语前聋儿童人工耳蜗植入术后一年内的听觉发展和言语识别

Development of early auditory and speech perception skills within one year after cochlear implantion in prelingual deaf children

目的 探索语前聋儿童人工耳蜗植入术后早期的听觉发展和言语识别,同时探讨现行中文听障儿童听觉和言语识别测试工具的可行性.方法 共有83例重度-极重度语前聋患儿参与本研究,按耳蜗植入手术时的年龄将患儿分为四组：A组（1～2岁）18例、B组（2～3岁）30例、C组（3～4岁）24例、D组（4～5岁）11例.使用婴幼儿/有意义听觉整合量表（Infant-Toddler/ Meaningful Auditory Integration Scale,MAIS/IT-MAIS）问卷,普通话早期言语感知测试（Mandarin Early Speech Perception Test,MESP）、普通话儿童言语能力测试（Mandarin Pediatric Speech Intelligibility Test,MPSI）等闭合式言语识别测试,由经过培训的听力学专业人员对患儿术后的听觉发展和言语识别能力进行评估.分别在术前和开机后3、6、12个月时对各组患儿进行评估,评估人员记录测试结果并采用SPSS19.0软件进行统计学分析.结果 术后早期的听觉发育和言语识别的发展随康复时间延长而逐步提高.各组受试患儿的MAIS/IT-MAIS得分随着康复时间的延长,均呈现相同的增长趋势,组间差异具有统计学意义（F=5.743,P=0.007）.植入年龄3～4岁的C组儿童术前MAIS/IT-MAIS得分即已高于其他各组,在术后各随访节点得分也高于另外三组.术前助听器使用经验多的儿童,其MAIS/IT-MAIS得分也高于未使用助听器或使用经验少的儿童（F=4.947,P=0.000）.MESP测试显示,在植入后1年内,患儿的言语察觉能力始终优先于言语识别能力,但言语识别能力随着人工耳蜗使用时间延长而有明显提高;各亚测试项的难度呈现较明显的渐次增大的层级.MPSI在开机12个月时才仅有约40％的受试儿童能完成安静条件下的测试,且随着语竞比的降低,能完成该测试的儿童的比例显著下降.结论 人工耳蜗植入术后1年,患儿即发展出一定的听力及言语识别能力.中文版IT-MAIS/MAIS、MESP、MPSI是评估植入后儿童早期听觉、言语识别的可用工具。

Objective To investigate the development of early auditory capability and speech perception in the prelingual deaf children after cochlear implantation,and to study the feasibility of currently available Chinese assessment instruments for the evaluation of early auditory skill and speech perception in hearing-impaired children.Methods A total of 83 children with severe-to-profound prelingual hearing impairment participated in this study.Participants were divided into four groups according to the age for surgery：A （1-2 years）,B （2-3 years）,C （3-4 years） and D （4-5years）.The auditory skill and speech perception ability of CI children were evaluated by trained audiologists using the infant-toddler/ meaningful auditory integration scale （IT-MAIS/MAIS） questionnaire,the Mandarin Early Speech Perception （MESP）test and the Mandarin Pediatric Speech Intelligibility （MPSI） test.The questionnaires were used in face to face interviews with the parents or guardians.Each child was assessed before the operation and 3 months,6 months,12 months after switch-on.Results After cochlear implantation,early postoperative auditory development and speech perception gradually improved.All MAIS/IT-MAIS scores showed a similar increasing trend with the rehabilitation duration （F =5.743,P =0.007）.Preoperative and post operative MAIS/IT-MAIS scores of children in age group C （3-4 years） was higher than that of other groups.Children who had longer hearing aid experience before operation demonstrated higher MAIS/IT-MAIS scores than those with little or no hearing aid experience（F =4.947,P =0.000）.The MESP test showed that,children were not able to perceive speech as well as detecting speech signals.However as the duration of CI use increased,speech perception ability also improved substantially.However,only about 40% of the subjects could be evaluated using the most difficult subtest on the MPSI in quiet at 12 months after switch-on.As MCR decreased,the proportion of children who could be tested using the MPSI reduced.Conclusions Within one year after CI,children develop early auditory and speech perception capabilities with time.Chinese versions of the IT-MAIS/MAIS,MESP and MPSI are useful instruments to document early auditory and speech perception skills in children after CI implantation.