Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Otol Neurotol. 2023 Dec 1;44(10):988-996. doi: 10.1097/MAO.0000000000004015. Epub 2023 Sep 15.
To evaluate the impact of preoperative and perioperative factors on postlinguistic adult cochlear implant (CI) performance and design a multivariate prediction model.
Prospective cohort study.
Tertiary referral center.
Two hundred thirty-nine postlinguistic adult CI recipients.
Speech-perception testing (consonant-nucleus-consonant [CNC], AzBio in noise +10-dB signal-to-noise ratio) at 3, 6, and 12 months postoperatively; electrocochleography-total response (ECochG-TR) at the round window before electrode insertion.
ECochG-TR strongly correlated with CNC word score at 6 months ( r = 0.71, p < 0.0001). A multivariable linear regression model including age, duration of hearing loss, angular insertion depth, and ECochG-TR did not perform significantly better than ECochG-TR alone in explaining the variability in CNC. AzBio in noise at 6 months had moderate linear correlations with Montreal Cognitive Assessment (MoCA; r = 0.38, p < 0.0001) and ECochG-TR ( r = 0.42, p < 0.0001). ECochG-TR and MoCA and their interaction explained 45.1% of the variability in AzBio in noise scores.
This study uses the most comprehensive data set to date to validate ECochG-TR as a measure of cochlear health as it relates to suitability for CI stimulation, and it further underlies the importance of the cochlear neural substrate as the main driver in speech perception performance. Performance in noise is more complex and requires both good residual cochlear function (ECochG-TR) and cognition (MoCA). Other demographic, audiologic, and surgical variables are poorly correlated with CI performance suggesting that these are poor surrogates for the integrity of the auditory substrate.
评估术前和围手术期因素对成年后天语后聋人工耳蜗（CI）性能的影响，并设计一个多变量预测模型。
前瞻性队列研究。
三级转诊中心。
239 名后天语后聋成人 CI 接受者。
术后 3、6 和 12 个月的语音感知测试（辅音-核-辅音[CNC]、噪声中 AzBio+10dB 信噪比）；电极插入前圆窗处的电 Cochleography-总反应（ECochG-TR）。
ECochG-TR 与 6 个月时的 CNC 单词得分具有很强的相关性（r=0.71，p<0.0001）。包括年龄、听力损失持续时间、角插入深度和 ECochG-TR 的多变量线性回归模型在解释 CNC 的变异性方面并不优于单独的 ECochG-TR。6 个月时的 AzBio 在噪声中与蒙特利尔认知评估（MoCA；r=0.38，p<0.0001）和 ECochG-TR 有中度线性相关（r=0.42，p<0.0001）。ECochG-TR、MoCA 及其相互作用解释了 AzBio 在噪声评分中的 45.1%的变异性。
本研究使用迄今为止最全面的数据集验证了 ECochG-TR 作为衡量与 CI 刺激适应性相关的耳蜗健康的指标，进一步强调了耳蜗神经基质作为言语感知性能主要驱动力的重要性。噪声中的性能更为复杂，需要良好的残余耳蜗功能（ECochG-TR）和认知能力（MoCA）。其他人口统计学、听力和手术变量与 CI 性能的相关性较差，表明这些变量是听觉基质完整性的不良替代指标。
