Rhino-Laryngology, Head and Neck Surgery, St. Elisabeth Hospital, Ruhr University Bochum; Department of Oto-Rhino-Laryngology, University Hospital Frankfurt; Department of Oto- Rhino-Laryngology, University Hospital Carl Gustav Carus Dresden.
Dtsch Arztebl Int. 2020 Oct 9;117(41):690-700. doi: 10.3238/arztebl.2020.0690.
Hearing impairment that is too severe to be adequately treated with conventional hearing aids can lead, in children, to severe developmental disturbances of hearing and language, and, in adults, to communicative and social deprivation. Recent advances in medical device technology and in microsurgical techniques have led to an expansion of the indications for cochlear implantation (CI) for adults with progressive hearing loss in older age, and to a restructuring of the process of care for these patients in Germany.
This review is based on pertinent publications retrieved by a selective search in PubMed, as well as on the CI guidelines and CI "white book" of the German Society of Otolaryngology and Head and Neck Surgery.
Early and accurate diagnosis is crucial for the successful auditory rehabilitation of high-grade hearing impairment. In children, a key role is played by newborn auditory screening, which is mandatory in Germany and enables the provision of a CI in the first year of life when necessary. 86% of the children receiving a CI achieve linguistic comprehension of fluently spoken sentences. For adults, positive prognostic factors for hearing after the provision of a CI include a highly motivated patient, "postlingual" onset of the hearing impairment (i.e., after the acquisition of language), and a brief duration of deafness. Auditory rehabilitation is associated with significant improvement, not just of hearing and of the comprehension of spoken language, but also of quality of life, particularly in elderly patients. For patients of any age with bilateral hearing loss, CIs should be provided on both sides, if possible. The more common complications of the procedure, with a probability of 2-4% each, are technical implant defects, dizziness, and wound-healing disturbances.
Cochlear implantation, performed in specialized centers, is a safe and reliable technique and regularly enables the successful rehabilitation of hearing in both children and adults.
对于常规助听器无法充分治疗的重度听力障碍，如果发生在儿童身上，可能导致严重的听力和语言发育障碍；如果发生在成年人身上，则可能导致交流和社交障碍。医疗器械技术和微创手术技术的最新进展，扩大了对老年渐进性听力损失成年人进行人工耳蜗植入（CI）的适应证，并对德国这些患者的护理流程进行了重构。
本综述基于在 PubMed 中进行选择性检索获得的相关出版物，以及德国耳鼻喉头颈外科学会的 CI 指南和 CI“白皮书”。
早期、准确的诊断对于重度听力障碍患者成功的听觉康复至关重要。在儿童中，新生儿听觉筛查起着关键作用，德国强制进行该筛查，使其能够在必要时在生命的第一年提供 CI。接受 CI 的儿童中有 86%能够流利地理解言语。对于成年人，提供 CI 后听力改善的积极预后因素包括：高度配合的患者、“后天性”听力障碍（即语言习得后）和短暂的耳聋时间。听觉康复不仅显著改善了听力和言语理解能力，还改善了生活质量，尤其是老年患者。对于任何年龄段有双侧听力损失的患者，如果可能，应在两侧都提供 CI。该手术更常见的并发症，每种并发症的概率为 2-4%，包括技术植入缺陷、头晕和伤口愈合障碍。
在专业中心进行的人工耳蜗植入是一种安全、可靠的技术，通常能够成功地恢复儿童和成年人的听力。
