成人人工耳蜗植入：长期听觉剥夺后的结局

文献信息

中文摘要

目的： 评估长期听觉剥夺的后语言聋成人接受人工耳蜗植入（CI）后的结局。
方法： 对2020年至2022年间接受CI的95例患者进行回顾性分析。纳入标准为年龄≥18岁。主要结局指标包括言语频率纯音平均听阈（PTA4）、言语感知评分（单音节词和句子）以及听觉能力分级II（CAP-II）。通过相关和回归分析探讨听觉剥夺与术后结局之间的关联，并校正植入年龄和既往助听器使用等混杂因素。
结果： 平均PTA4改善70.8 dB HL，100词和100句识别评分中位数分别为82%和84%。剥夺时间≥30年的患者CAP-II评分显著较低（p=0.015）。线性回归显示耳聋持续时间与音调增益之间存在轻度负相关（每年-0.331 dB）。在65岁以下的参与者中，长期剥夺与音调增益和CAP-II评分降低相关，而在老年人中未观察到这种效应。植入年龄影响单音节词识别，但不影响句子感知。
讨论： 研究结果表明，听觉剥夺的后果在年轻成人中更为明显，可能反映了听力损失发生较早时中枢听觉处理易损性增加。
结论： 人工耳蜗植入在各年龄组均提供显著获益。长期听觉剥夺对65岁以下成人的影响更大，支持早期植入和持续听觉刺激以保护中枢听觉处理并优化长期结局。

英文摘要

OBJECTIVES: To evaluate outcomes following cochlear implantation (CI) in postlinguistically deaf adults with prolonged auditory deprivation.
METHODS: A retrospective analysis was conducted on 95 patients who underwent CI between 2020 and 2022. Inclusion criteria were age ≥18 years. Main outcome measures included the pure-tone average across speech frequencies (PTA4), speech perception scores (monosyllabic words and sentences), and the Categories of Auditory Performance II (CAP-II). Correlation and regression analyses examined associations between auditory deprivation and postoperative outcomes, adjusting for confounders such as age at implantation and prior hearing aid use.
RESULTS: Mean PTA4 improved by 70.8 dB HL, with median 100-word and 100-sentence recognition scores of 82% and 84%, respectively. Patients with ≥30 years of deprivation showed significantly lower CAP-II scores (p = 0.015). Linear regression revealed a modest inverse relationship between duration of deafness and tonal gain (-0.331 dB per year). Among participants under 65 years, prolonged deprivation correlated with reduced tonal gain and CAP-II scores, whereas no such effect was observed in older adults. Age at implantation influenced monosyllabic word recognition but not sentence perception.
DISCUSSION: Findings indicate that the consequences of auditory deprivation are more pronounced in younger adults, likely reflecting increased vulnerability of central auditory processing when hearing loss occurs earlier in life.
CONCLUSION: Cochlear implantation provides substantial benefits across age groups. Prolonged auditory deprivation exerts a greater impact in adults under 65 years, supporting early implantation and continuous auditory stimulation to preserve central auditory processing and optimize long-term outcomes.