13 studies, the mean age at implantation ranged from 51.2 to 63.7 years and the mean duration of hearing loss ranged from 9.5 to 31.8 years; for the 825 patients for whom sex was reported, 421 (51.0%) were women. A weak negative correlation was observed between age at implantation and postimplant sentence recognition in quiet (r = -0.31 [95% CI, -0.41 to -0.20]). Other correlations between patient-related factors and postimplant word or sentence recognition were statistically significant, but all correlations were absent to negligible (r = 0.02-0.27).
Given that most associations were weak, negligible, or absent, patient-related factors often thought to affect CI speech recognition ability offer limited assistance in clinical decision-making in cochlear implantation. Additional research is needed to identify patient-related and other factors that predict CI outcomes, including speech recognition and other important variables related to success with CIs.
多项研究评估了人工耳蜗植入(CI)后言语识别结果与患者相关因素之间的关系。目前的文献往往存在分歧或矛盾,因此对于哪些因素有助于 CI 言语识别结果成功知之甚少。
使用荟萃分析汇总现有文献中的数据,客观总结患者相关因素与 CI 言语识别结果之间关联的现有证据。
2019 年 1 月,使用 PubMed、Scopus 和 CINAHL 数据库,采用以下搜索词进行文献检索:耳蜗植入或耳蜗植入物或耳蜗植入和言语识别或单词识别或句子识别。纳入了报道单词或句子识别得分的后天失聪成年 CI 接受者的研究。
纳入标准为后天失聪成年 CI 接受者,年龄 18 岁或以上,植入后至少 6 个月有单词或句子识别得分。排除了包括接受修正或重新植入手术的患者的研究。
根据系统评价和荟萃分析的首选报告项目(PRISMA)指南,对 1809 篇摘要进行了回顾,对 121 篇全文进行了回顾,对 13 项研究的 1095 例患者进行了荟萃分析。当异质性检验得出低值 P (P<0.05)时,采用随机效应模型。
计划的主要结局是植入后言语识别得分与患者相关因素之间的汇总相关值。
在纳入的 13 项研究的 1095 例患者中,植入时的平均年龄为 51.2 至 63.7 岁,平均听力损失时间为 9.5 至 31.8 年;在报告性别为 825 例患者中,421 例(51.0%)为女性。在安静环境下,植入年龄与植入后句子识别呈弱负相关(r=-0.31[95%CI,-0.41 至-0.20])。其他患者相关因素与植入后单词或句子识别之间的相关性具有统计学意义,但所有相关性均为弱、无或不存在(r=0.02-0.27)。
鉴于大多数相关性较弱、无或不存在,通常认为与 CI 言语识别能力相关的患者相关因素在耳蜗植入的临床决策中提供的帮助有限。需要进一步研究以确定预测 CI 结果的患者相关因素和其他因素,包括言语识别以及与 CI 成功相关的其他重要变量。