Ullah Mohammed N, Cevallos Ashley, Shen Sarek, Carver Courtney, Dunham Rachel, Marsiglia Dawn, Yeagle Jennifer, Della Santina Charles C, Bowditch Steve, Sun Daniel Q
Johns Hopkins Medicine, Johns Hopkins University, Baltimore, MD, United States.
Department of Otolaryngology - Head and Neck Surgery and Cochlear Implant Center, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States.
Front Neurosci. 2023 Oct 9;17:1247269. doi: 10.3389/fnins.2023.1247269. eCollection 2023.
Single sided deafness (SSD) results in profound cortical reorganization that presents clinically with a significant impact on sound localization and speech comprehension. Cochlear implantation (CI) has been approved for two manufacturers' devices in the United States to restore bilateral function in SSD patients with up to 10 years of auditory deprivation. However, there is great variability in auditory performance and it remains unclear how auditory deprivation affects CI benefits within this 10-year window. This prospective study explores how measured auditory performance relates to real-world experience and device use in a cohort of SSD-CI subjects who have between 0 and 10 years of auditory deprivation.
Subjects were assessed before implantation and 3-, 6-, and 12-months post-CI activation via Consonant-Nucleus-Consonant (CNC) word recognition and Arizona Biomedical Institute (AzBio) sentence recognition in varying spatial speech and noise presentations that simulate head shadow, squelch, and summation effects (SN, SN, SN; 0 = front, SSD = impacted ear, NH = normal hearing ear). Patient-centered assessments were performed using Tinnitus Handicap Inventory (THI), Spatial Hearing Questionnaire (SHQ), and Health Utility Index Mark 3 (HUI3). Device use data was acquired from manufacturer software. Further subgroup analysis was performed on data stratified by <5 years and 5-10 years duration of deafness.
In the SSD ear, median (IQR) CNC word scores pre-implant and at 3-, 6-, and 12-months post-implant were 0% (0-0%), 24% (8-44%), 28% (4-44%), and 18% (7-33%), respectively. At 6 months post-activation, AzBio scores in SN and SN configurations ( = 25) demonstrated statistically significant increases in performance by 5% ( = 0.03) and 20% ( = 0.005), respectively. The median HUI3 score was 0.56 pre-implant, lower than scores for common conditions such as anxiety (0.68) and diabetes (0.77), and comparable to stroke (0.58). Scores improved to 0.83 (0.71-0.91) by 3 months post-activation. These audiologic and subjective benefits were observed even in patients with longer durations of deafness.
By merging CI-associated changes in objective and patient-centered measures of auditory function, our findings implicate central mechanisms of auditory compensation and adaptation critical in auditory performance after SSD-CI and quantify the extent to which they affect the real-world experience reported by individuals.
单侧耳聋（SSD）会导致大脑皮层发生深刻的重组，临床上会对声音定位和言语理解产生重大影响。在美国，两种制造商生产的设备已获批用于人工耳蜗植入（CI），以恢复听觉剥夺长达10年的SSD患者的双侧功能。然而，听觉表现存在很大差异，目前尚不清楚在这10年的时间范围内，听觉剥夺如何影响CI的益处。这项前瞻性研究探讨了在一组听觉剥夺时间在0至10年之间的SSD-CI受试者中，测量的听觉表现与实际体验和设备使用之间的关系。
在植入前以及CI激活后的3个月、6个月和12个月，通过辅音-元音-辅音（CNC）单词识别以及在模拟头影、静噪和叠加效应的不同空间言语和噪声环境中（SN、SN、SN；0=前方，SSD=患侧耳，NH=正常听力耳）进行亚利桑那生物医学研究所（AzBio）句子识别，对受试者进行评估。使用耳鸣障碍量表（THI）、空间听力问卷（SHQ）和健康效用指数Mark 3（HUI3）进行以患者为中心的评估。从制造商软件获取设备使用数据。对耳聋持续时间<5年和5-10年分层的数据进行进一步的亚组分析。
在SSD耳中，植入前以及植入后3个月、6个月和12个月的CNC单词得分中位数（IQR）分别为0%（0-0%）、24%（8-44%）、28%（4-44%）和18%（7-33%）。激活后6个月，在SN和SN配置下（=25）的AzBio得分显示，表现分别有统计学意义的提高，提高了5%（=0.03）和20%（=0.005）。植入前HUI3得分中位数为0.56，低于焦虑（0.68）和糖尿病（0.77）等常见疾病的得分，与中风（0.58）相当。激活后3个月，得分提高到0.83（0.71-0.91）。即使在耳聋持续时间较长的患者中也观察到了这些听力学和主观益处。
通过将CI相关的客观和以患者为中心的听觉功能测量变化相结合，我们的研究结果表明，听觉补偿和适应的中枢机制在SSD-CI后的听觉表现中至关重要，并量化了它们对个体报告的实际体验的影响程度。
