Bruschke Stefanie, Zeh Roland, Baumann Uwe, Helbig Silke, Stöver Timo
Klinik für HNO-Heilkunde, Goethe-Universität Frankfurt, Universitätsklinikum, Frankfurt a. M, Deutschland.
MEDIAN Kaiserberg-Klinik, Bad Nauheim, Deutschland.
HNO. 2024 Jun;72(6):412-422. doi: 10.1007/s00106-024-01440-z. Epub 2024 Feb 15.
The Association of the Scientific Medical Societies in Germany (AWMF) clinical practice guideline on cochlear implant (CI) treatment, which was updated in 2020, defined the entire process of CI care for the first time. In the present study, the feasibility and results of very early rehabilitation were examined.
The intervention group (IG) comprised 54 patients in whom rehabilitation was initiated within 14 (maximally 28) days after implantation. Patients with a significantly longer waiting time were included in the control group (CG, n = 21). In addition to the start and duration of rehabilitation, the speech intelligibility achieved with CI was recorded at different timepoints within a 12-month period. In addition, questionnaires were used to assess the effort of fitting the CI processor and the patients' satisfaction with the outcome as well as the timing of the start of rehabilitation.
Median waiting time between implantation and start of rehabilitation was 14 days in the IG and 106 days in the CG; 92.6% of IG patients were able to start rehabilitation within 14 days. The effect of rehabilitation in the IG was 35 and in the CG 25 percentage points (Freiburg monosyllabic test). After 6 and 12 months of CI use, both groups showed comparable results in the test condition in quiet (IG/CG 6 months: 70%/70%; 12 months: 70%/60%, Freiburg monosyllabic test) and in noise (IG/CG 6 months: -1.1-0.85 dB SNR; 12 months: -0.65 dB SNR/0.3 dB SNR, Oldenburg sentence test). Hearing quality assessment scores collected by SSQ (Speech, Spatial and Qualities of Hearing Scale) questionnaire showed better scores in the IG at 6 months, which converged to CG scores at 12 months. The IG was significantly more satisfied with the timing of the start of rehab than the CG. All other data obtained from questionnaires showed no differences between the two groups.
A very early start of inpatient rehabilitation after cochlear implantation was successfully implemented. The rehabilitation was completed within 7 weeks of CI surgery. Comparison of speech recognition test results before and after rehabilitation showed a significant improvement. A clear rehabilitation effect can therefore be demonstrated. Inclusion of CI rehabilitation in the German catalog of follow-up treatments is thus scientifically justified and therefore strongly recommended.
德国科学医学协会联合会（AWMF）关于人工耳蜗（CI）治疗的临床实践指南于2020年更新，首次对CI护理的全过程进行了定义。在本研究中，对极早期康复的可行性和效果进行了研究。
干预组（IG）包括54例患者，他们在植入后14天（最长28天）内开始康复治疗。等待时间明显更长的患者被纳入对照组（CG，n = 21）。除了康复的开始时间和持续时间外，还记录了CI在12个月内不同时间点实现的言语清晰度。此外，还使用问卷来评估CI处理器调试的难度、患者对结果的满意度以及康复开始的时间。
IG组植入与康复开始之间的中位等待时间为14天，CG组为106天；92.6%的IG组患者能够在14天内开始康复。IG组康复效果为35个百分点，CG组为25个百分点（弗莱堡单音节测试）。在使用CI 6个月和12个月后，两组在安静测试条件下（IG/CG 6个月：70%/70%；12个月：70%/60%，弗莱堡单音节测试）和噪声环境下（IG/CG 6个月：-1.1 - 0.85 dB SNR；12个月：-0.65 dB SNR/0.3 dB SNR，奥尔登堡句子测试）的结果相当。通过SSQ（言语、空间和听力质量量表）问卷收集的听力质量评估分数显示，IG组在6个月时得分更高，在12个月时与CG组得分趋同。IG组对康复开始时间的满意度明显高于CG组。从问卷中获得的所有其他数据显示两组之间没有差异。
人工耳蜗植入后极早期开始住院康复治疗得以成功实施。康复在CI手术后7周内完成。康复前后言语识别测试结果的比较显示有显著改善。因此，可以证明有明显的康复效果。将CI康复纳入德国后续治疗目录在科学上是合理的，因此强烈推荐。
