Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston.
JAMA Otolaryngol Head Neck Surg. 2021 Mar 1;147(3):280-286. doi: 10.1001/jamaoto.2020.5094.
Cochlear implantation is highly effective at improving hearing outcomes, but results have been limited to groupwise analysis. That is, limited data are available for individual patients that report comparisons of preoperative aided speech recognition and postimplantation speech recognition.
To assess changes in preoperative aided vs postoperative speech recognition scores for individual patients receiving cochlear implants when considering the measurement error for each speech recognition test.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a prospectively maintained database of patients who received cochlear implants between January 1, 2012, and December 31, 2017, at a tertiary, university-based referral center. Adults with bilateral sensorineural hearing loss undergoing cochlear implantation with 6- or 12-month postoperative measures using 1 or more speech recognition tests were studied.
Cochlear implantation.
Postoperative word recognition (consonant-nucleus-consonant word test), sentence recognition (AzBio sentences in quiet), and sentence recognition in noise (AzBio sentences in +10-dB signal-to-noise ratio) scores, and association of each speech recognition score change with aided preoperative score to each test's measurement error.
Analysis of data from a total of 470 implants from 323 patients included 253 male (53.8%) patients; the mean (SD) age was 61.2 (18.3) years. Most patients had statistically significant improvement in all speech recognition tests postoperatively beyond measurement error, including 262 (84.8%) for word recognition, 226 (87.6%) for sentence recognition, and 33 (78.6%) for sentence recognition in noise. A small number of patients had equivalent preoperative and postoperative scores, including 45 (14.5%) for word recognition, 28 (10.9%) for sentence recognition, and 9 (21.4%) for sentence recognition in noise. Four patients (1.6%) had significantly poorer scores in sentence recognition after implantation. The associations between age at implantation and change in speech recognition scores were -0.12 (95% CI, -0.23 to -0.01) for word recognition, -0.22 (95% CI, -0.34 to -0.10) for sentence recognition, and -0.10 (95% CI, -0.39 to 0.21) for sentence recognition in noise. Patients with no significant improvement were similarly distributed between all preoperative aided speech scores for word recognition (range, 0%-58%) and sentence recognition (range, 0%-56%) testing.
In this cross-sectional study, with respect to preoperative aided speech recognition, postoperative cochlear implant outcomes for individual patients were largely encouraging. However, improvements in scores for individual patients remained highly variable, which may not be adequately represented in groupwise analyses and reporting of mean scores. Presenting individual patient data from a large sample of individuals with cochlear implants provides a better understanding of individual differences in speech recognition outcomes and contributes to more complete interpretations of successful outcomes after cochlear implantation.
人工耳蜗植入术在改善听力结果方面非常有效，但结果仅限于组间分析。也就是说，对于报告术前辅助言语识别和植入后言语识别比较的个别患者，可用的有限数据。
当考虑到每个言语识别测试的测量误差时，评估接受人工耳蜗植入的个体患者的术前辅助与术后言语识别评分的变化。
设计、地点和参与者：这项横断面研究使用了 2012 年 1 月 1 日至 2017 年 12 月 31 日期间在一家三级、大学附属转诊中心接受人工耳蜗植入的患者的前瞻性维护数据库。研究对象为双侧感音神经性听力损失患者，接受人工耳蜗植入术，术后 6 或 12 个月有 1 个或多个言语识别测试的测量值，使用 1 个或多个言语识别测试。
人工耳蜗植入术。
术后单词识别（辅音-核-辅音单词测试）、句子识别（安静时的 AzBio 句子）和句子识别噪声（+10dB 信噪比时的 AzBio 句子）评分，以及每个语音识别评分变化与每个测试的测量误差的辅助术前评分之间的关系。
对来自 323 名患者的 470 个植入物的数据进行分析，其中包括 253 名男性（53.8%）患者；平均（SD）年龄为 61.2（18.3）岁。大多数患者术后所有言语识别测试的评分均显著提高，超出了测量误差，包括单词识别 262 例（84.8%），句子识别 226 例（87.6%），句子识别噪声 33 例（78.6%）。少数患者术前和术后的评分相同，包括单词识别 45 例（14.5%），句子识别 28 例（10.9%），句子识别噪声 9 例（21.4%）。4 例（1.6%）患者植入后句子识别评分明显变差。植入年龄与言语识别评分变化之间的相关性为：单词识别为-0.12（95%CI，-0.23 至-0.01），句子识别为-0.22（95%CI，-0.34 至-0.10），句子识别噪声为-0.10（95%CI，-0.39 至 0.21）。没有显著改善的患者在单词识别（范围为 0%-58%）和句子识别（范围为 0%-56%）测试中，术前辅助言语评分的分布情况相似。
在这项横断面研究中，就术前辅助言语识别而言，个别患者的人工耳蜗植入术后结果大多令人鼓舞。然而，个别患者的评分提高仍然高度可变，这可能无法在组间分析和平均评分报告中得到充分体现。从大量接受人工耳蜗植入的患者中提供个别患者的数据，可以更好地了解言语识别结果的个体差异，并有助于更全面地解释人工耳蜗植入后的成功结果。
