Deshpande Nikita, Aminpour Nathan, Cheng Hui, Johns J Dixon, Hoa Michael
Georgetown University School of Medicine, Washington, DC.
Bioinformatics and Biostatistics Collaboration Core, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, MD.
Otol Neurotol Open. 2021 Dec 9;1(2):e006. doi: 10.1097/ONO.0000000000000006. eCollection 2021 Dec.
To assess outcomes in autoimmune inner ear disease (AIED) after cochlear implantation (CI) through systematic review and meta-analysis.
PubMed, MedLine, Embase, and CINAHL.
Databases were queried for inclusion of AIED patients who underwent CI with outcomes recorded ≥3 months postoperatively. We examined demographics, pure-tone average (PTA), speech perception, preoperative imaging, intraoperative management, and postoperative complications.
Twenty-six articles encompassing 124 patients met inclusion criteria. Mean implantation age was 26.2 years (range 4-65 years) with average length of follow-up at 28.2 months (range 3-120 months). Meta-analysis demonstrated significant improvement in speech perception following CI. There was a statistically significant improvement in speech recognition score (SRS) (standard mean difference [SMD] = 6.5, 95% confidence interval [CI], 4.8-8.0, < 0.0001) as well as word recognition score (WRS) (SMD = 5.5, 95% CI, 4.2-6.8, < 0.0001) after CI. Anomalous preoperative radiologic manifestations were reported by 57.7% (15/26) studies. Disease activity-related intraoperative adjustment was noted in 57.7% (15/26) studies; common consequences were cochlear drill-out (53.3%), difficult round window insertion (26.7%), and scala vestibuli insertion (26.7%). Frequent postoperative complications noted in 26.9% (7/26) studies included systemic AIED flares (71.4%) and wound healing delay (42.9%).
Findings of this systematic review of AIED cochlear implant literature demonstrate a lack of consistent reporting standards for PTA and speech perception as well as a lack of long-term follow-up. Despite these findings, meta-analysis suggests that CI is a viable treatment for improving speech perception in AIED patients.
通过系统评价和荟萃分析评估人工耳蜗植入（CI）治疗自身免疫性内耳疾病（AIED）的疗效。
PubMed、MedLine、Embase和CINAHL。
查询数据库，纳入术后≥3个月记录了疗效的接受CI治疗的AIED患者。我们研究了人口统计学、纯音平均听阈（PTA）、言语感知、术前影像学检查、术中处理及术后并发症。
26篇文章共纳入124例患者，符合纳入标准。平均植入年龄为26.2岁（范围4 - 65岁），平均随访时间为28.2个月（范围3 - 120个月）。荟萃分析显示CI术后言语感知有显著改善。CI术后言语识别得分（SRS）（标准均差[SMD]=6.5，95%置信区间[CI]，4.8 - 8.0，P<0.0001）及单词识别得分（WRS）（SMD = 5.5，95% CI，4.2 - 6.8，P<0.0001）均有统计学意义的提高。57.7%（15/26）的研究报告了术前异常影像学表现。57.7%（15/26）的研究记录了与疾病活动相关的术中调整；常见情况为耳蜗开窗（53.3%）、圆窗插入困难（26.7%）和前庭阶插入（26.7%）。26.9%（7/26）的研究中常见的术后并发症包括全身性AIED复发（71.4%）和伤口愈合延迟（42.9%）。
对AIED人工耳蜗植入文献的这一系统评价结果表明，PTA和言语感知缺乏一致的报告标准，且缺乏长期随访。尽管有这些发现，但荟萃分析表明CI是改善AIED患者言语感知的一种可行治疗方法。
