双侧先天性外耳道闭锁婴幼儿佩戴软带BAHA的疗效分析

Efficacy of BAHA softband in young children with bilateral congenital aural atresia

目的 回顾性分析佩戴软带骨锚式助听器（BAHA）对双侧先天性外耳道闭锁、耳廓畸形的婴幼儿听觉及言语发育的影响.方法 2010年8月至2013年1月在北京协和医院耳鼻咽喉科就诊的双侧先天性外耳道闭锁、耳廓畸形婴幼儿12例（年龄3个月至7岁）,佩戴软带BAHA.根据患儿开始佩戴的年龄分为＜4岁组（7例,平均年龄1岁2个月）和≥4岁组（5例,平均年龄6岁5个月）.＜4岁组患儿通过听性脑干反应（ABR）测试其裸耳骨、气导听阈;通过婴幼儿有意义听觉整合量表（IT-MAIS）评估其早期听能发育.≥4岁组通过声场下的纯音测听测试其裸耳及佩戴软带BAHA后的平均听阈;在声场70 dB SPL给声强度下通过中文普通话版儿童词汇相邻性词表（LNT）测试其佩戴前、佩戴当日、佩戴6、12、24个月言语识别率（SDS）.结果 ＜4岁组患儿裸耳ABR气导听阈范围70～90 dB nHL,平均（73±12）dB nHL,骨导听阈范围15～25 dB nHL,平均（21±4）dB nHL.在佩戴软带BAHA 6个月时IT-MAIS得分与佩戴前比较差异有统计学意义（P〈0.05）.≥4岁组患儿裸耳声场下纯音测听平均听阈（63±6）dB HL,佩戴软带BAHA后平均听阈（31±4）dB HL.佩戴软带BAHA后患儿听阈较裸耳平均下降（32±3）dB HL.用LNT测试佩戴当日、6、12个月的言语识别率与佩戴前比较差异均有统计学意义（均P＜0.05）.结论 双侧先天性外耳道闭锁婴幼儿佩戴软带BAHA能够有效提高听力.早期佩戴软带BAHA有助于婴幼儿的听能及言语发育,随着佩戴时间的延长,言语发育水平逐渐接近健听婴幼儿.

Objective To retrospectively analyze the auditory and speech development of young children with bilateral congenital aural atresia after using bone-anchored hearing aid （BAHA） softband. Methods From August 2010 to January 2013, a total of 12 patients aged at a range of 3 months to 6 years with bilateral aural atresia using BAHA softband were divided into under 4-year-old group （ n = 7, an average age of 14 months） and over 4-year-old group （n = 5, an average age of 77 months）. The air and bone auditory thresholds of the under 4-year-old group were assessed by auditory brainstem response （ABR）. The Infant-Toddler Meaningful Auditory Integration Scale （IT-MAIS） was used to evaluate early auditory development. Soundfield pure tone audiometry （PTA） was applied in the over 4-year-old group. The Standard Chinese lexical neighborhood test （LNT） was conducted to evaluate the speech discrimination scores unaided and aided for 6,12 and 24 months. Results For the under 4-year-old group, the unaided air and bone conduction hearing thresholds were 70 - 90 （73 ± 12 ） and 15 - 25 （ 21 ± 4） dB nHL respectively. IT-MAIS score improved significantly after using softband for 6 months in comparisons with unaided situations. The average hearing threshold of patients in the over 4-year-old group was （63 ± 6 ）dB HL unaided versus （31 ± 4） dB HL aided. The average decline in pure-tone threshold was （ 32 ± 3 ） dB HL with BAHA softbands and LNT demonstrated improvements in the speech discrimination score. The differences of paired comparison were significant （ all P 〈 0. 05 ）. Conclusions The hearing ability of children with bilateral congenital aural atresia improves significantly after using BAHA softband. And its application at a young age can guarantee a relatively normal hearing development and avoid oral communication impairment.