Predicting Performance in Adult Cochlear Implantation

人工耳蜗（Cl）可以恢复听力，言语理解和沟通能力的成人听力损失从助听器获得有限的好处，从而提高生活质量。尽管Cls取得了成功，但与患者和治疗因素相关的表现仍存在很大差异。传记性/听力学变量，如年龄、发病年龄、持续时间、病因学、听力损失的严重程度以及助听器和Cl使用的持续时间，以及手术因素，长期以来被用于预测言语感知表现。这些变量仅占安静环境下言语感知测试分数变化的10-20%，这意味着它们是听觉系统对Cl刺激适应性的较差生物标志物。最近的研究表明，老年人在背景噪音中的Cl表现更差，部分原因与年龄相关的中央处理差异有关。我们认为，在成年Cl候选人中，准确评估耳蜗-神经和中枢听觉基质可以预测表现。预测表现与患者咨询和共同决策（临床医生和患者之间）、听觉康复的设计和建议、设备映射和故障排除的考虑以及未来临床试验中的患者分层相关。耳蜗电图（ECochG）是一种评估耳蜗神经基质的声诱发电生理方法；在95%的Cl接受者中存在应答，并且可以占到安静时开放集语音感知分数的50%。然而，ECochG-total response （ECochG-TR）对于预测噪声环境下的语音感知是必要的，但不是充分的。在ecocg - tr中加入术前认知筛查可改善预测模型（ΔR2=0.26; R2mode1=0.60）。因此，良好的耳蜗神经基础和认知功能都需要在噪声环境下进行语音理解。我们将使用传记/听力学变量以及术前、经鼓室（ttECochG）和/或术中（iECochG） ECochG和手术因素，来开发临床上有用的术前和/或术后（预激活）语音感知预测模型。目的1：与已验证的iECochG-TR相比，确定术前tecochg - tr是否能有效测量与氯离子刺激相关的耳蜗-神经基质完整性。为此，我们将确定ttECochG与：（1a） iECochG-TR和（1b）安静（6个月）植入耳语音感知测量之间的相关性强度。目标2：在使用氯离子6个月后，建立植入耳在噪音（初级）和安静（次级）下的语音感知评分预测模型。模型将包括基线人口统计学/听力学变量，认知测量加上：（2a）术前临床ttecog - tr；（2b）术后（激活前）iECochG-TR和植入后CT成像的手术因素。目标3：建立预测模型在不同地理位置（范德比尔特大学）和圣路易斯华盛顿大学的普遍性（外部验证），因为不同地点的患者和手术因素可能不同。

Cochlear implants (Cl) can restore audibility, speech understanding, and communication abilities for adults with hearing loss receiving limited benefit from hearing aids, thereby improving quality of life. Despite the success of Cls, there remains wide variability in performance related to both patient and treatment factors. Biographical/audiological variables such as age, age at onset, duration, etiology, and severity of hearing loss as well as duration of hearing aid and Cl use together with surgical factors have long been used to predict speech perception performance. These variables account for only 10-20% of the variability in speech perception test scores in quiet, implying they are poor biomarkers of auditory system suitability for Cl stimulation. Recent studies demonstrate that Cl performance in background noise is worse in the elderly, in part, related to age-dependent central processing differences. We propose that in adult Cl candidates, accurate assessment of both the cochlear-neural and central auditory substrates can predict performance. Predicting performance has relevance to patient counseling and shared decision making (between clinician and patient), design and recommendations for auditory rehabilitation, consideration for device mapping and troubleshooting, and patient stratification in future clinical trials. Electrocochleography (ECochG) is an acoustically-evoked electrophysiological method to assess the cochlear-neural substrate; responses are present in >95% of Cl recipients, and can account for up to ~50% of open set speech perception scores in quiet. However, the ECochG-total response (ECochG-TR), is necessary but not sufficient to predict speech perception in noise. Adding a preoperative cognitive screener to ECochG-TR improves the prediction model (ΔR2=0.26; R2mode1=0.60). Thus, a good cochlear-neural substrate and cognitive function are both needed for speech understanding in noise. We will use biographical/audiological variables together with preoperative, transtympanic (ttECochG) and/or intraoperative (iECochG) ECochG and surgical factors, to develop clinically useful preoperative and/or postoperative (pre-activation) speech perception prediction models. Aim 1: Determine if preoperative ttECochG-TR is a valid measure of cochlear-neural substrate integrity as it relates to Cl stimulation, compared to the validated iECochG-TR. To this end, we will determine the strength of correlation between ttECochG and: (1a) iECochG-TR and (1 b) implant ear speech perception measures in quiet (6-month). Aim 2: Develop prediction models for implant ear speech perception scores in noise (Primary) and quiet (Secondary) after 6 months of Cl use. Models will include baseline demographic/audiologic variables, cognitive measures plus: (2a) Preoperative ttECochG-TR in the clinic; (2b) Postoperative (pre-activation) iECochG-TR and surgical factors from post-implant CT imaging. Aim 3: Establish the generalizability (external validation) of the prediction models in a geographically separate location (Vanderbilt University) from Washington University in St. Louis as patient and surgical factors can vary across sites.