双模式干预对婴幼儿单侧人工耳蜗植入后早期听觉言语发育的影响

Effects of bimodal intervention on the development of auditory and speech ability in infants with unilateral cochlear implantation

目的探讨双模式干预对婴幼儿单侧人工耳蜗植入（cochlear implantation，CI）后早期听觉言语发育的影响。方法选取单侧人工耳蜗植入患儿35例，植入时年龄0.7～2.8岁，平均（1.6±0.6）岁。根据非植入耳是否佩戴助听器（hearing aids，HA）分为两组：CI＋HA组20例，一侧人工耳蜗植入，对侧佩戴助听器；单CI组15例，仅单侧植入人工耳蜗。采用婴幼儿有意义听觉整合量表（Infant Toddler－ Meaningful Auditory Integration Scale, IT－MAIS）、有意义使用言语量表（Meaningful Use of Speech Scale, MUSS）、听觉能力分级（Categoriesof Auditory Performance, CAP）和言语可懂度分级（Speech Intelligibility Rating, SIR）四个问卷分别评估两组患儿在开机后0、0.5、1、3、6、12、18及24个月时的得分情况，采用SPSS 19.0软件重复测量方差分析法比较两组患儿各个量表的得分差异。结果两组患儿4个量表得分均随着开机时间的延长而逐渐提高。开机后0、0.5、1、3、6、12及18个月，CI＋HA组患儿IT－MAIS量表得分均高于单CI组，其中开机后0.5、1、3、6及12个月，组间差异具有统计学意义（P值均〈0.05）。在评估的各个阶段，CI＋HA组CAP量表得分均高于单CI组，其中开机3、6、12、18及24个月时组间差异具有统计学意义（P值均〈0.05）。在开机1个月之后的各评估时间点，CI＋HA组MUSS量表得分均高于单CI组，其中开机12、18及24个月时组间差异有统计学意义（P值均〈0.05）。在开机3个月之后的各评估时间点，CI＋HA组SIR得分均高于单CI组，其中开机12、18及24个月时组间差异有统计学意义（P值均〈0.05）。结论单侧植入人工耳蜗后，对侧同时使用助听器有助于患儿早期听觉言语发育，建议单侧人工耳蜗植入术后，非植入耳同时使用助听器。

ObjectiveTo explore the effects of bimodal intervention on the development of auditory and speech ability in the infants with unilateral cochlear implantation（CI）.MethodsTotal 35 bilateral profound sensorineural hearing loss infants with unilateral CI, aged 0.7 to 2.8 years old, were selected. The subjects were divided into two groups： the group with unilateral CI（cochlear implant alone, n= 15）, and the bimodal group with CI and contralateral fitting hearing aid（n= 20）. Their auditory and speech abilities were estimated at the different time points after switch-on（the 0th, 0.5th, 1st, 3rd, 6th, 12th, 18th, and 24th month, respectively） using Infant Toddler-Meaningful Auditory Integration Scale（IT-MAIS）, Meaningful Use of Speech Scale（MUSS）, Categories of Auditory Performance（CAP）, and Speech Intelligibility Rating（SIR） scores.ResultsThe IT-MAIS scores of bimodal group after switch-on were higher than unilateral CI group（the 0.5th, 1st, 3rd, 6th, 12th, and 18th month）, the statistical significances were identified at the 0.5th, 1st, 3rd, 6th, and 12th month, respectively（P〈0.05）. The CAP scores of bimodal group before CI operation and after switch-on（the 0.5th, 1st, 3rd, 6th, 12th, 18th and 24th month）were higher than unilateral CI group, the statistical significances were seen at the 3rd, 6th, 12th, 18th and 24th month after switch-on（P〈0.05）. The MUSS scores of bimodal group after switch-on were higher than unilateral CI group（the 1st, 3rd, 6th, 12th, 18th and 24th month）, the statistical significances were found at the 12th, 18th and 24th month, respectively（P〈0.05）. The SIR scores of bimodal group after switch-on were higher than unilateral CI group（the 3rd, 6th, 12th, 18th and 24th month）, and significant differences appeared at the 12th, 18th and 24th month after switch-on（P〈0.05）.ConclusionBimodal intervention could be helpful to the development of auditory and speech ability of infants.