Effectiveness Of Auditory Neuropathy Spectrum Disorder Children Following Cochlear Implantation Systematic Review And A Meta-analysis

Objective：To assess the clinical effectiveness of auditory neuropathy spectrum disorderChildren following cochlear implantation.Methods：Cochrane library、 CDSR、 MEDLINE(1999.01-2014.03)、 Pubmed ClinicalQueries、ScienceDirect、CBM（1999.01-2014.03) and CNKI(1999.01-2014.03）database have been searched,Only including English and Chinese related literatures.Collecting non-randomized clinical studies about which speech perception level wereregularly tested during follow-up times for the auditory neuropathy spectrum disorderchildren who had followed cochlear implantation more than six months. Twoindependently assessed the methodological quality of studies and extracted data andchecked one another. Disagreement was resolved by discussion or the third person.Revman5.2had been used for meta-analysis.Results：There were8non-randomized control studies met our inclusion criteria，including145children in auditory neuropathy spectrum disorder group and153children in severe to profound sensorineural hearing loss group. And results of128children were involved in meta-analysis. All trials were of lower methodologicalquality.1)Comparing SRTs: one study demonstrated that there were no significant differences in average speech recognition thresholds in quiet and noise in childrenwith ANSD compared to children with severe to profound SNHL.2)Comparing speech recognition sore：Three studies including98childrenwere involved in meta-analysis，there are51and47samples in ANSD group andSNHL group separately. The fixed effect model and random effect model bothsuggested that there were no significant differences in speech recognition sore in twogroups.[MD=-3.99，95%CI（-1.86，9.84），Z=1.34，P=0.18].The homogeneity wasgood（I2=0%).3)Comparing CAP grade: Two studies including49children were involved inmeta-analysis，there are17and32samples in ANSD group and SNHL groupseparately. Speech perception test tool all were categories of auditory performancegrade，homogeneity was good，used the fixed effect model，which suggested that therewere no significant differences in speech recognition sore in two groups.(Z=0.35,P=0.72）.Conclusion:There were no significant differences in average speech recognition level inchildren with ANSD compared to children with severe to profound SNHL who hadfollowed cochlear implants after half of year or more. Cochlear implant is theeffective method to ANSD children.Due to the lack of RCT research on this topic, the literature including are notrandomized controlled studies, quality is somewhat low; The limitation of language,may cause the literature selection bias; All research in the experimental stages werenot use the blind method; Verbal test material lack of horizontal comparability; All islimited strength of argument. Clinical work in future, it is necessary for us to:1） Identify the standardization and calibration of the speech perception testmaterial, thus have horizontal and/or vertical (between groups, group, ownbefore-and-after) comparability.2）Use prospective method to design high quality of non-random or randomcontrolled study, long-term follow-up assessment, thus providing goodevidence-based health policy-making basis for guiding.