老年人適合植入人工耳蝸嗎

Are the Elderly Indicated for Cochlear Implantation

吳俊良(Jiunn-Liang Wu)

《台灣耳鼻喉頭頸外科雜誌》 41卷1期 (2006/02) Pp. 1-6

https://doi.org/10.6286/2006.41.1.1

摘要

老年人的聽力損傷，會隨著其年齡的增加而加重，進一步對他們日常生活造成衝擊。助聽器固然可幫助大多數的聽障老人，然而還是有為數不少的個案是必須仰賴人工耳蝸才能令其重拾有聲世界。我們考量他們是否適合植入人工耳蝸時，必須關注以下的層面：包括健康狀況、中樞聽覺功能狀況、整體的認知功能、社交層面以及成本效益的考量。
針對以上的考量，我們就必須探究：老年人進行人工耳蝸植入的手術是否和年輕成人一樣安全；他們自人工耳蝸所得到的助益，是否和年輕成人一樣；以及人工耳蝸是否值得他們在金錢上的花費？手術的安全性在現今的醫療水準下，已證實不會增加危險性。而在人工耳蝸的助益上，年齡因素雖然會略微影響了他們術後的語言辨識的能力，但他們還是可以從人工耳蝸在語言辨識上獲得相當大的助益。生活品質的改善也未因年齡因素影響到改善的程度，且較高齡之植入者因原先聽損造成的障礙較大，似乎在術後主觀感覺上所得到的助益有較多的傾向。以客觀的成本效益探討，高齡之植入者也並未比年輕的植入者差。
老年人在面對接受手術與否，是會有更多的考量，他們可能會有其他全身性疾病影響手術的危險性。然除此以外，我們相信罹患雙側極重度聽障的老年人仍是人工耳蝸適合的植入者，年齡的因素似乎不應該單獨成為他們不接受人工耳蝸植入的理由。

關鍵字

老年人 ； 人工耳蝸 ； 適應症

並列摘要

Along with increased age, severe hearing loss among aged people exacerbates problems in their daily life. Hearing aids are the first choice of treatment. However, cochlear implants may provide a hearing solution for some who only obtain limited benefit from a hearing aid. When considering candidacy for cochlear implant in aged persons, some additional issues are of concern. These include medical considerations, central auditory considerations, general cognitive considerations, social considerations and cost-effectiveness.
In order to answer these concerns, we need to establish the safety level, the benefits and the cost-effectiveness of cochlear implantation for these patients at pre-operative assessment.
Reported medical complications include anesthesia risk, wound breakdown and the impact of other illnesses and are no greater than for a normal adult population. Although the post-operative speech recognition performance is not as good as with a normal adult population, the accrued benefits of speech recognition that are obtained are tremendous; this improves the patients daily communication significantly. The improvement in quality-of life is similar to that for a normal adult population. The cost-effectiveness in older adults has also been found to be similar to that of the general adult population.
However, older adults may have higher incidence of systemic disorders that may affect the safety of the operation. Nonetheless, after excluding the possibility of systemic disorders, we believe that elderly patients with bilateral, profound sensorineural hearing loss can be good candidates for cochlear implantation and that they should not be denied cochlear implantation on the basis of age alone.

並列關鍵字

elderly ； cochlear implant ； indication