Bilateral Cochlear Implants or Bimodal Hearing for Children with Bilateral Sensorineural Hearing Loss.
Bilateral Cochlear Implants or Bimodal Hearing for Children with Bilateral Sensorineural Hearing Loss.
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DOI：
10.1007/s40136-020-00314-6
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发表时间：
2020-12
影响因子：
0.6
通讯作者：
Gifford RH
中科院分区：
文献类型：
--
作者：
Gifford RH
这篇综述描述了使用双模听力（人工耳蜗加对侧助听器）的儿童与双侧CIs儿童的语言感知和语言结果，并将这些发现与成人文献进行了对比。目前缺乏临床证据来支持推荐双侧和双侧CI，因此，临床医生通常不确定何时为残听儿童推荐第二次CI。因此，本综述的目的是确定可能影响有残余听觉的儿童CI候选人临床决策的科学信息。双侧CIs被认为是双侧重度至重度感音神经性听力损失儿童的标准护理。对于有辅助听觉的儿童——即使只是低频的——早期的双峰刺激与更好的言语感知、词汇和语言发展有显著的联系。然而，HA可听性通常不如CI可听性，导致言语感知、头部阴影、脑干和皮层活动和发育的耳间不对称。因此，有必要优化“双耳”听力，同时最大限度地发挥儿童在听力、言语和语言方面的潜力，同时确保我们限制不对称驱动的听觉神经可塑性。最近一项针对双峰和双侧CI使用者的大型研究表明，一段时间的双峰刺激仅对耳朵纯音平均(PTA)≤73 dB HL的儿童有益。这个73-dB-HL的临界值甚至适用于最终接受双侧ci的儿童。虽然我们还没有明确的指南来确定双侧CI与双侧CI的适用性，但越来越多的证据表明：1)双侧CI对双侧重度至重度听力损失的儿童有更好的结果；2)早期的双侧CI刺激有益于言语感知和语言发展，但仅适用于听力较好的PTA≤73 dB HL的儿童。对于有残余听觉的儿童，即使只是在低频范围内，快速顺序双侧人工耳蜗植入后进行一段试验期的双峰刺激，将在听觉、语言和学术发展方面取得最佳效果。当然，也有越来越普遍的人工耳蜗植入与声学听力保护允许联合电和声刺激，甚至在双侧植入。
This review describes speech perception and language outcomes for children using bimodal hearing (cochlear implant (CI) plus contralateral hearing aid) as compared to children with bilateral CIs and contrasts said findings with the adult literature. There is a lack of clinical evidence driving recommendations for bimodal versus bilateral CI candidacy and as such, clinicians are often unsure about when to recommend a second CI for children with residual acoustic hearing. Thus the goal of this review is to identify scientific information that may influence clinical decision making for pediatric CI candidates with residual acoustic hearing. Bilateral CIs are considered standard of care for children with bilateral severe-to-profound sensorineural hearing loss. For children with aidable acoustic hearing—even in just the low frequencies—an early period of bimodal stimulation has been associated with significantly better speech perception, vocabulary, and language development. HA audibility, however, is generally poorer than that offered by a CI resulting in interaural asymmetry in speech perception, head shadow, as well as brainstem and cortical activity and development. Thus there is a need to optimize “two-eared” hearing while maximizing a child’s potential with respect to hearing, speech, and language while ensuring that we limit asymmetrically driven auditory neuroplasticity. A recent large study of bimodal and bilateral CI users suggested that a period of bimodal stimulation was only beneficial for children with a better-ear pure tone average (PTA) ≤ 73 dB HL. This 73-dB-HL cutoff applied even to children who ultimately received bilateral CIs. Though we do not yet have definitive guidelines for determining bimodal versus bilateral CI candidacy, there is increasing evidence that 1) bilateral CIs yield superior outcomes for children with bilateral severe-to-profound hearing loss and, 2) an early period of bimodal stimulation is beneficial for speech perception and language development, but only for children with better-ear PTA ≤ 73 dB HL. For children with residual acoustic hearing, even in just the low-frequency range, rapid sequential bilateral cochlear implantation following a trial period with bimodal stimulation will yield best outcomes for auditory, language, and academic development. Of course, there is also an increasing prevalence of cochlear implantation with acoustic hearing preservation allowing for combined electric and acoustic stimulation even following bilateral implantation.
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影响因子：
3.7
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