Clinical Outcomes for Adult Single-Sided Deafness Cochlear Implantees Exceeding the 5% Candidacy Criterion.

IF 2.6 2区 医学 Q1 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY
Ear and Hearing Pub Date : 2025-03-01 Epub Date: 2024-10-17 DOI:10.1097/AUD.0000000000001578
Joshua G W Bernstein, Elicia M Pillion, Anthony M Tolisano
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引用次数: 0

Abstract

Objectives: While single-sided deafness cochlear implants (SSD-CIs) have now received regulatory approval in the United States, candidate-ear candidacy criteria (no better than 5% word-recognition score) are stricter than for traditional CI candidates (50 to 60% speech recognition, best-aided condition). SSD implantation in our center began before regulatory approval, using a criterion derived from traditional candidacy: 50% consonant-nucleus-consonant (CNC) word-identification score in the candidate ear. A retrospective analysis investigated whether SSD patients exceeding the 5% CNC criterion nevertheless benefitted from a CI as assessed by spatial-hearing tests (speech understanding in noise [SIN] and localization) and by a patient-reported outcome measure quality-of-life instrument validated for patients with CIs.

Design: A retrospective chart review assessed the clinical experience of a single CI center. Subjects consisted of 27 adult CI recipients with SSD (N = 21) or asymmetric hearing loss (AHL; N = 6) implanted since September 2019 with at least 3 months of postoperative follow-up. Patients with revision surgery or simultaneous labyrinthectomy and CI surgery were excluded from the sample. Subjects were divided into 2 groups based on preoperative CNC scores measured under best-aided conditions with a behind-the-ear hearing aid in the sound field at 0.9 m from a front loudspeaker, and the better ear masked using an insert earphone with 45 dB HL speech-weighted noise. The "MEETS" group had preoperative CNC word scores <5%; the "EXCEEDS" group had scores >5%. The clinical protocol also included intelligibility tests using AzBio sentences in the same test conditions as CNC; binaural spatial testing (broadband-noise sound localization, and matrix-sentence speech-reception thresholds in spatially separated noise) using a custom-built 7-speaker array; and the CI Quality of Life (CIQOL) instrument. To evaluate CI benefit, preoperative unaided performance was compared with postoperative binaural (acoustic ear + CI ear) performance at a clinic visit closest to 6 months postsurgery.

Results: Of 27 SSD-CI recipients, 11 subjects exceeded the 5% preoperative CNC candidacy criterion. Both the MEETS and EXCEEDS groups improved significantly on all 5 primary study outcome measures (CI-alone CNC and AzBio, binaural SIN and sound localization, and CIQOL). The only statistically significant differences observed between the MEETS and EXCEEDS groups were that preoperative CNC and AzBio scores were significantly higher for the EXCEEDS group, as expected given that the groups were defined based on preoperative speech-perception scores in quiet. There were no statistically significant differences between the MEETS and EXCEEDS groups in postoperative scores in any test or in the magnitude of the improvement from preoperative to postoperative assessment.

Conclusions: SSD- and AHL-CI recipients exceeding the 5% CNC preoperative candidacy criterion significantly improved in CI-alone speech perception, spatial hearing, and subjectively reported CIQOL outcomes and the observed benefits were indistinguishable from SSD- and AHL-CI recipients who met the 5% criterion. A less-restrictive SSD-CI and AHL-CI candidacy criterion should be considered, and larger-scale clinical trials to evaluate CI efficacy using a less-stringent candidate-ear criterion are warranted.

超过 5% 候选标准的成年单侧耳聋人工耳蜗植入者的临床结果。
目标:虽然单侧耳聋人工耳蜗(SSD-CIs)现已获得美国监管部门的批准,但候选耳的候选标准(单词识别率不超过 5%)比传统 CI 候选者(50% 至 60% 的语音识别率,最佳辅助条件)更为严格。我们中心的固态硬盘植入手术在获得监管部门批准之前就已开始,采用的标准源自传统的候选标准:候选耳的辅音-核-共振(CNC)词识别率为 50%。一项回顾性分析调查了超过 5% CNC 标准的 SSD 患者是否仍能从 CI 中获益,空间听力测试(噪声中的语音理解 [SIN] 和定位)和患者报告的生活质量测量工具对 CI 患者进行了验证:设计:回顾性病历审查评估了一家 CI 中心的临床经验。受试者包括自2019年9月以来植入的27名成年CI接受者,他们患有SSD(21人)或非对称听力损失(AHL;6人),术后随访至少3个月。样本中不包括接受过翻修手术或同时接受过迷路切除术和 CI 手术的患者。受试者根据术前 CNC 评分分为两组,术前 CNC 评分是在最佳助听条件下使用耳背式助听器在距离前方扬声器 0.9 米处的声场中测量的,较好的耳朵使用插入式耳机屏蔽 45 dB HL 语音加权噪声。MEETS "组的术前 CNC 单词得分率为 5%。临床方案还包括在与 CNC 相同的测试条件下使用 AzBio 句子进行的可懂度测试;使用定制的 7 扬声器阵列进行的双耳空间测试(宽带-噪声声音定位和空间隔离噪声中的矩阵-句子语音接收阈值);以及 CI 生活质量(CIQOL)工具。为了评估 CI 的益处,在术后最接近 6 个月的门诊中,将术前的无助性能与术后的双耳(听力耳 + CI 耳)性能进行了比较:在 27 名 SSD-CI 受试者中,有 11 名受试者超过了术前 5% CNC 候选标准。MEETS组和EXCEEDS组在所有5个主要研究结果指标(CI-单独CNC和AzBio、双耳SIN和声音定位以及CIQOL)上都有明显改善。在 MEETS 组和 EXCEEDS 组之间观察到的唯一具有统计学意义的差异是,EXCEEDS 组的术前 CNC 和 AzBio 分数明显更高,这在意料之中,因为这两组是根据术前安静时的言语感知分数确定的。MEETS组和EXCEEDS组在任何测试的术后得分或术前到术后评估的改善程度上都没有明显的统计学差异:超过 5% CNC 术前候选标准的 SSD 和 AHL-CI 受助者在 CI 单独言语感知、空间听力和主观报告的 CIQOL 结果方面都有显著改善,观察到的益处与达到 5% 标准的 SSD 和 AHL-CI 受助者没有区别。应考虑采用限制性较小的 SSD-CI 和 AHL-CI 候选标准,并应采用限制性较小的候选耳标准进行更大规模的临床试验,以评估 CI 的疗效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Ear and Hearing
Ear and Hearing 医学-耳鼻喉科学
CiteScore
5.90
自引率
10.80%
发文量
207
审稿时长
6-12 weeks
期刊介绍: From the basic science of hearing and balance disorders to auditory electrophysiology to amplification and the psychological factors of hearing loss, Ear and Hearing covers all aspects of auditory and vestibular disorders. This multidisciplinary journal consolidates the various factors that contribute to identification, remediation, and audiologic and vestibular rehabilitation. It is the one journal that serves the diverse interest of all members of this professional community -- otologists, audiologists, educators, and to those involved in the design, manufacture, and distribution of amplification systems. The original articles published in the journal focus on assessment, diagnosis, and management of auditory and vestibular disorders.
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