单侧人工耳蜗植入学龄前耳聋儿童听觉言语康复效果影响因素分析

The Infulence of Factors on Auditory and Speech Performances in Preschool Children with Unilateral Cochlear Implantation

目的探讨学龄前耳聋儿童单侧人工耳蜗植入（cochlear implantation,CI）后早期康复效果的影响因素。方法对行单侧人工耳蜗植入术且在听觉言语康复机构按照中国残联聋康中心标准进行听觉言语康复1年以上的165例双耳极重度感音神经性聋患儿进行听觉行为分级（categories of auditory performance,CAP）、言语可懂度分级（speech intelligibility rating,SIR）评估,分析性别、植入年龄、基因突变类型、助听器佩戴经验以及内耳畸形与康复效果的关系。结果经过多因素回归分析,植入年龄、基因突变与CI儿童的CAP、SIR得分增长相关（P〈0.05）,而性别、助听器佩戴史及内耳畸形（大前庭水管综合症）与CAP、SIR得分增长无关（P〈0.05）。1~3岁组CAP提高速度最快,2、3、4岁组SIR增长速度最快;GJB2基因突变致聋的CI儿童康复12个月后的CAP、SIR得分均高于非GIB2突变者。结论植入年龄为1~3岁者早期听觉康复速度较快,植入年龄为2~4岁者早期言语能力发育速度较快;GJB2突变致聋的儿童人工耳蜗植入后听觉言语康复效果更优;大前庭水管综合症患儿人工耳蜗植入效果与非大前庭水管患儿相同。

Objective To investigate the affecting factors on auditory and speech performances in preschool children with unilateral cochlear implantation（CI）.Methods The clinical data of the preschool children（n=165）with unilateral cochlear implantation in the Second Xiangya hospital from January 2006 to April 2013 were collected.These children received rehabilitation according to the method recommended by the China Rehabilitation Research Center for Deaf Children,and the data were analyzed retrospectively.The categories of auditory performance（CAP）and speech intelligibility rating（SIR）were used to assess their auditory and speech performances.The relationships between the performance and gender,implanted age,genotype,inner ear malformation,history of hearing aid were evaluated.Results Implanted ages and genotypes were associated with the auditory and speech performance of participants（P〈0.05）,while genders,hearing aid experience,and inner ear malformations（enlarged vestibular aqueduct syndrome,EVAS）were not significant related（P〈0.05）.Children were found to have achieved better CAP and SIR growths when CI was implanted during 1~3years old and 2~4years old,respectively（P〈0.05）.The outcomes of CI recipients with GJB2 mutation were significantly better than those of the GJB2-nonrelated CI recipients（P〈0.05）.Conclusion This study provides evidence that CIs during first 1~3years old having better auditory rehabilitation results than those of during 4~6years old,and CIs during 2~4years old obtaining a better speech development in the first 12 months after operation.Deaf children with GJB2 mutation show better auditory and speech performances after CIs than those of the peers without GJB2 mutation.CIs can be effectively performed in deaf children associated with EVAs as in those without EVAS.