儿童人工耳蜗植入年龄下限降至9月龄的启示与应对

Official approval to lower the age of pediatric cochlear implantation to 9 months: inspiration and responses

摘要:

食品与药品管理局(FDA)批准将儿童人工耳蜗植入年龄下限降至9月龄表明：有必要更早地植入人工耳蜗，以收获聋儿植入后更佳的听力、言语和语言康复成效。在低龄婴幼儿中进行人工耳蜗植入，离不开一批训练有素的医护及麻醉团队提供围手术期支持，对诊断、麻醉风险、外科技术、术中测试和术后编程、长期安全等方面提出了更高要求。同时也对婴幼儿听力学诊断、干预和评估带来了挑战。9~24月龄儿童植入人工耳蜗的指征仍为双侧极重度感音神经性听力损失，围绕“先天聋儿植入人工耳蜗的指征和时机”“植入前是否试配助听器”等话题，耳外科专家与听力学专家应携起手来，审慎、稳妥、积极地开展低龄儿童人工耳蜗植入的循证医学研究。

Abstract:

ObjectiveThe Food and Drug Administration (FDA) approved to lower the age of cochlear implantation from 12 months to 9 months for children with bilateral, profound sensorineural hearing loss, indicating that earlier access to a cochlear implant will provide them with the hearing capabilities to develop speech and language at a trajectory similar to their hearing peers. Cochlear implantation in children 12 months of age and younger poses higher requirements on diagnosis, risk management in anesthesia, surgical technique, intraoperative monitoring and postoperative programming, and longterm safety, as well as challenges in the audiological assessment, intervention, and outcome measurement. Thus, welltrained medical and anesthesia teams are required to provide perioperative support.Bilateral, profound sensorineural hearing loss is still the essential indication for cochlear implantation in children 9 to 24 months of age. This paper focusing on the topics such as “indications and timing of cochlear implantation for children with congenital deafness” and “whether to try hearing aids before implantation”,so that otolaryngologists and audiologists should collaborate to conduct evidencebased medical research on cochlear implantation in children younger than 12 months in a deliberate, prudent and proactive manner.