助听是否能改善前庭老年病和/或跌倒风险？
Can hearing amplification improve presbyvestibulopathy and/or the risk-to-fall ?
机构信息
Department of Otolaryngology at UKB, Charité Med School, Hospital of the Univ of Berlin, Warener Str. 7, 12683, Berlin, Germany.
出版信息
Eur Arch Otorhinolaryngol. 2021 Aug;278(8):2689-2694. doi: 10.1007/s00405-020-06414-9. Epub 2020 Oct 9.
PURPOSE
The decline of sensory systems during aging has been widely investigated and several papers have correlated the visual, hearing and vestibular systems and the consequences of their functional degeneration. Hearing loss and presbyvestibulopathy have been found to be positively correlated as is with the risk-to-fall.
MATERIAL AND METHODS
The present study was therefore designed as systematic review (due to PRISMA criteria) which should correlate hearing amplification by hearing aids and/or cochlear implants with balance outcome. However, the literature review (Cochrane, PubMed) revealed ten paper (prospective, controlled trials and acute trials) with heterogenous patient popiulations and non-uniform outcome measures (i.e., gait analysis, questionnaires, postural stabilometry) so that no quantitative, statistical analysis could be performed.
RESULTS
The qualitative analysis oft he identified studies showed that hearing amplification in the elderly improves spatio-temporal orientation (particularly with cochlear implants) and that the process of utilizing auditory information for balance control takes some time (i.e., the neuroplasticity-based, learning processes), usually some months in cochlear implantees.
DISCUSSION
Hearing and balance function degenerate independently from each other and large interindividual differences require a separate neurotological examination of each patient. However, hearing amplification is most helpful to improve postural stability, particularly in the elderly. Future research should focus on controlled, prospective clinical trials where a standardized test battery covering the audiological and neurotological profile of each elderly patient pre/post prescription of hearing aids and/or cochlear implantation should be followed up (for at least 1 year) so that also the balance improvements and the risk-to-fall can be reliably assessed (e.g., by mobile posturography and standardized questionnaires, e.g., the DHI).
目的
衰老过程中感觉系统的衰退已经得到了广泛的研究，并且有几篇论文已经将视觉、听觉和前庭系统及其功能退化的后果联系起来。已经发现听力损失和前庭功能障碍呈正相关，并且与跌倒风险相关。
材料和方法
因此，本研究设计为系统评价（根据 PRISMA 标准），该评价应将助听器和/或人工耳蜗的听力放大与平衡结果相关联。然而，文献综述（Cochrane，PubMed）显示有 10 篇论文（前瞻性、对照试验和急性试验）具有异质的患者群体和非统一的结果测量（即步态分析、问卷、姿势稳定度测量），因此无法进行定量、统计学分析。
结果
对确定的研究进行定性分析表明，老年人的听力放大改善了时空定向（特别是使用人工耳蜗），并且利用听觉信息进行平衡控制的过程需要一些时间（即基于神经可塑性的学习过程），在人工耳蜗植入者中通常需要几个月的时间。
讨论
听力和平衡功能彼此独立退化，个体间差异较大，需要对每个患者进行单独的神经耳科学检查。然而，听力放大最有助于改善姿势稳定性，特别是在老年人中。未来的研究应集中在对照的前瞻性临床试验上，在这些试验中，每个老年患者的听力和神经耳科学特征都应遵循标准化的测试方案，包括助听器和/或人工耳蜗的处方前和后（至少 1 年），以便可靠地评估平衡改善和跌倒风险（例如，通过移动姿势描记术和标准化问卷，例如 DHI）。
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