65岁及以上成人单侧耳聋及非对称性听力损失的耳蜗植入。

文献信息

中文摘要

背景： 耳蜗植入已被证明是治疗儿童和成人单侧耳聋（SSD）及非对称性听力损失（AHL）的成功方法。然而，在65岁及以上成人中，由于当前Medicare指南对耳蜗植入（CI）的保险覆盖限制，针对SSD和AHL的耳蜗植入治疗一直难以研究。
目的： 本研究旨在评估65岁及以上因SSD和AHL接受耳蜗植入的患者的结果，以提供支持改变Medicare受益人CI候选指征的数据。
方法： 从单一三级CI中心识别了一组年龄超过65岁的CI接受者，其患有SSD（植入耳4频率纯音平均[4fPTA]≥90 dB，较好耳≤30 dB）或AHL（4fPTA耳间差≥15 dB HL，较好耳4fPTA>30 dB HL且≤70 dB HL）。
结果： 共识别出40名≥65岁的CI接受者（9名SSD；31名AHL）。在SSD（3个月，+38 Δ%；6个月，+40 Δ%；12个月，+47 Δ%）和AHL受试者（3个月，40 Δ%；6个月，+41 Δ%；12个月，+42 Δ%）中，CI使用在辅音-核-辅音（CNC）评分上从基线到3个时间点均显示出显著改善（百分点变化，Δ%）。在SSD（3个月，+67 Δ%；6个月，+45 Δ%；12个月，+68 Δ%）和AHL受试者（3个月，+44 Δ%；6个月，+57 Δ%；12个月，+54 Δ%）中，安静环境下AzBio句子测试也显示出显著改善。对侧耳状态在6或12个月时对CNC改善的方差解释很少。在6个月时观察到设备使用与CNC单词及AzBio句子测试之间存在中度正相关。
结论： ≥65岁患有SSD和AHL并接受CI的成人的结果支持在Medicare受益人中使用植入，并为耳特异性候选标准提供了进一步证据。

英文摘要

BACKGROUND: Cochlear implantation has proven success as a treatment for single sided deafness (SSD) and asymmetric hearing loss (AHL) in children and adults. However, in adults 65 years and older, cochlear implantation for the treatment of SSD and AHL has been difficulty to study given the restrictions in insurance coverage for cochlear implants (CI) due to current Medicare guidelines.
OBJECTIVE: This study aimed to evaluate outcomes in patients 65 years old and older who underwent cochlear implantation for SSD and AHL to provide data supporting a change in CI candidacy indications for Medicare beneficiaries.
METHODS: A cohort of CI recipients over the age of 65 years with either SSD (4-frequency pure tone average [4fPTA] ≥90 dB in the implanted ear and ≤30 dB in the better hearing ear) or AHL (interaural difference in 4fPTA ≥15 dB HL, better hearing ear 4fPTA >30 dB HL and ≤70 dB HL) was identified from a single tertiary-level CI center.
RESULTS: Forty CI recipients ≥65 years (9 SSD; 31 AHL) were identified. There were significant improvements (percentage point change, ∆%) demonstrated with CI use on consonant-nucleus-consonant (CNC) scores from baseline to 3 timepoints in both SSD (3 m, +38 ∆%; 6 m, +40 Δ%; 12 m, +47 Δ%) and AHL subjects (3 m, 40 Δ%; 6 m, +41 Δ%; 12 m, +42 Δ%). Significant improvements were also seen on AzBio sentences in quiet in both SSD (3 m, +67 Δ%; 6 m, +45 Δ%; 12 m, +68 Δ%) and AHL subjects (3 m, +44 Δ%; 6 m, +57 Δ%; 12 m, +54 Δ%). The status of the contralateral ear accounted for little variance in CNC improvement at 6 or 12 months. Moderate positive associations between device usage and CNC word and AzBio sentence testing were observed at 6 months.
CONCLUSIONS: Outcomes in adults ≥65 years old with SSD and AHL who undergo CI support the use of implantation in Medicare beneficiaries and provide further evidence for ear-specific candidacy criteria.