Völter Christiane, Stöckmann Carolin, Schirmer Christiane, Dazert Stefan
Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr University Bochum, St Elisabeth Hospital, Bochum, Germany.
Kampmann Hearing Aid Acoustics, Bochum, Germany.
JMIR Rehabil Assist Technol. 2021 Mar 12;8(1):e20405. doi: 10.2196/20405.
Technologies allowing home-based rehabilitation may be a key means of saving financial resources while also facilitating people's access to treatment. After cochlear implantation, auditory training is necessary for the brain to adapt to new auditory signals transmitted by the cochlear implant (CI). To date, auditory training is conducted in a face-to-face setting at a specialized center. However, because of the COVID-19 pandemic's impact on health care, the need for new therapeutic settings has intensified.
The aims of this study are to assess the feasibility of a novel teletherapeutic auditory rehabilitation platform in adult CI recipients and compare the clinical outcomes and economic benefits of this platform with those derived from conventional face-to-face rehabilitation settings in a clinic.
In total, 20 experienced adult CI users with a mean age of 59.4 (SD 16.3) years participated in the study. They completed 3 weeks of standard (face-to-face) therapy, followed by 3 weeks of computer-based auditory training (CBAT) at home. Participants were assessed at three intervals: before face-to-face therapy, after face-to-face therapy, and after CBAT. The primary outcomes were speech understanding in quiet and noisy conditions. The secondary outcomes were the usability of the CBAT system, the participants' subjective rating of their own listening abilities, and the time required for completing face-to-face and CBAT sessions for CI users and therapists.
Greater benefits were observed after CBAT than after standard therapy in nearly all speech outcome measures. Significant improvements were found in sentence comprehension in noise (P=.004), speech tracking (P=.004) and phoneme differentiation (vowels: P=.001; consonants: P=.02) after CBAT. Only speech tracking improved significantly after conventional therapy (P=.007). The program's usability was judged to be high: only 2 of 20 participants could not imagine using the program without support. The different features of the training platform were rated as high. Cost analysis showed a cost difference in favor of CBAT: therapists spent 120 minutes per week face-to-face and 30 minutes per week on computer-based sessions. For CI users, attending standard therapy required an average of approximately 78 (SD 58.6) minutes of travel time per appointment.
The proposed teletherapeutic approach for hearing rehabilitation enables good clinical outcomes while saving time for CI users and clinicians. The promising speech understanding results might be due to the high satisfaction of users with the CBAT program. Teletherapy might offer a cost-effective solution to address the lack of human resources in health care as well as the global challenge of current or future pandemics.
允许居家康复的技术可能是节省财政资源的关键手段，同时也便于人们获得治疗。人工耳蜗植入后，听觉训练对于大脑适应人工耳蜗（CI）传输的新听觉信号是必要的。迄今为止，听觉训练是在专门中心进行面对面训练。然而，由于新冠疫情对医疗保健的影响，对新治疗环境的需求日益增加。
本研究旨在评估一种新型远程治疗性听觉康复平台在成年人工耳蜗植入受者中的可行性，并将该平台的临床结果和经济效益与诊所中传统面对面康复环境的结果进行比较。
共有20名经验丰富的成年人工耳蜗使用者参与研究，平均年龄为59.4（标准差16.3）岁。他们先完成3周的标准（面对面）治疗，然后在家中进行3周的基于计算机的听觉训练（CBAT）。在三个时间点对参与者进行评估：面对面治疗前、面对面治疗后以及CBAT后。主要结果是安静和嘈杂环境下的言语理解。次要结果包括CBAT系统的可用性、参与者对自身听力能力的主观评分，以及人工耳蜗使用者和治疗师完成面对面和CBAT训练所需的时间。
在几乎所有言语结果测量中，CBAT后的益处均大于标准治疗后。CBAT后，噪声中句子理解（P = 0.004）、言语跟踪（P = 0.004）和音素辨别（元音：P = 0.001；辅音：P = 0.02）有显著改善。传统治疗后仅言语跟踪有显著改善（P = 0.007）。该程序的可用性被判定为较高：20名参与者中只有2人无法想象在没有支持的情况下使用该程序。训练平台的不同功能被评为较高。成本分析显示成本差异有利于CBAT：治疗师面对面治疗每周花费120分钟，基于计算机的训练每周花费30分钟。对于人工耳蜗使用者，每次预约参加标准治疗平均需要约78（标准差58.6）分钟的出行时间。
所提出的远程治疗性听力康复方法能产生良好的临床效果，同时为人工耳蜗使用者和临床医生节省时间。令人鼓舞的言语理解结果可能归因于用户对CBAT程序的高度满意度。远程治疗可能提供一种经济有效的解决方案，以应对医疗保健领域人力资源短缺以及当前或未来疫情带来的全球挑战。
