Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium,
Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium,
Audiol Neurootol. 2021;26(2):61-75. doi: 10.1159/000508433. Epub 2020 Jul 10.
Cochlear implants (CI) have increasingly been adopted in older adults with severe to profound sensorineural hearing loss as a result of the growing and aging world population. Consequently, researchers have recently shown great interest in the cost-effectiveness of cochlear implantation and its effect on quality of life (QoL) in older CI users. Therefore, a systematic review and critical evaluation of the available literature on QoL in older adult CI users was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were selected by searching MEDLINE (PubMed) and the Cochrane Library and by checking the reference lists of relevant articles. Inclusion criteria were as follows: (1) the study sample were adults aged 50 years and older with postlingual onset of bilateral severe to profound hearing loss, (2) all subjects received a multi-electrode CI, and (3) QoL was assessed before and after implantation. Out of 1,093 records, 18 articles were accepted for review. Several studies demonstrated significant positive effects of cochlear implantation on QoL in older adults, but high-level evidence-based medicine is lacking. An improvement of QoL was generally reported when using disease-specific instruments, which are designed to detect treatment-specific changes, whereas the outcomes of generic QoL questionnaires, assessing general health states, were rather ambiguous. However, only generic questionnaires would be able to provide calculations of the cost-effectiveness of CI and comparisons across patient populations, diseases, or interventions. Hence, generic and disease-specific QoL instruments are complementary rather than contradictory. In general, older CI users' QoL was assessed using a variety of methods and instruments, which complicated comparisons between studies. There is a need for a standardized, multidimensional, and comprehensive QoL study protocol including all relevant generic and disease-specific instruments to measure and compare QoL, utility, and/or daily life performance in CI users.
人工耳蜗植入（CI）已越来越多地用于因世界人口增长和老龄化而导致严重到极重度感音神经性听力损失的老年患者。因此，研究人员最近对人工耳蜗植入的成本效益及其对老年 CI 用户生活质量（QoL）的影响表现出极大的兴趣。因此，根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，对老年 CI 用户 QoL 的现有文献进行了系统评价和批判性评估。通过搜索 MEDLINE（PubMed）和 Cochrane 图书馆以及检查相关文章的参考文献列表来选择研究。纳入标准如下：（1）研究样本为 50 岁及以上、后天双侧严重至极重度听力损失的成年人，（2）所有受试者均接受多电极 CI，（3）在植入前后评估 QoL。在 1093 条记录中，有 18 篇文章被接受进行综述。一些研究表明，人工耳蜗植入对老年人的生活质量有显著的积极影响，但缺乏基于高级别证据的医学证据。一般来说，当使用旨在检测特定治疗变化的疾病特异性仪器时，报告了 QoL 的改善，而通用 QoL 问卷的结果则相当模糊，这些问卷评估一般健康状况。然而，只有通用问卷才能提供 CI 的成本效益计算，并对患者人群、疾病或干预措施进行比较。因此，通用和疾病特异性 QoL 工具是互补的，而不是相互矛盾的。总的来说，老年 CI 用户的 QoL 使用了各种方法和工具进行评估，这使得研究之间的比较变得复杂。需要一种标准化的、多维的、全面的 QoL 研究方案，包括所有相关的通用和疾病特异性仪器，以测量和比较 CI 用户的 QoL、效用和/或日常生活表现。
