人工耳蜗未使用者的临床与行为特征界定：一项20年回顾性描述性分析

文献信息

中文摘要

背景： 尽管人工耳蜗（CI）能有效恢复听力，但设备弃用（“未使用”）仍是限制长期听觉康复的关键挑战。
目的/目标： 本研究旨在评估CI未使用的患病率、临床与影像学特征及患者报告的原因，比较语前聋与语后聋个体，以指导长期保留策略。
材料与方法： 我们回顾性分析了2002年至2023年间植入的545例CI接受者（排除24例失访或数据不完整的患者）。分析了36例未使用者的临床特征、颞骨CT、内听道MRI及言语-语言治疗记录。
结果： 总体未使用率为6.6%（36/545），其中语前聋接受者为8.7%（25/287），语后聋接受者为4.3%（11/258）。在11例语前聋未使用者中发现内耳畸形，包括2例孤立性耳蜗神经缺陷。主要未使用原因为声音适应不良（语前聋48.0% vs. 语后聋36.4%）及缺乏主观聆听效果（48.0% vs. 18.2%）。语后聋未使用者表现出独特的成人特异性心理社会障碍（27.3%），包括抑郁和认知功能下降。
结论与意义： CI未使用由取决于耳聋发病时间的独特生理、心理和社会经济因素驱动。界定这些发病特异性特征为量身定制的术前咨询和适龄的植入后监测提供了重要指导，以尽量减少长期设备弃用。

英文摘要

BACKGROUND: Although cochlear implants (CIs) effectively restore hearing, device abandonment ('non-use') remains a critical challenge limiting long-term auditory rehabilitation.
AIMS/OBJECTIVES: This study aimed to evaluate the prevalence, clinical and radiological characteristics, and patient-reported reasons for CI non-use, comparing pre-lingually and post-lingually deafened individuals to inform long-term retention strategies.
MATERIAL AND METHODS: We retrospectively reviewed 545 CI recipients implanted between 2002 and 2023 (excluding 24 patients lost to follow-up or with incomplete data). Clinical features, temporal bone CT, internal auditory canal MRI, and speech-language therapy records of 36 non-users were analyzed.
RESULTS: Overall non-use rate was 6.6% (36/545), comprising 8.7% (25/287) in pre-lingual and 4.3% (11/258) in post-lingual recipients. Inner ear anomalies were identified in 11 pre-lingual non-users, including two with isolated cochlear nerve deficiency. Primary non-use reasons were sound maladaptation (48.0% pre-lingual vs. 36.4% post-lingual) and lack of subjective listening effect (48.0% vs. 18.2%). Post-lingual non-users presented distinct adult-specific psychosocial barriers (27.3%), including depression and cognitive decline.
CONCLUSIONS AND SIGNIFICANCE: CI non-use is driven by distinct physiological, psychological, and socioeconomic factors depending on deafness onset. Delineating these onset-specific profiles provides essential guidance for tailored preoperative counseling and age-appropriate post-implantation monitoring to minimize long-term device abandonment.