Cleveland Clinic Head and Neck Institute, Cleveland, Ohio.
Otol Neurotol. 2022 Sep 1;43(8):e895-e902. doi: 10.1097/MAO.0000000000003623.
To quantify objective and subjective outcomes in cochlear implant (CI) recipients with asymmetric hearing loss, including single-sided deafness (SSD) whose candidacy was determined on an ear-specific basis when word recognition was 50% or less.
Retrospective case review.
Tertiary referral center.
The effectiveness of CI in cases of SSD and asymmetric hearing loss (AHL) has been described in terms of tinnitus suppression, improved speech recognition in quiet and noise, enhanced localization ability, and improved quality of life. However, CI is not yet routinely offered as a top option or standard of care for these individuals. Recent Food and Drug Administration (FDA) labeling limits aided word recognition in the ear to be implanted to only 5% in cases of AHL/SSD, which is significantly poorer than 40 to 50%, which is often referenced in cases of bilateral hearing loss. Anecdotal experience suggests that patients with much better preoperative word recognition than 5% can benefit from CI.
We conducted a retrospective chart review of all adult CI candidates, with one ear exhibiting consonant-nucleus-consonant (CNC) word recognition scores at least 50% and one ear not meeting CI candidacy (i.e., CNC word recognition >50%). Outcome variables of interest included word and sentence recognition and subjective handicap questionnaires (hearing, tinnitus, dizziness) and the Speech Spatial Qualities questionnaire.
Statistically and clinically significant improvement in speech understanding (word, sentence, sentence in noise) was noted for both the SSD and AHL groups in the implanted ear. There were statistically and clinically significant subjective improvements noted for both groups on the Hearing Handicap Inventory, the Tinnitus Handicap Inventory, and the Speech Spatial Qualities questionnaire by 1 month after activation. There were no significant differences between the AHL and SSD groups on either objective or subjective measures of the implanted ear. Individual word understanding improved for the majority of recipients across both groups and is not dependent on meeting the FDA criteria of less than 5%.
Cochlear implantation is a viable option with measurable objective and perceived benefits for recipients with preoperative aided CNC word scores exceeding current FDA labeling. There is no significant difference between the AHL and SSD groups, suggesting that candidacy and outcome expectations should be set based on the ear to be implanted alone, without regard for the ability of the better hearing ear.
量化单侧聋（SSD）和非对称听力损失（AHL）患者耳蜗植入（CI）后的客观和主观结果，这些患者的入选标准是基于当识别单词的能力低于 50%时，每只耳朵的具体情况。
回顾性病例研究。
三级转诊中心。
已经描述了 SSD 和 AHL 情况下 CI 的有效性，包括在安静和嘈杂环境中提高言语识别、改善耳鸣抑制、增强定位能力和提高生活质量。然而，CI 尚未作为这些患者的首选或标准治疗方法。最近食品和药物管理局（FDA）的标签限制将 AHL/SSD 情况下植入耳的辅助单词识别能力限制在仅 5%，这明显低于双侧听力损失情况下经常参考的 40%至 50%。经验表明，术前单词识别能力远高于 5%的患者可以从 CI 中受益。
我们对所有成年 CI 候选者进行了回顾性图表审查，其中一只耳朵的辅音-核-辅音（CNC）单词识别得分至少为 50%，而另一只耳朵不符合 CI 入选标准（即 CNC 单词识别>50%）。感兴趣的结果变量包括单词和句子识别以及主观障碍问卷（听力、耳鸣、头晕）和言语空间质量问卷。
在植入耳中，SSD 和 AHL 组的言语理解（单词、句子、噪声中的句子）均有统计学和临床意义上的显著改善。两组在植入耳的听力障碍问卷、耳鸣障碍问卷和言语空间质量问卷上均有统计学和临床意义上的主观改善，在激活后 1 个月即可观察到。在植入耳的客观和主观测量中，AHL 和 SSD 组之间没有显著差异。大多数接受者的单个单词理解都有所提高，这与满足 FDA 不到 5%的标准无关。
对于术前辅助 CNC 单词得分超过当前 FDA 标签的患者，CI 是一种可行的选择，具有可衡量的客观和感知益处。AHL 和 SSD 组之间没有显著差异，这表明候选资格和预期结果应基于要植入的耳朵单独设定，而无需考虑听力较好的耳朵的能力。
