人工耳蜗植入对老年语后聋患者疗效的Meta分析

Meta analysis of clinical efficacy of cochlear implant in elderly patients with postlingual deafness

摘要

目的 评估人工耳蜗植入对老年语后聋患者听力康复以及生活质量的影响。方法 检索2000~2023年PubMed、SinoMed、CNKI、万方、维普数据库，收集老年组(≥60岁)和对照组(<60岁)语后聋人工耳蜗植入术后康复效果的研究，纳入符合标准的文献，提取数据，分别对老年组术前术后、老年组与年轻组对照组进行Meta分析，评估人工耳蜗植入后的听力康复及对生活质量的影响。结果 共14篇文献纳入本研究，并根据不同的分析指标，纳入相应的文献进行Meta分析。老年语后聋患者人工耳蜗植入术后与术前相比，在词识别[SMD=2.20，95%CI(1.73，2.67)]、安静中句子[SMD=1.63，95%CI(1.37，1.89)]、噪音中句子[MD=38.91，95%CI(33.04，44.78)]、听觉行为分级[MD=2.81，95%CI(2.72，2.91)]方面均较术前明显提高，差异均具有统计学意义(P均<0.001)。老年语后聋人工耳蜗植入术后在词识别[SMD=-0.59，95%CI(-0.81，-0.36)]、听觉行为分级[MD=2.81，95%CI(2.72，2.91)]、安静中句子识别[SMD=-0.32，95%CI(-0.57，-0.07)]均低于对照组患者，差异均具有统计学意义(P均<0.05)，而噪音中句子识别[MD=-6.94，95%CI(-14.60，0.71)]和纯音听阈测试[MD=1.35，95%CI(-8.55，11.25)]与对照组患者比较差异无统计学意义。在生活质量方面，老年组格拉斯哥受益量表总分与对照组比较，差异无统计学意义(MD=-3.12，95%CI:-22.89，16.66)。结论 人工耳蜗植入可以改善老年语后聋患者术后听觉能力；在噪音中句子识别和生活质量评分方面，可以获得与年轻患者相似的术后康复效果，但在词识别、安静中句子识别、听觉行为分级等听觉康复方面效果差于低于年轻患者。

Abstract

Objective Evaluate the impact of cochlear implant on hearing rehabilitation and quality of life in elderly patients with postlingual deafness. Methods Search was conducted in the PubMed, SinoMed, CNKI, WanFang data and VIP databases from 2000 to 2023. Studies on the postoperative rehabilitation effects of cochlear implantation in the elderly group (≥60 years old) and the young control group (<60 years old) with postlingual deafness, and last include literature that meets the standards and extract data. After all these steps, Meta analysis was conducted on the elderly group before and after surgery, as well as the elderly group and the year group control group, to evaluate the hearing rehabilitation and its impact on quality of life after cochlear implantation. Results A total of 14 literature were included in this study, and corresponding literature was included for Meta-analysis based on different analysis indicators. After cochlear implantation in elderly patients with postlingual deafness, compared to before surgery, in terms of word recognition rate [SMD=2.20, 95%CI(1.73, 2.67)], sentence recognition rate in quiet environment [SMD=1.63, 95%CI(1.37, 1.89)], sentence recognition rate in noisy environment [MD=38.91, 95%CI(33.04, 44.78)], and auditory performance [MD=2.81, 95%CI(2.72, 2.91)], there were significant improvements compared to preoperative results, and these differences are statistically significant (all P<0.001). The word recognition rate [SMD=-0.59, 95%CI(-0.81, -0.36)], auditory Performance [MD=2.81, 95%CI(2.72, 2.91)] and sentence recognition rate in a quiet environment [SMD=-0.32, 95%CI(-0.57, -0.07)] after cochlear implantation in elderly patients with postlingual deafness were lower than those in the young control group, and the differences were statistically significant (all P<0.05). However, there was no statistically significant difference in sentence recognition rate [MD=-6.94, 95%CI(-14.60, 0.71)] and pure tone hearing threshold test [MD=1.35, 95%CI(-8.55, 11.25)] in noisy environment compared to the control group patients. In terms of quality of life, there was no statistically significant difference in the total score of the Glasgow Benefit Scale [MD=-3.12, 95%CI(-22.89, 16.66, P>0.05)] between the elderly group and the control group. Conclusion Cochlear implantation can improve postoperative hearing ability in elderly patients with postlingual deafness. In terms of sentence recognition and quality of life scoring in noisy environments, similar postoperative rehabilitation effects can be achieved as young patients. However, the effectiveness of aural rehabilitation in terms of word recognition rate, sentence recognition rate in quiet environments, and auditory performance is lower than that of young patients.

关键词

人工耳蜗植入 / 听力康复 / 生活质量 / Meta分析

Key words

Cochlear implant / Aural rehabilitation / Quality of life / Meta analysis

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