电极-蜗轴距离作为人工耳蜗性能的决定因素：系统综述与荟萃分析
Electrode-Modiolar Distance as a Determinant of Cochlear Implant Performance: A Systematic Review and Meta-Analysis.
文献信息
| PMID | 42914132 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Nidhin Das K |
| 作者单位 | Department of Otorhinolaryngology, All India Institute of Medical Sciences, Bilaspur, India. |
| 期刊 | Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery |
| SCI 分区 | Q2 |
| IF | 2 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 量化电极-蜗轴距离（EMD）与人工耳蜗（CI）在言语/感知、电生理和编程结局方面的关系，并描述EMD的剂量-反应效应。
方法： 按照PRISMA指南对PubMed/MEDLINE、Embase、Scopus、Web of Science和Cochrane CENTRAL进行了系统检索。纳入报告CT或CBCT衍生的EMD及CI结局的人体研究。效应量转换为比值比（OR），并使用随机效应模型进行合并。进行了亚组、敏感性和剂量-反应分析。使用I2评估异质性，并使用漏斗图和Egger检验评估发表偏倚。
结果： 共纳入21项研究，约1181只植入耳。较小的EMD与有利CI结局的显著更高几率相关（合并OR=2.16，95% CI：1.89-2.45；p<0.001；I2=0%）。在言语/感知结局（OR=2.23）、电生理指标（敏感性调整后OR=2.80）和编程参数（OR=1.72）方面观察到一致效应。剂量-反应模型显示单调梯度，EMD每增加1 mm，有利结局的几率降低20%-30%（每mm OR≈0.72；p<0.001）。未检测到显著发表偏倚（Egger p=0.056）。
结论： 电极-蜗轴邻近度是CI性能强而一致的决定因素，具有明确的剂量-反应关系，支持其作为临床可操作的影像生物标志物，用于优化电极选择、手术策略和个体化编程。
试验注册： PROSPERO：CRD420261380236。
英文摘要
OBJECTIVE: To quantify the relationship between electrode-modiolar distance (EMD) and cochlear implant (CI) performance across speech/perceptual, electrophysiological and programming outcomes and to characterize the dose-response effect of EMD.
METHODS: A systematic search of PubMed/MEDLINE, Embase, Scopus, Web of Science and Cochrane CENTRAL was conducted in accordance with PRISMA guidelines. Human studies reporting CT- or CBCT-derived EMD and CI outcomes were included. Effect sizes were transformed to odds ratios (ORs) and pooled using random-effects models. Subgroup, sensitivity and dose-response analyses were performed. Heterogeneity was assessed using I2, and publication bias was evaluated using funnel plots and Egger's test.
RESULTS: Twenty-one studies comprising approximately 1181 implanted ears were included. Reduced EMD was associated with significantly higher odds of favourable CI outcomes (pooled OR = 2.16, 95% CI: 1.89-2.45; p < 0.001; I2 = 0%). Consistent effects were observed for speech/perceptual outcomes (OR = 2.23), electrophysiological measures (OR = 2.80 after sensitivity adjustment) and programming parameters (OR = 1.72). Dose-response modelling demonstrated a monotonic gradient, with each 1 mm increase in EMD associated with a 20%-30% reduction in the odds of favourable outcomes (OR per mm ≈0.72; p < 0.001). No significant publication bias was detected (Egger's p = 0.056).
CONCLUSION: Electrode-modiolar proximity is a strong and consistent determinant of CI performance with a clear dose-response relationship, supporting its role as a clinically actionable imaging biomarker for optimizing electrode selection, surgical strategy and individualized programming.
TRIAL REGISTRATION: PROSPERO: CRD420261380236.