数据驱动的多参数预测分析：人工耳蜗康复结局

文献信息

中文摘要

目的： 本研究分析人工耳蜗（CI）术后听力结局的术前预测因素之间的交叉关系，以弥补在二元候选标准之外，向CI候选者提供术后听力预期咨询方面的空白。
研究设计： 回顾性队列研究。
地点： 三级学术医学中心和第三方CI数据库。
方法： 术前听力测量指标包括未植入对侧耳（CE）和植入耳（IE）的言语识别得分（WRS）和纯音平均听阈（PTA）。术后WRS评估延长至术后500天，以约6个月时间点作为主要结局时间点。治疗成功定义为术后WRS≥60%或对于术前WRS≥30%的个体出现临床意义的改善（ΔWRS≥20%）。统计分析包括热图和Kaplan-Meier图，以评估术前变量与治疗成功时间之间的关系。
结果： 当使用WRS<60%和PTA>60标准时，CE和IE听力状态对CI结局的预测能力相当；然而，IE状态的F1分数更高（0.27 vs. 0.069）。年龄是一个关键调节因素；60岁以下患者比年长患者更快达到治疗成功（275 vs. 470天；HR=0.41；95% CI：0.31-0.55，P<0.05）。60岁以下患者在使用术前PTA<60 dB时，听力改善速度显著快于术前PTA≥60 dB（HR=0.47，95% CI：0.22-0.99，P<0.05）。在年长患者中，CE WRS≥60%者相比WRS<60%者，改善可能性显著更高（HR=5.15；95% CI：3.29-8.08，P<0.05）。
结论： CI成功的术前听力预测因素因年龄而异，年轻患者受益于植入耳的残余听力，而年长患者依赖其对侧未植入耳进行康复。这些按年龄分层的模式使得能够就人工耳蜗植入后功能性听力改善的预期时间提供更个性化的预后咨询。

英文摘要

OBJECTIVE: This study analyzes intersections between preoperative predictors of postcochlear implant (CI) hearing outcomes to address the gap in counseling CI candidates on postoperative hearing expectations beyond binary candidacy criteria.
STUDY DESIGN: Retrospective cohort study.
SETTING: Tertiary academic medical center and a third-party CI database.
METHODS: Preoperative audiometric measures included word recognition score (WRS) and pure-tone average (PTA) for the unimplanted contralateral ear (CE) and implanted ear (IE). Postoperative WRS assessments extended to 500 days postsurgery, with the ~6-month mark as the primary outcome time point. Treatment success was defined as a postoperative WRS≥60% or clinically meaningful improvement (ΔWRS≥20%) for individuals with preoperative WRS≥30%. Statistical analyses included heatmaps and Kaplan-Meier plots to assess relationships between preoperative variables and time to treatment success.
RESULTS: Both CE and IE audiometric status demonstrated comparable predictive ability for CI outcomes when using the WRS<60% and PTA>60 criteria; however, IE status had a higher F1 score (0.27 vs. 0.069). Age was a critical modifier; patients below 60 years achieved treatment success faster than older patients (275 vs. 470 d; HR=0.41; 95% CI: 0.31-0.55, P<0.05). Patients below 60 years achieved hearing improvement at a significantly faster rate when using a pre-PTA<60 dB than a pre-PTA≥60 dB (HR=0.47, 95% CI: 0.22-0.99, P<0.05). Among older patients, those with CE WRS≥60% had a substantially higher likelihood of improvement compared with those with WRS <60% (HR=5.15; 95% CI: 3.29-8.08, P<0.05).
CONCLUSION: Preoperative audiometric predictors of CI success vary significantly by age, with younger patients benefiting from residual hearing in the implanted ear and older patients relying on their contralateral, unimplanted ear for rehabilitation. These age-stratified patterns enable more personalized prognostic counseling about expected time to functional hearing improvement following cochlear implantation.