Individual Differences in Speech Recognition Changes After Cochlear Implantation
Individual Differences in Speech Recognition Changes After Cochlear Implantation
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DOI：
10.1001/jamaoto.2020.5094
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发表时间：
2021-01-07
影响因子：
7.8
通讯作者：
McRackan, Theodore R.
中科院分区：
文献类型：
--
作者：
Dornhoffer, James R.;Reddy, Priyanka;McRackan, Theodore R.
重要性耳蜗植入术在改善听力结果方面非常有效，但结果仅限于分组分析。也就是说，有限的数据可用于个别患者，报告术前辅助语音识别和植入后语音recognition. ObjectiveTo比较术前辅助与术后语音识别分数的变化，为个别患者接受人工耳蜗植入时，考虑到每个语音识别测试的测量误差。这项横断面研究使用了一个前瞻性维护的数据库，该数据库包含2012年1月1日至2017年12月31日期间在一个基于大学的三级转诊中心接受人工耳蜗植入的患者。对双侧感音神经性耳聋的成年人进行人工耳蜗植入术，术后6个月或12个月进行一次或多次语音识别测试。（辅音-核-辅音词测试），句子识别（AzBio句子在安静的环境中），以及噪音中的句子识别（AzBio句子在+10 dB信噪比）评分，结果分析了323例患者共470个种植体的数据，其中男性253例，（53.8%）例患者;平均（SD）年龄为61.2（18.3）岁。大多数患者术后的所有语音识别测试均在统计学上显著改善，超过测量误差，包括262例（84.8%）单词识别，226例（87.6%）句子识别和33例（78.6%）噪音中的句子识别。少数患者的术前和术后评分相同，包括45例（14.5%）单词识别、28例（10.9%）句子识别和9例（21.4%）噪声中句子识别。4例患者（1.6%）植入后句子识别评分明显较差。植入年龄与言语识别评分变化之间的相关性为：单词识别为-0.12（95%CI，-0.23至-0.01），句子识别为-0.22（95%CI，-0.34至-0.10），噪声中句子识别为-0.10（95%CI，-0.39至0.21）。没有显着改善的患者之间分布相似的所有术前辅助语音分数单词识别（范围，0%-58%）和句子识别（范围，0%-56%）testing.CONCLUSIONS和相关性在这项横断面研究中，术前辅助语音识别，术后人工耳蜗植入的结果，为个别患者在很大程度上是令人鼓舞的。然而，个体患者的评分改善仍然存在高度变异性，这可能无法在分组分析和平均评分报告中充分体现。呈现来自人工耳蜗植入个体的大样本的个体患者数据提供了对语音识别结果的个体差异的更好理解，并有助于对人工耳蜗植入后的成功结果进行更完整的解释。
IMPORTANCE Cochlear implantation is highly effective at improving hearing outcomes, but results have been limited to groupwise analysis. That is, limited data are available for individual patients that report comparisons of preoperative aided speech recognition and postimplantation speech recognition.OBJECTIVE To assess changes in preoperative aided vs postoperative speech recognition scores for individual patients receiving cochlear implants when considering the measurement error for each speech recognition test.DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used a prospectively maintained database of patients who received cochlear implants between January 1, 2012, and December 31, 2017, at a tertiary, university-based referral center. Adults with bilateral sensorineural hearing loss undergoing cochlear implantation with 6- or 12-month postoperative measures using 1 or more speech recognition tests were studied.EXPOSURES Cochlear implantation.MAIN OUTCOMES AND MEASURES Postoperative word recognition (consonant-nucleus-consonant word test), sentence recognition (AzBio sentences in quiet), and sentence recognition in noise (AzBio sentences in +10-dB signal-to-noise ratio) scores, and association of each speech recognition score change with aided preoperative score to each test's measurement error.RESULTS Analysis of data from a total of 470 implants from 323 patients included 253 male (53.8%) patients; the mean (SD) age was 61.2 (18.3) years. Most patients had statistically significant improvement in all speech recognition tests postoperatively beyond measurement error, including 262 (84.8%) for word recognition, 226 (87.6%) for sentence recognition, and 33 (78.6%) for sentence recognition in noise. A small number of patients had equivalent preoperative and postoperative scores, including 45 (14.5%) for word recognition, 28 (10.9%) for sentence recognition, and 9 (21.4%) for sentence recognition in noise. Four patients (1.6%) had significantly poorer scores in sentence recognition after implantation. The associations between age at implantation and change in speech recognition scores were -0.12 (95% CI, -0.23 to -0.01) for word recognition, -0.22 (95% CI, -0.34 to -0.10) for sentence recognition, and -0.10 (95% CI, -0.39 to 0.21) for sentence recognition in noise. Patients with no significant improvement were similarly distributed between all preoperative aided speech scores for word recognition (range, 0%-58%) and sentence recognition (range, 0%-56%) testing.CONCLUSIONS AND RELEVANCE In this cross-sectional study, with respect to preoperative aided speech recognition, postoperative cochlear implant outcomes for individual patients were largely encouraging. However, improvements in scores for individual patients remained highly variable, which may not be adequately represented in groupwise analyses and reporting of mean scores. Presenting individual patient data from a large sample of individuals with cochlear implants provides a better understanding of individual differences in speech recognition outcomes and contributes to more complete interpretations of successful outcomes after cochlear implantation.