语前聋儿童人工耳蜗植入术后听觉表现及言语可懂度变化特点分析

Characteristics of Auditory Performance and Speech Intelligibility in Prelingually Hearing-impaired Children after Cochlear Implantation

目的通过对15例语前聋人工耳蜗植入患儿术后3年的听觉及言语能力进行评估，总结其发育规律，分析各可能因素在人工耳蜗植入术后听觉及言语康复过程中的作用。方法通过问卷调查的方式对15例语前聋人工耳蜗植入患者的各项可能影响因素进行统计，并在开机后1、3、6，12、18，24、30、36个月运用听觉行为分级标准（categories of auditoryperformance，CAP）和言语可懂度分级标准（speech intelligibility rating，SIR）对患儿的听觉及言语能力进行评估，并对影响术后康复效果的相关因素进行二元变量的相关分析。结果患儿开机后12个月内，CAP及SIR得分与术后康复时间正相关（rCAP=0．884，rSIR=0．873，P〈0．05），个体间差异较大；开机12个月后，个体间差异减小。术前助听听阂（r=0．234，P〈0．05）、术前康复时间（r=O．736，P〈0．05）与CAP分级显著相关，术后人工耳蜗植入对侧耳配戴助听器与SIR分级显著相关（r=O．201，P〈O．05）。结论语前聋患儿人工耳蜗植入后听觉及言语能力发育呈先快后慢趋势，术后1年内显著提高，术前助听听阈低、康复时间长的患儿术后听觉发育较好，术后人工耳蜗植入对侧耳配戴助听器有助于言语发育。

Objective To evaluate the auditory and speech performance of 15 prelingually hearing-impaired children with cochlear implants within 3 years after surgery, to summarize the development rules of auditory and speech abilities and to analyze the role of relevant factors in hearing and speech rehabilitation. Methods A total of 15 children with prelingually profound hearing loss participated in this study. The categories of auditory performance （CAP） and speech intelligibility rating （SIR） were used to evaluate these children 1 month, 3 months, 6 months, 12 months, 18 months, 24 months,30 months and 36 months after cochlear implantation. Correlation analysis was used to analyze the effects of relevant factors on the CAP or SIR scores. Results The results showed a significant positive correlation between CAP and SIR scores and postoperative time（rcnp=0.884, rS]R=0.873, P〈0.05）. Significant differences were observed in CAP and SIR scores among individuals within 1 year after surgery, but reduced 12 months after surgery. There was a significant correlation between CAP scores and preoperative aided thresholds （r---0.234,P〈0.05） and preoperative rehabilitation time（r=0.736,P〈0.05）. There was a significant correlation between SIR scores and postoperative aided hearing mode （whether to use a hearing aid in the non-implanted ear）（r=0.201, P〈0.05）. Conclusion There is significant improvement in auditory and speech performance of children with prelingually profound hearing loss within the first year after cochlear implantation. The children with better aided thresholds and longer preoperative rehabilitation time will obtain better auditory abilities, and the children who use a hearing aid in the non-implanted ear will obtain better speech abilities.