同龄接受助听器或人工耳蜗干预的极重度聋患儿早期语前听能发育规律的对比研究

Comparative study on the EPLAD of profoundly deaf children with hearing aid fittings or cochlear implantations at the same age

目的:比较同龄接受助听器(HA)验配或人工耳蜗植入(CI)的极重度聋患儿早期语前听能发育(EPLAD)规律,从而为听损患儿的康复工作以及咨询指导提供较好的临床依据。方法:采用纵向研究方法,纳入2岁时接受HA验配或CI的104例极重度聋患儿,分为CI组和HA组。使用婴幼儿有意义听觉整合量表(IT-MAIS)评估其在接受干预后3、6及12个月时的EPLAD情况,评估期间允许失访1次。结果:2组患儿的IT-MAIS得分均随着佩戴时间的增加而提高。CI组在开机后3、6和12个月时的IT-MAIS得分均差异有统计学意义(P=0.000);而HA组仅在验配后3个月和12个月时的IT-MAIS得分差异有统计学意义(P=0.042)。2组患儿的IT-MAIS得分分别在开机/验配后6个月和12个月时差异有统计学意义(P=0.026、0.005)。另外,CI组患儿在开机后12个月时的IT-MAIS平均得分接近于未助听轻度听损同龄患儿的平均水平。而HA组患儿在验配后12个月时的IT-MAIS平均得分接近未助听中度听损同龄患儿的平均水平。结论:CI和HA均能够较好地帮助极重度聋患儿早期语前听能的发育。相较于HA,CI能够更好地帮助极重度聋患儿提升其早期语前听能水平。通过与健听儿童、未助听弱听患儿比较,也为弱听患儿的康复工作以及咨询指导提供了更全面的临床依据。

Objective:The purpose of the current study was to provide good clinical values for rehabilitation exercises and counseling of hearing impaired children by comparing the early prelingual auditory development(EPLAD)of children with hearing aid fittings or cochlear implantations at the same age.Method:Longitudinal evaluation of EPLAD,profoundly deaf children,who received hearing aid fittings or cochlear implantations at 2 years of age,were recruited in this study,and would be tested with Infant-toddler meaningful auditory integration scale(IT-MAIS)at 3,6 and 12 months after intervention.One hundred and four children were recruited in this study and divided into two groups based on the types of devices:Cochlear implant group(CI group)and Hearing aid group(HA group).Each child could be permitted to miss follow-up one time.Result:The IT-MAIS scores of children in both groups improved with increasing wear time.The scores in CI group showed a statistically significant improvement between each interval after switch-on(P=0.000).However,there was just a statistical difference between overall scores at 3 and 12 months after fitting in HA group(P=0.042).In addition,the IT-MAIS scores of the two groups were statistically significant at 6 and 12 months after switch-on/fitting(P=0.026,P=0.005).Simultaneously,the mean overall score of children in CI group at 12 months after switch-on approached the average level of unaided peers with mild hearing loss.However,the mean score at 12 months after fitting was close to the average level of unaided peers with moderate hearing loss.Conclusion:Both of CI and HA could improve EPLAD of profoundly deaf children.However,the EPLAD of CI children could improve faster in the first year after switch-on.And the results would also provide more comprehensive clinical values for rehabilitation and counseling of hearing impaired children by comparing to normal and unaided hearing impaired children.