语后聋成人人工耳蜗植入后听觉表现的决定因素：超越听力损失持续时间

文献信息

中文摘要

目的： 长期听觉剥夺会逐渐损害中枢听觉通路的完整性，但其对接受人工耳蜗植入的语后聋成人的预后影响仍不明确。本研究评估听力损失持续时间——以绝对值表示、按传统10年阈值二分，以及作为听力损失占一生比例表示——对听觉表现的影响，并识别与即刻激活效应及植入后轨迹相关的临床决定因素。
方法： 在Unidade Local de Saúde de Santo António进行的单中心、回顾性、观察性研究，纳入2018年至2024年间接受CI的109名语后聋成人，最短随访时间为12个月。听觉表现通过纯音平均听阈、言语接受阈和言语识别得分进行评估。纵向建模使用线性混合效应模型，区分即刻激活效应与随后的时间进展。
结果： 听力损失持续时间较长的患者在所有指标上均表现出更严重的植入前听觉损害，呈连续剂量-反应关系，无阈值效应的证据。10年标准未显示出区分价值——无论是在即刻效应还是植入后轨迹方面，两组之间均相当。植入耳的选择和术前助听器状态是激活时达到水平的最强决定因素。助听器使用覆盖听力损失持续时间的比例是唯一与言语指标纵向恢复更优相关的预测因素。
结论： 在该队列中，听力损失持续时间并未识别出未能获益的患者，这些单中心数据不支持将其作为人工耳蜗植入的独立排除标准。对于大多数决定因素，激活时建立的功能差异在整个随访期间保持不变，没有补偿性追赶，使得优化激活时达到的水平成为干预的主要目标。个体化考虑植入耳、维持助听器使用至手术日期，以及最大化助听器使用覆盖听力损失持续时间的比例，构成主要的可修改干预目标，并与功能结局相关。

英文摘要

PURPOSE: Prolonged auditory deprivation progressively compromises central auditory pathway integrity, yet its prognostic impact in post-lingual adults undergoing cochlear implantation remains poorly defined. This study evaluates the influence of hearing loss duration - expressed in absolute terms, dichotomised by the conventional 10-year threshold, and as a proportion of lifetime with hearing loss - on auditory performance, and identifies the clinical determinants associated with the immediate activation effect and the post-implantation trajectory.
METHODS: Single-centre, retrospective, observational study at Unidade Local de Saúde de Santo António, including 109 post-lingual adults undergoing CI between 2018 and 2024, with a minimum follow-up of 12 months. Auditory performance was assessed through pure-tone average, speech reception threshold, and speech discrimination score. Longitudinal modelling used linear mixed-effects models, distinguishing the immediate activation effect from subsequent temporal progression.
RESULTS: Patients with longer hearing loss duration presented greater pre-implantation auditory impairment across all metrics, following a continuous dose-response relationship with no evidence of a threshold effect. The 10-year criterion showed no discriminative value - either in the immediate effect or in the post-implantation trajectory, which was equivalent between groups. Ear selection for implantation and pre-operative hearing aid status were the strongest determinants of the level reached at activation. The proportion of hearing loss duration covered by hearing aid use was the only predictor associated with superior longitudinal recovery in the speech metrics.
CONCLUSION: In this cohort, duration of hearing loss did not identify patients who failed to benefit, and these single-centre data do not support its use as a stand-alone exclusion criterion for cochlear implantation. For most determinants, the functional differential established at activation was maintained throughout follow-up without compensatory catch-up, making optimisation of the level reached at activation the principal target of intervention. Individualised consideration of the ear to be implanted, maintenance of hearing aid use until the date of surgery, and maximisation of the proportion of hearing loss duration covered by hearing aid use constitute the main modifiable targets for intervention, and are associated with functional outcomes.