Evidence for the Expansion of Pediatric Cochlear Implant Candidacy
Evidence for the Expansion of Pediatric Cochlear Implant Candidacy
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DOI：
10.1097/mao.0000000000000607
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发表时间：
2015-01-01
影响因子：
2.1
通讯作者：
Gifford, Rene H.
中科院分区：
文献类型：
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作者：
Carlson, Matthew L.;Sladen, Douglas P.;Gifford, Rene H.
目的：检验一种假设，即非传统人工耳蜗术后，在适当安装的助听器和干预措施下没有进步的儿童，将从人工耳蜗术中获得显著的益处，如(1)言语知觉的改善，(2)听觉技能的发展，和(或)(3)接受和表达语言的标准化测量的进步。研究设计：回顾性病例序列。地点：两个三级学术人工耳蜗术中心。患者：所有接受人工耳蜗术的儿童患者。只有那些符合以下一项或两项标准的儿童才被包括在内：(1)听力损失没有目前指征中规定的严重，(2)能够参与言语感知测试的儿童的开放式单词和/或句子识别分数超过30%。排除听神经病患者。干预(S)：植入人工耳蜗术。主要观察指标：术前、术后适龄语音识别测试结果、听力问卷、标准化常模语音和语言发育评估。结果：共有51例患者符合研究标准。手术时的平均年龄为8.3岁，其中24%的患者接受了双侧序贯植入。总体而言，植入耳的语音识别能力平均提高了63个百分点(p<；0.001)，而双峰耳的平均语音识别能力提高了40个百分点(p<；0.001)。听力和语言发育测试结果显示，植入后有显著改善(p<；0.05)。结论：非传统儿科植入物的接受者从人工耳蜗术中获益显著。有必要对儿童人工耳蜗术前的候选资格进行大规模的重新评估，包括不那么严重的听力损失和更高的术前语音识别率，以使更多的儿童能够享受到人工耳蜗术的好处。
Objective: To test the hypothesis that children who are non-traditional cochlear implant candidates, but are not making progress with appropriately fitted hearing aids and intervention, will demonstrate significant benefit from cochlear implantation as defined by improvement in (1) speech perception, (2) auditory skills development, and/or (3) progress on standardized measures of receptive and expressive language. Study Design: Retrospective case series.Setting: Two tertiary academic cochlear implant centers.Patients: All pediatric patients that underwent cochlear implantation were reviewed. Only those meeting one or both of the following criteria were included: (1) less severe hearing loss than specified in the current indications and (2) open-set word and/or sentence recognition scores greater than 30% for children who are able to participate in speech perception testing. Patients with auditory neuropathy were excluded.Intervention(s): Cochlear implantation.Main Outcome Measures: Pre-and postoperative results of age appropriate speech recognition tests, auditory questionnaires, and standardized norm-referenced estimates of speech and language development.Results: A total of 51 patients met study criteria. The mean age at time of surgery was 8.3 years and 24% underwent bilateral sequential implantation. Overall, the mean speech recognition improvement was 63 percentage points in the implanted ear (p < 0.001) and 40 percentage points in the bimodal condition (p < 0.001). Results of auditory and language development measures revealed significant improvement after implantation (p < 0.05).Conclusion: Non-traditional pediatric implant recipients derive significant benefit from cochlear implantation. A large-scale reassessment of pediatric cochlear implant candidacy, including less severe hearing losses and higher preoperative speech recognition, is warranted to allow more children access to the benefits of cochlear implantation.