老年听障患者人工耳蜗植入临床问题探讨（Ⅰ）——术前决策与围手术期关键问题

林以鹏; 高珊仙; 张丽娜; 刘天翊; 梁爽; 梁巍; 银力

doi:10.3969/j.issn.1672-4933.2026.04.022

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老年听障患者人工耳蜗植入临床问题探讨（Ⅰ）——术前决策与围手术期关键问题

继续教育 | 更新时间：2026-09-22

- 老年听障患者人工耳蜗植入临床问题探讨（Ⅰ）——术前决策与围手术期关键问题
- Clinical Issues in Cochlear Implantation for Elderly Patients With Hearing Loss (Part I): Preoperative Decision-Making and Key Perioperative Considerations
- 中国听力语言康复科学杂志 2026年24卷第4期页码：440-448
- 作者机构：
  
  1.东南大学生物科学与医学工程学院南京 210000
  2.浙江诺尔康神经电子科技股份有限公司杭州 311100
  3.全省智能康复与神经电子转化重点实验室杭州 311100
  4.杭州市余杭区启航公益服务中心杭州 311100
  5.中国听力语言康复研究中心北京 100029
  6.杭州未来科技城医院杭州 311100
- 作者简介：
  
  林以鹏博士工程师；研究方向：人工耳蜗应用
  银力，E-mail： yinli@nurotron.com
- 基金信息：
  
  全省智能康复与神经电子转化重点实验室(2024E10108)
- DOI：10.3969/j.issn.1672-4933.2026.04.022
  中图分类号： R764.5
- 收稿：2026-04-30，
  
  修回：2026-05-22，
  
  录用：2026-06-30，
  
  纸质出版：2026-07-15
- 稿件说明：
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林以鹏,高珊仙,张丽娜等.老年听障患者人工耳蜗植入临床问题探讨（Ⅰ）——术前决策与围手术期关键问题[J].中国听力语言康复科学杂志,2026,24(04):440-448.

LIN Yi-peng,GAO Shan-xian,ZHANG Li-na,et al.Clinical Issues in Cochlear Implantation for Elderly Patients With Hearing Loss (Part I): Preoperative Decision-Making and Key Perioperative Considerations[J].Chinese Scientific Journal of Hearing and Speech Rehabilitation,2026,24(04):440-448.
林以鹏,高珊仙,张丽娜等.老年听障患者人工耳蜗植入临床问题探讨（Ⅰ）——术前决策与围手术期关键问题[J].中国听力语言康复科学杂志,2026,24(04):440-448. DOI： 10.3969/j.issn.1672-4933.2026.04.022.

LIN Yi-peng,GAO Shan-xian,ZHANG Li-na,et al.Clinical Issues in Cochlear Implantation for Elderly Patients With Hearing Loss (Part I): Preoperative Decision-Making and Key Perioperative Considerations[J].Chinese Scientific Journal of Hearing and Speech Rehabilitation,2026,24(04):440-448. DOI： 10.3969/j.issn.1672-4933.2026.04.022.

摘要

随着人口老龄化进程的加快，老年性听力损失患病率持续上升，部分患者进展为重度至极重度听力障碍，成为人工耳蜗植入的候选人群。相较于儿童及中青年患者，老年患者在病因构成、全身功能储备、合并基础疾病、听觉剥夺时长及术后康复依从性等方面具有特殊性，使其在术前决策及围手术期管理中面临更多挑战。本文结合临床实践与相关研究，围绕老年听障患者人工耳蜗植入过程中的关键临床问题进行系统梳理，内容包括耳聋病因与危害、植入动机、期望管理、经济负担、前庭功能评估、不同听力损失类型下的植入策略、麻醉方式选择及植入体区皮瓣处理等。笔者强调，老年患者术前评估不应仅以年龄作为判断依据，应关注听障持续时间，尤其是重度至极重度听力损失持续时间对术后言语识别和听觉适应的影响。随着人工耳蜗适应证的拓展，单侧听障和非对称性听力损失患者的适应证、术后双耳听觉适应及康复依从性亦需重视；对于双侧重度至极重度感音神经性听力障碍患者应充分评估单侧植入后可能存在的听觉疲劳及双侧植入在声源定位、噪声下言语识别和降低聆听负荷方面的潜在优势。总体而言，老年人工耳蜗植入应基于个体化评估，综合权衡听觉获益、手术风险、前庭功能、经济条件及康复支持，制订合理的方案。加强术前沟通、优化期望管理及规范围手术期处理，有助于提高患者的依从性和长期获益。本文旨在为老年人工耳蜗植入的临床决策及全流程管理提供参考。

Abstract

With the acceleration of population aging

the prevalence of age-related hearing loss is increasing

and a proportion of elderly patients progress to severe-to-profound hearing impairment

becoming potential candidates for cochlear implantation. Compared with chilren and younger adults

elderly patients present unique characteristics in disease etiology

physiological reserve

comorbidities

duration of auditory deprivation

and postoperative rehabilitation adherence

which pose additional challenges for preoperative decision-making and perioperative management. This review systematically summarizes key clinical issues in cochlear implantation for elderly patients with hearing loss

including the causes and consequences of hearing loss

implantation motivation and expectation management

economic burden

vestibular function assessment

implantation strategies for different types of hearing loss

anesthesia selection

and flap management at the implant site. This review emphasizes that preoperative assessment in elderly patients should not be based on age alone

but should also consider the duration of deafness

especially the duration of severe-to-profound hearing loss

and its influence on postoperative speech recognition and auditory adaptation. With the expansion of cochlear implantation indications

the indications

postoperative binaural adaptation

and rehabilitation adherence of patients with single-sided deafness and asymmetric hearing loss also warrant attention. For patients with bilateral severe-to-profound sensorineural hearing loss

potential listening fatigue after unilateral implantation and the potential advantages of bilateral implantation in sound localization

speech recognition in noise

and reduction of listening effort should be fully evaluated. Overall

cochlear implantation in elderly patients should be based on individualized assessment

with comprehensive consideration of auditory benefits

surgical risks

vestibular function

economic factors

and rehabilitation support to formulate an appropriate implantation strategy. Strengthening preoperative counseling

optimizing expectation management

and standardizing perioperative care may improve patient adherence and long-term benefit.This review aims to provide a reference for clinical decision-making and comprehensive management of cochlear implantation in elderly patients.

关键词

Keywords

references

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