人工耳蜗植入后10年长期阻抗趋势：一项回顾性比较分析

文献信息

中文摘要

重要性： 阻抗监测是人工耳蜗（CI）手术的关键组成部分，然而缺乏全面的纵向数据限制了基于证据的术后监测指南的制定，可能损害患者预后。
目的： 追踪植入后10年的阻抗趋势，评估电极设计对阻抗动态的影响，并检查患者年龄对阻抗行为的影响。
设计： 回顾性队列研究。
地点： 三级医疗中心。
参与者： 2006年6月至2014年12月期间共有554只耳接受了人工耳蜗植入；每只耳接受了6种电极类型中的1种电极阵列。
暴露或干预： 在7个时间点分析了顶端、中间和基底电极触点的纵向阻抗数据。
主要结局指标： 阻抗轨迹因年龄组、电极设计和耳蜗区域而异，持续变化观察到长达10年。
结果： 在大多数阵列中，阻抗从术中到首次激活显著增加，尽管在CI512成人中观察到顶端触点显著下降（P = .0008）。顶端和中间触点此后通常稳定或下降。相比之下，基底电极表现出更异质性的模式，包括在12至60个月随访期间增加，在60至120个月期间减少。与PM阵列相比，LW电极显示出更高的顶端阻抗，中间阻抗大多相当且随时间变化，并且基底阻抗持续低于CI512。在LW阵列中，CI422始终表现出最高的阻抗，而MED-EL电极系列中，Flexsoft表现出最高的阻抗。总体而言，早期儿童接受者的阻抗较高，而成人往往在基底区域显示较高值。
结论： 本研究首次提供了长达十年的阻抗变化特征，揭示了不同设计和年龄组的人工耳蜗接受者中电极阻抗的动态变化。
相关性： 本研究强调了长期监测的必要性，并为个体化编程和电极设计提供了实用指导。

英文摘要

ImportanceImpedance monitoring is a critical component of cochlear implant (CI) surgery, yet the lack of comprehensive longitudinal data limits the development of evidence-based postoperative monitoring guidelines, potentially compromising patient outcomes.ObjectiveTo track impedance trends over 10 years post-implantation, evaluate the effects of electrode design on impedance dynamics, and examine the influence of patient age on impedance behavior.DesignRetrospective cohort study.SettingTertiary medical center.ParticipantsA total of 554 ears underwent cochlear implantation between June 2006 and December 2014; each ear received 1 electrode array from 1 of 6 electrode types.Exposure or InterventionLongitudinal impedance data were analyzed across apical, medial, and basal electrode contacts at 7 time points.Main Outcome MeasuresImpedance trajectories varied by age group, electrode design, and cochlear region, with persistent changes observed up to 10 years.ResultsImpedance increased markedly from intraoperative to first activation in most arrays, although a significant decrease in apical contacts was observed in CI512 adults (P = .0008). Apical and medial contacts generally stabilized or declined thereafter. In contrast, basal electrodes exhibited more heterogeneous patterns, including increases during 12 to 60 months of follow-up and decreases during 60 to 120 months. Compared to PM arrays, LW electrodes showed higher apical impedances, medial impedances that were mostly comparable and time-dependent, and persistently lower basal impedances than CI512. Among LW arrays, CI422 consistently demonstrated the highest impedance, whereas the MED-EL electrode series, Flexsoft exhibited the highest impedance. Overall impedances were higher in early childhood recipients, while adults tended to show higher values in the basal region.ConclusionThis study provides the first decade-long characterization of impedance changes, revealing dynamic variations in electrode impedance across different designs and age groups of cochlear implant recipients.RelevanceThis study highlights the need for long-term monitoring and offering practical guidance for individualized programming and electrode design.