Tsuji Robinson Koji, Hamerschmidt Rogério, Lavinsky Joel, Felix Felippe, Silva Vagner Antonio Rodrigues
Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil.
Universidade Federal do Paraná (UFPR), Departamento de Otorrinolaringologia, Curitiba, PR, Brazil.
Braz J Otorhinolaryngol. 2025 Jan-Feb;91(1):101514. doi: 10.1016/j.bjorl.2024.101514. Epub 2024 Sep 24.
To make evidence-based recommendations for the treatment of Single-Sided Deafness (SSD) in children and adults.
Task force members were instructed on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on SSD were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions.
The topics were divided into 3 parts: (1) Impact of SSD in children; (2) Impact of SSD in adults; and (3) SSD in patients with temporal bone tumors.
Decision-making for patients with SSD is complex and multifactorial. The lack of consensus on the quality of outcomes and on which measurement tools to use hinders a proper comparison of different treatment options. Contralateral routing of signal hearing aids and bone conduction devices can alleviate the head shadow effect and improve sound awareness and signal-to-noise ratio in the affected ear. However, they cannot restore binaural hearing. Cochlear implants can restore binaural hearing, producing significant improvements in speech perception, spatial localization of sound, tinnitus control, and overall quality of life. However, cochlear implantation is not recommended in cases of cochlear nerve deficiency, a relatively common cause of congenital SSD.
为儿童和成人单侧耳聋(SSD)的治疗提供循证建议。
工作组成员接受了知识综合方法的指导,包括电子数据库检索、相关文献的回顾与筛选以及对所选研究的批判性评价。符合纳入标准的文章需为用英文或葡萄牙文撰写的关于SSD的文章。采用美国医师学会的指南分级系统和美国甲状腺协会的指南标准对证据进行批判性评价,并对治疗干预措施提出建议。
主题分为三个部分:(1)SSD对儿童的影响;(2)SSD对成人的影响;(3)颞骨肿瘤患者的SSD。
SSD患者的决策复杂且受多种因素影响。在结局质量以及使用何种测量工具方面缺乏共识,这阻碍了对不同治疗方案进行恰当比较。对侧信号助听器和骨传导装置可以减轻头影效应,提高患耳的声音感知和信噪比。然而,它们无法恢复双耳听力。人工耳蜗可以恢复双耳听力,在言语感知、声音空间定位、耳鸣控制和总体生活质量方面产生显著改善。然而,对于先天性SSD的相对常见病因——耳蜗神经缺乏的病例,不建议进行人工耳蜗植入。