Supplementary Material for: The Effect of Comorbidities on Cochlear Implantation Outcomes in Adults Under 60

Introduction: Prior studies have demonstrated that comorbid conditions can negatively impact cochlear implantation (CI) outcomes in elderly patients, but few have examined how comorbidities affect younger adult CI recipients. This study examines the relationship between comorbidities and CI outcomes in adults under 60 years old.
Methods: We reviewed all CI recipients between 20 to 60 years old from 2015-2019 at a tertiary academic medical center. Patient data were collected including comorbidities, demographics, etiology, and length of deafness (LOD). Patients’ Charlson Comorbidity Index (CCI) was calculated. The primary outcome was speech perception scores at 1-year on the consonant-nucleus-consonant (CNC) word test.
Results: There were 118 patients who underwent CI (15% 20-29 years, 22% 30-39, 21% 40-49, 42% 50-60), averaging 1.8 comorbidities. Mean LOD was 19.7 years, and most etiologies were unknown (53.4%). 34% had no comorbidities, and the most frequent comorbidities were hypertension (14%), asthma (10%), anxiety (8%), acoustic neuroma (8%), and arthritis (7%). Comorbidity frequency was similar across ages, but cardiovascular comorbidities varied by patient decade (50-60 yrs: 41% vs. 20-49 yrs: 12-22%, p = 0.004). Compared to studies on elderly CI outcomes, our cohort had fewer comorbidities with reduced cardiac events and neurological conditions. We did not find differences in 1-year CNC scores or complications based on the number of comorbidities or any single comorbidity. However, there was a difference in individual improvement in CNC word scores by age group (p = 0.024). Patients’ CCI did not correlate to post-op scores.
Conclusion: Subjects showed improved speech understanding post-CI. The number and type of comorbidities were not meaningful predictors of 1-year speech perception scores, suggesting adult CI users under 60 years with comorbidities can expect comparable outcomes to those without comorbidities.

引言：既往研究已证实，合并症会对老年患者的人工耳蜗植入（cochlear implantation, CI）术后效果产生负面影响，但鲜有研究探讨合并症对年轻成人人工耳蜗植入受者的影响。本研究旨在探究60岁以下成人中，合并症与人工耳蜗植入术后效果之间的关联。
方法：本研究回顾了某三级学术医疗中心2015年至2019年间收治的所有20至60岁人工耳蜗植入受者的临床资料。收集的患者数据涵盖合并症、人口统计学特征、耳聋病因以及耳聋时长（length of deafness, LOD）。研究人员计算了每位患者的查尔森合并症指数（Charlson Comorbidity Index, CCI）。本研究的主要结局指标为术后1年的辅音-元音-辅音（consonant-nucleus-consonant, CNC）词语测试言语识别得分。
结果：本研究共纳入118例行人工耳蜗植入术的患者，其中20~29岁占15%、30~39岁占22%、40~49岁占21%、50~60岁占42%，患者平均合并症数量为1.8种。患者平均耳聋时长为19.7年，多数耳聋病因不明（53.4%）。34%的患者无合并症，最常见的合并症依次为高血压（14%）、哮喘（10%）、焦虑症（8%）、听神经瘤（8%）以及关节炎（7%）。各年龄组的合并症发生率总体相似，但心血管合并症的占比随年龄组存在显著差异（50~60岁组为41%，20~49岁组为12%~22%，p=0.004）。与既往针对老年人工耳蜗植入患者的研究相比，本研究队列的合并症更少，心脏事件及神经系统疾病的占比更低。未观察到术后1年的CNC词语测试得分或并发症发生率与合并症总数或单一合并症存在相关性。不过，不同年龄组的CNC词语测试得分提升幅度存在显著差异（p=0.024）。患者的CCI得分与术后言语识别得分无相关性。
结论：所有受试者在人工耳蜗植入术后的言语理解能力均得到改善。合并症的数量与类型均无法有效预测术后1年的言语识别得分，这提示60岁以下合并症患者接受人工耳蜗植入后，其术后效果与无合并症的患者相当。