Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstrasse, 35043, Marburg, Germany.
Eur Arch Otorhinolaryngol. 2023 Mar;280(3):1063-1071. doi: 10.1007/s00405-022-07558-6. Epub 2022 Aug 10.
Pre-operative assessments before cochlear implantation (CI) includes the examination of both tone hearing, and the level of the cochlear reserve indicated by speech understanding. The goal of this study was to explore the predictive influence of tone hearing and cochlear reserve in CI.
We did a retrospective cohort study, which included adult patients who had undergone CI between January 2012 and December 2019 in a tertiary care center. The pre-operative tone hearing, unaided maximum monosyllabic word recognition score (WRSmax), aided hearing gain, aided monosyllabic word recognition score at 65 dB (WRS65(HA)), and speech perception gap (SPG) were measured. The duration of unaided hearing loss (UHL) was also assessed. These variables were compared with post-operative monosyllabic word recognition score after CI at 65 dB (WRS65(CI)).
103 patients and 128 ears were included in this study. Regardless of tone hearing, patients with better pre-operative WRSmax and WRS65(HA) performed better post-operatively. WRSmax was found to be the most important factor that was statistically significantly associated with WRS65(CI). SPG was statistically significantly associated with WRSmax and SPG ≥ 20% group performed better post-operatively. Any duration of unaided hearing loss was statistically significantly inversely associated with WRSmax above 0%.
Cochlear reserve represented by WRSmax may play the most important role as a predictive factor in outcomes after CI. SPG should be considered for indicating CI in patients, when WRS65(HA) does not reach WRSmax. Early rehabilitation with hearing aids and duration of hearing aid usage might play an important role in preserving cochlear reserve in adults.
人工耳蜗植入（CI）前评估包括对音调听力和言语理解所指示的耳蜗储备水平的检查。本研究的目的是探讨音调听力和耳蜗储备对 CI 的预测影响。
我们进行了一项回顾性队列研究，该研究纳入了 2012 年 1 月至 2019 年 12 月期间在一家三级保健中心接受 CI 的成年患者。测量了术前音调听力、未助听最大单音节词识别得分（WRSmax）、助听增益、65dB 助听单音节词识别得分（WRS65（HA））和言语感知差距（SPG）。还评估了未助听听力损失（UHL）的持续时间。这些变量与 CI 后 65dB 时的术后单音节词识别得分（WRS65（CI））进行了比较。
本研究共纳入 103 名患者和 128 只耳朵。无论音调听力如何，术前 WRSmax 和 WRS65（HA）较好的患者术后表现更好。WRSmax 是与 WRS65（CI）统计学显著相关的最重要因素。SPG 与 WRSmax 统计学显著相关，且 SPG≥20%组术后表现更好。任何未助听听力损失的持续时间与 WRSmax 高于 0%呈统计学显著负相关。
WRSmax 代表的耳蜗储备可能是 CI 后结果的预测因素中最重要的因素。当 WRS65（HA）未达到 WRSmax 时，应考虑 SPG 来指示 CI。早期使用助听器进行康复以及助听器使用时间可能在保护成年人耳蜗储备方面发挥重要作用。
