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[长期规律使用人工耳蜗的语前聋晚期植入患者的康复效果]

[Long-term rehabilitation outcomes of prelingually deafened late-implanted patients with regular use].

作者信息

Liu R Y, Wang Q, Zhao H, Li J N, Yang S M

机构信息

Senior Department of Otolaryngology Head and Neck Surgery, the 6th Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, State Key Laboratory of Hearing and Balance Science, Key Laboratory of Hearing Science, Ministry of Education, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Beijing 100048, China.

出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2025 Jun 7;60(6):597-603. doi: 10.3760/cma.j.cn115330-20240928-00551.

DOI:10.3760/cma.j.cn115330-20240928-00551
PMID:40692223
Abstract

To evaluate the outcomes of cochlear implantation in prelingually deafened late-implanted patients with regular cochlear implant use and to analyze the influencing factors of rehabilitation effects. This before-after self-controlled study design included 60 subjects, comprising 36 males and 24 females, who had received cochlear implantation at Chinese PLA General Hospital. Post-implantation, all patients demonstrated continuous and regular use of cochlear implants (≥8 hours daily). Rehabilitation outcomes were evaluated by using the Categories of Auditory Performance scale (CAP), Meaningful Auditory Integration Scale (MAIS), Speech Intelligibility of Rating scale (SIR), Meaningful Use of Speech Scale (MUSS) and speech recognition score (SRS) in 2018 and 2023. 9 potential risk factors were analyzed by univariate analysis with SPSS 25.0. The influencing factors associated with outcomes were evaluated through multivariate logistic regression. Longitudinal data of 60 participants followed-up in 2018 and 2023 were analyzed. The average duration of cochlear implant use for all patients was (11.3±3.0) years. The mean score of CAP, SIR and MUSS improved significantly over time. The mean CAP score before surgery was (1.0±0.9). From 2018 to 2023, the mean CAP score improved from (5.1±1.4) to (5.9±1.6), with a statistical significance (<0.01); the mean SIR score before surgery was (1.3±0.5), and the mean SIR score improved from (2.7±1.1) to (3.2±1.3), with a statistical significance (<0.01); the mean MUSS score increased from (16.8±9.7) to (21.1±10.9) between the two follow-ups, with a statistical significance (<0.01); the MAIS was only initiated in the 2023 follow-up, with a mean score of (31.0±10.2). The speech recognition score for monosyllabic words increased from (23.9±16.0)% to (25.2±13.0)%, with no statistically significant difference (=0.66). Preoperative residual hearing significantly predicted rehabilitation outcomes at univariate analysis (<0.05), but the statistical significance was lost at multivariate analysis (>0.05). Age at implantation was identified as an independent predictive factor by both univariate and multivariate analysis (Hazard Ratio, 0.88; 95% Confidence Interval 0.79-0.97; =0.014). The cut-off point for predicting further rehabilitation effects was 19.2 years old. In the correlation analysis of different scales, the CAP score was positively correlated with the total score of MAIS. So were the SIR score and the total score of MUSS. For prelingually deafened late-implanted patients with regular CI use, there was still potential for further improvement of auditory and speech abilities even after 10 years post-implantation. Age at implantation was an independent predictive factor and the cut-off point was 19.2 years old.

摘要

评估语前聋晚期植入患者规律使用人工耳蜗后的植入效果,并分析康复效果的影响因素。本前后自身对照研究设计纳入了60名受试者,包括36名男性和24名女性,他们在中国人民解放军总医院接受了人工耳蜗植入。植入后,所有患者均持续规律使用人工耳蜗(每天≥8小时)。分别于2018年和2023年使用听觉表现分级量表(CAP)、有意义听觉整合量表(MAIS)、言语可懂度评分量表(SIR)、言语有效使用量表(MUSS)和言语识别得分(SRS)评估康复效果。采用SPSS 25.0进行单因素分析,分析9个潜在风险因素。通过多因素逻辑回归评估与结局相关的影响因素。分析了2018年和2023年随访的60名参与者的纵向数据。所有患者人工耳蜗的平均使用时长为(11.3±3.0)年。CAP、SIR和MUSS的平均得分随时间显著提高。术前CAP平均得分为(1.0±0.9)。2018年至2023年,CAP平均得分从(5.1±1.4)提高到(5.9±1.6),差异有统计学意义(<0.01);术前SIR平均得分为(1.3±0.5),SIR平均得分从(2.7±1.1)提高到(3.2±1.3),差异有统计学意义(<0.01);两次随访间MUSS平均得分从(16.8±9.7)提高到(21.1±10.9),差异有统计学意义(<0.01);MAIS仅在2023年随访时启用,平均得分为(31.0±10.2)。单音节词言语识别得分从(23.9±16.0)%提高到(25.2±13.0)%,差异无统计学意义(=0.66)。单因素分析显示术前残余听力显著预测康复结局(<0.05),但多因素分析时该统计学意义消失(>0.05)。单因素和多因素分析均确定植入时年龄为独立预测因素(风险比,0.88;95%置信区间0.79 - 0.97;=0.014)。预测进一步康复效果的截断点为19.2岁。在不同量表的相关性分析中,CAP得分与MAIS总分呈正相关。SIR得分与MUSS总分也呈正相关。对于语前聋晚期植入且规律使用人工耳蜗的患者,即使在植入后10年,听觉和言语能力仍有进一步提升的潜力。植入时年龄是独立预测因素,截断点为19.2岁。

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