极重度感音神经性聋佩戴助听器与人工耳蜗植入患儿残余听力的比较分析

Comparison of the residual hearing on the profound hearing-impaired children with the hearing aids and cochlear implants

目的:通过回顾性比较分析极重度感音神经性聋患儿接受佩戴助听器和人工耳蜗植入手术2种不同干预方式人群的听力学评估参数,探讨极重度感音神经性聋患儿有效残余听力的临床判断方法。方法:选取听力学评估和言语康复训练资料完整的22例双耳极重度感音神经性聋患儿,其中10例佩戴助听器并接受超过3个月的言语康复训练,另外12例接受人工耳蜗植入手术,其中有10例年龄区间与佩戴助听器组一致。佩戴助听器组患儿,根据言语康复训练效果分为良好(7例)和较差(3例),分别统计其佩戴助听器前ASSR和听力言语康复训练期间裸耳纯音测听在500、1000、2000、4000Hz4个频点的听阈阈值情况。年龄与佩戴助听器组一致的10例接受人工耳蜗植入术患儿,根据术前有否佩戴助听器情况,分为曾佩戴助听器但听力言语康复效果差者(5例)和未接受佩戴助听器者(5例),分别统计其佩戴助听器前和(或)手术前的ASSR在500、1000、2000、4000Hz4个频点的听阈阈值情况。结果:①ASSR的阈值情况。佩戴助听器且言语康复训练效果良好的7例(14耳)患儿,平均每耳有2.71个频点可引出ASSR反应,所引出的ASSR平均阈值为(110.92±7.43)dBHL;佩戴助听器言语康复训练效果较差的3例患儿,再加上曾佩戴助听器但听力言语康复效果差而接受人工耳蜗植入术的5例,共8例(16耳),平均每耳只有1.06个频点可引出ASSR反应,所引出的ASSR平均阈值为(110.88±8.52)dBHL。②裸耳纯音测听情况。佩戴助听器且言语康复训练效果良好的7例(14耳)患儿,所测频点的平均听阈为(96.11±7.81)dBHL;其中,每耳平均有3个频率点的裸耳纯音测听阈值≤100dBHL。而在效果差的3例(6耳)患儿中,所测频点的平均听阈为(112.19±5.15)dBHL,裸耳纯音测听阈值≤100dBHL耳的数量为0。结论:500、1000、2000、4000Hz各频率引出ASSR的频点数量和裸耳纯音测听阈值≤100dBHL的数量,是临床上判断极重度感音神经性聋患儿有否存在可利用助听残余听力的有效指标。

Objective：To compare the hearing test data of the profound hearing-impaired children with the hearing aids and with cochlear implants; to find out the useful method to measure the residual hearing.Method：Twenty-two profound hearing-impaired children participated in the study with complete set of hearing test and verbal rehabilitation file.Ten children fitted hearing aids and underwent verbal rehabilitation more than 3 months.Among the other 12 children with cochlear implants,10 children fell in the same year range with the hearing aid patients.The children with hearing aids were divided into two groups according to the achievement of the verbal rehabilitation.ASSR threshold and pure-tone threshold were compared between the groups.Result：①ASSR test：7 children （14 ears）with hearing aids achieved good verbal representation,in which ASSR threshold can be recorded on 2.71 frequency on average [（110.92±7.43 ） dB HL].Among 3 children with hearing aids representing poor verbal achievement and 5 children with additional cochlear implant because of the poor verbal achievement with hearing aids,only 1.06 frequency had response of ASSR test [（110.88±8.52 ）dB HL].②Pure tone audiometry：the average threshold of the 7 children with good representation was （96.11±7.81 ）dB HL,and the threshold on 3 frequency were less than 100 dB HL on average.The average threshold of the other 3 children with poor verbal achievement was （112.19±5.15） dB HL,and none of the frequency threshold was ≤100 dB HL.Conclusion：The number of the frequency with the response of ASSR and the threshold ≤100 dB HL of pure tone audiometry is an effective indication of the useful residual hearing.