人工耳蜗植入是一种治疗选择,深刻的,或中度倾斜至重度双侧感音神经性听力损失(SNHL),很少或根本没有受益于助听器;然而,成人人工耳蜗植入仍然不是常规的。
为了达成关于成人单侧人工耳蜗植入的共识声明,深刻的,或中度倾斜至深双侧SNHL。
本研究是一个改良的Delphi共识过程,是通过对文献和临床专业知识的系统回顾得出的。在以下数据库中进行了搜索:(1)MEDLINE过程中和其他非索引引文和OvidMEDLINE,(2)Embase,(3)Cochrane图书馆。使用确定的证据制定了关于人工耳蜗植入的共识声明。这一共识过程与成人单侧人工耳蜗植入的使用有关,深刻的,或中度倾斜至深双侧SNHL。文献检索于2018年7月18日进行,并在随后的9个月期间进行了3步Delphi共识法,直至2019年3月30日。
由30名国际专家组成的德尔福共识小组就关于人工耳蜗植入的共识声明进行了投票,由SR告知文献和临床专业知识。这次投票产生了20个基于证据的共识声明,符合临床经验。使用改进的3步Delphi共识方法对共识声明进行投票和完善。这种方法包括两轮电子邮件问卷和最后一轮小组成员的面对面会议。审查了所有共识声明,讨论,并在面对面会议上定稿。
总共,在电子数据库的搜索中确定了6492篇文章。删除重复的文章后,74篇文章符合所有纳入标准,并被用来创建20个基于证据的共识声明。关于在SNHL成人中使用单侧人工耳蜗植入的这20个共识声明与以下7个关键领域相关:人工耳蜗植入的意识水平(1个共识声明);从诊断到手术的最佳实践临床路径(3个共识声明);手术的最佳实践指南(2个共识声明);人工耳蜗植入的临床有效性(4个共识声明);与植入后结果相关的因素(4个共识声明);抑郁与听力损失之间认知,和痴呆症(5个共识声明);和人工耳蜗植入的成本影响(1个共识声明)。
这些共识声明代表了制定SNHL成人人工耳蜗植入最佳实践国际指南的第一步。为儿童单侧人工耳蜗植入制定共识声明的进一步研究,双侧人工耳蜗植入,电-声联合刺激,单侧人工耳蜗植入治疗单侧耳聋,儿童和成人的不对称听力损失可能有利于优化这些患者的听力和生活质量。
Cochlear implants are a treatment option for individuals with severe, profound, or moderate sloping to profound bilateral sensorineural hearing loss (SNHL) who receive little or no benefit from hearing aids; however, cochlear implantation in adults is still not routine.
To develop consensus statements regarding the use of unilateral cochlear implants in adults with severe, profound, or moderate sloping to profound bilateral SNHL.
This study was a modified Delphi consensus process that was informed by a systematic
review of the literature and clinical expertise. Searches were conducted in the following databases: (1) MEDLINE In-Process & Other Non-Indexed Citations and Ovid MEDLINE, (2) Embase, and (3) the Cochrane Library. Consensus statements on cochlear implantation were developed using the evidence identified. This consensus process was relevant for the use of unilateral cochlear implantation in adults with severe, profound, or moderate sloping to profound bilateral SNHL. The literature searches were conducted on July 18, 2018, and the 3-step Delphi consensus method took place over the subsequent 9-month period up to March 30, 2019.
A Delphi consensus panel of 30 international specialists voted on consensus statements about cochlear implantation, informed by an SR of the literature and clinical expertise. This vote resulted in 20 evidence-based consensus statements that are in line with clinical experience. A modified 3-step Delphi consensus method was used to vote on and refine the consensus statements. This method consisted of 2 rounds of email questionnaires and a face-to-face meeting of panel members at the final round. All consensus statements were reviewed, discussed, and finalized at the face-to-face meeting.
In total, 6492 articles were identified in the searches of the electronic databases. After removal of duplicate articles, 74 articles fulfilled all of the inclusion criteria and were used to create the 20 evidence-based consensus statements. These 20 consensus statements on the use of unilateral cochlear implantation in adults with SNHL were relevant to the following 7 key areas of interest: level of awareness of cochlear implantation (1 consensus statement); best practice clinical pathway from diagnosis to surgery (3 consensus statements); best practice guidelines for surgery (2 consensus statements); clinical effectiveness of cochlear implantation (4 consensus statements); factors associated with postimplantation outcomes (4 consensus statements); association between hearing loss and depression, cognition, and dementia (5 consensus statements); and cost implications of cochlear implantation (1 consensus statement).
These consensus statements represent the first step toward the development of international guidelines on best practices for cochlear implantation in adults with SNHL. Further research to develop consensus statements for unilateral cochlear implantation in children, bilateral cochlear implantation, combined electric-acoustic stimulation, unilateral cochlear implantation for single-sided deafness, and asymmetrical hearing loss in children and adults may be beneficial for optimizing hearing and quality of life for these patients.