成人人工耳蜗植入者术中激素给药与听阈及言语感知结局的关联：一项回顾性队列研究

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中文摘要

背景： 人工耳蜗植入术中给予激素旨在减轻耳蜗炎症并保护听觉功能，但其临床获益证据仍不一致。本研究评估了成人人工耳蜗植入者术中激素使用与术后纯音测听（PTA）阈值及言语感知结局之间的关联。
方法： 开展了一项回顾性队列研究，纳入370名具有完整PTA数据的成人以及332名具有可解读言语感知评分的成人。患者按术中是否使用激素进行分层（PTA：n = 112；言语：n = 96）与未使用激素（PTA：n = 258；言语：n = 236）。术后PTA代表未助残余声学听力，在不佩戴人工耳蜗的情况下于500、1000、2000、4000和8000 Hz测量。言语感知在人工耳蜗激活后三个月、仅使用人工耳蜗、安静条件下采用BKB和AB测试评估，所有患者采用相同的测试方法。组间比较采用参数和非参数检验。使用协方差分析（ANCOVA）校正基线表现。还进行了敏感性分析以及按术前言语评分分层的亚组分析。
结果： 两组残余声学PTA均显著改善，组间无显著差异（激素组：27.1 dB vs. 无激素组：30.4 dB；p = 0.107）。ANCOVA证实激素使用与PTA结局之间无独立关联（β = -0.14 dB，95% CI -1.80至+1.52；p = 0.869）。相反，激素组术后言语感知较低（64.5% vs. 71.3%；p = 0.048），且较基线的改善幅度较小（36.6 vs. 47.1个百分点；p = 0.004）。校正后，激素使用与言语评分低8.4个百分点相关（95% CI 2.0至14.8；p = 0.010）。该发现在多项敏感性分析中一致。亚组分析在大多数基线分层中未显示统计学显著差异，但在术前言语评分较高的患者中观察到显著关联。鉴于观察性设计，该关联可能反映未测量的混杂因素，包括手术选择因素。
结论： 在本队列中，术中激素使用与PTA结局改善无关。观察到的与较低言语感知结局的关联可能受残余混杂影响，应谨慎解读。需要前瞻性、标准化的研究来确定术中激素在人工耳蜗植入中的作用。

英文摘要

Background: Intra-operative steroid administration during cochlear implantation is intended to reduce cochlear inflammation and preserve auditory function, but clinical evidence of benefit remains inconsistent. This study evaluated the association between intra-operative steroid use and post-operative pure tone audiometry (PTA) thresholds and speech perception outcomes in adult cochlear implant recipients. Methods: A retrospective cohort study was conducted including 370 adults with complete PTA data and 332 with interpretable speech perception scores. Patients were stratified by intra-operative steroid use (PTA: n = 112; speech: n = 96) versus no steroid use (PTA: n = 258; speech: n = 236). Post-operative PTA represented unaided residual acoustic hearing, measured without the cochlear implant at 500, 1000, 2000, 4000 and 8000 Hz. Speech perception was assessed using BKB and AB tests in quiet, with the CI alone, at three months after CI activation, using the same testing approach for all patients. Between-group comparisons were performed using parametric and non-parametric tests. Analysis of covariance (ANCOVA) was used to adjust for baseline performance. Sensitivity analyses and subgroup analyses stratified by pre-operative speech scores were undertaken. Results: Residual acoustic PTA improved substantially in both groups, with no significant between-group difference (steroid: 27.1 dB vs. no-steroid: 30.4 dB; p = 0.107). ANCOVA confirmed no independent association between steroid use and PTA outcome (β = -0.14 dB, 95% CI -1.80 to +1.52; p = 0.869). In contrast, the steroid group demonstrated lower post-operative speech perception (64.5% vs. 71.3%; p = 0.048) and smaller improvement from baseline (36.6 vs. 47.1 percentage points; p = 0.004). After adjustment, steroid use was associated with an 8.4 percentage point lower speech score (95% CI 2.0 to 14.8; p = 0.010). This finding was consistent across multiple sensitivity analyses. Subgroup analyses did not show statistically significant differences in most baseline strata, although a significant association was observed in patients with higher pre-operative speech scores. Given the observational design, this association may reflect unmeasured confounding, including surgical selection factors. Conclusions: Intra-operative steroid use was not associated with improved PTA outcomes in this cohort. An observed association with lower speech perception outcomes is likely influenced by residual confounding and should be interpreted with caution. Prospective, standardised studies are required to determine the role of intra-operative steroids in cochlear implantation.