Bilateral Cochlear Implantation for Hearing-Impaired Children: Criterion of Candidacy Derived from an Observational Study
Bilateral Cochlear Implantation for Hearing-Impaired Children: Criterion of Candidacy Derived from an Observational Study
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DOI：
10.1097/aud.0000000000000087
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发表时间：
2015-01-01
期刊：
影响因子：
3.7
通讯作者：
Summerfield, Arthur Quentin
中科院分区：
文献类型：
--
作者：
Lovett, Rosemary Elizabeth Susan;Vickers, Deborah Anne;Summerfield, Arthur Quentin
目的：政策制定者一直在努力定义最低程度的听力障碍，在这种听力障碍下，儿童应该接受人工耳蜗植入，而不是侵入性较小的声学助听器。本研究比较了双侧人工耳蜗植入和儿童与双侧助听器的儿童的结果，以确定一个标准的候选资格为小儿双侧人工耳蜗implantation.Design：这项观察性研究测量的听力技能的儿童谁收到常规的听力护理在英国。参与者是从医院、教育机构和慈善机构招募的。入选标准包括31个月龄前诊断为听力损伤，双侧2和4 kHz纯音听阈大于或等于50 dB HL。71名儿童参与了研究，年龄为46至86个月（平均64个月）。28名儿童使用了同时手术中提供的双侧植入物; 43名儿童使用了双侧数字助听器。两组儿童在预测听力障碍儿童结局的变量方面在人口统计学上相似。儿童理解言语的能力是在三种条件下使用封闭式单词辨别测试来测量的：安静、粉红噪音和两个说话者的牙牙学语。对于每个听力测试，精算方法被用来比较从儿童与人工耳蜗植入和儿童与助听器的分数分布。其目的是计算无辅助纯音平均（PTA）听力水平，在该水平下，儿童使用植入物的结果比使用助听器的结果好4：1。与4：1的比值相关的PTA先前已被用于定义植入的候选资格标准。主要分析使用四频率PTA（听力较好耳在0.5、1、2和4 kHz下的无辅助阈值平均值）。额外的分析使用了三频PTA（0.5，1和2 kHz）和双频PTA（2和4 kHz）。结果：4：1的几率与植入物的更好结局相关，分别用于安静，噪音和牙牙学语中的单词辨别测试的四频PTA为79，86和76 dB HL。这三个估计值的平均值为80 dB HL。在幼儿中测量四频PTA可能很困难，但通常可以测量双频PTA。4：1的几率分别与安静、噪音和多语干扰条件下单词辨别测试的双频PTA 83、92和80 dB HL相关。这三个估计的平均值为85 dB HL。结论：儿童与一个独立的四频率PTA的80 dB HL或更差的双耳应考虑双侧人工耳蜗植入的候选人。在无法测量四频PTA的情况下，候选标准应是双耳的双频PTA为85 dB HL或更低。如果这些建议被政策制定者采纳，将扩大英格兰和威尔士儿童人工耳蜗植入的范围。
Objectives: Policy-makers have struggled to define the minimum degree of hearing impairment at which children should be offered cochlear implants rather than the less invasive alternative of acoustic hearing aids. This study compared outcomes for children with bilateral cochlear implants and children with bilateral hearing aids, to determine a criterion of candidacy for pediatric bilateral cochlear implantation.Design: This observational study measured the listening skills of children who received routine audiological care in the United Kingdom. Participants were recruited from hospitals, educational services, and charities. Eligibility criteria included a diagnosis of hearing impairment before 31 months of age and pure-tone thresholds greater than or equal to 50 dB HL at 2 and 4 kHz bilaterally. Seventy-one children participated, aged 46 to 86 months (mean 64 months). Twenty-eight children used bilateral implants provided in a simultaneous surgery; 43 used bilateral digital hearing aids. The two groups of children were demographically similar in variables that predict outcomes for children with hearing impairment. Children's ability to understand speech was measured using closed-set tests of word discrimination in three conditions: in quiet, in pink noise, and in two-talker babble. For each listening test, an actuarial method was used to compare the distribution of scores from children with cochlear implants and children with hearing aids. The aim was to calculate the unaided pure-tone average (PTA) hearing level at which a child has odds of 4:1 of a better outcome with implants than with hearing aids. The PTA associated with odds of 4:1 has been used previously to define criteria of candidacy for implantation. The main analyses used a four-frequency PTA (mean of unaided thresholds at 0.5, 1, 2, and 4 kHz in the better-hearing ear). Additional analyses used a three-frequency PTA (0.5, 1, and 2 kHz) and two-frequency PTA (2 and 4 kHz).Results: Odds of 4:1 of a better outcome with implants were associated with a four-frequency PTA of 79, 86, and 76 dB HL for tests of word discrimination in quiet, noise, and babble, respectively. The mean of these three estimates is 80 dB HL. It can be difficult to measure a four-frequency PTA in young children, but a two-frequency PTA typically can be measured. Odds of 4:1 were associated with a two-frequency PTA of 83, 92, and 80 dB HL for tests of word discrimination in quiet, noise, and babble, respectively. The mean of these three estimates is 85 dB HL.Conclusions: Children with an unaided four-frequency PTA of 80 dB HL or poorer in both ears should be considered candidates for bilateral cochlear implantation. In cases where a four-frequency PTA cannot be measured, the criterion of candidacy should be a two-frequency PTA of 85 dB HL or poorer in both ears. If adopted by policy-makers, these recommendations would expand the provision of cochlear implants among children in England and Wales.