成人语前聋人工耳蜗植入者术后康复效果及影响因素

Postoperative rehabilitation effect and influence factors of adult prelingual deafness with cochlear implant

目的探讨自幼听觉补偿不足的语前聋成人患者能否从人工耳蜗中获益以及相关影响因素。方法招募符合纳入标准的语前聋人工耳蜗植入者26例[男性11例,女性15例,手术时年龄(24.5±5.7)岁]以及作为对照组的语后聋人工耳蜗植入者13例[男性5例,女性8例,手术时年龄(42.2±11.4)岁]。客观测试包括佩戴人工耳蜗后的助听听阈和言语识别率测试,主观测试采用《Nijmegen人工耳蜗植入量表》评估受试者聆听相关生活质量。比较语前聋组患者手术前后听觉能力的改变以及与语后聋组术后听觉效果的差别,并以诊断为重度及以上听力损失的年龄、佩戴助听器无效的年龄、人工耳蜗使用时间等作为因素指标,分析其与患者术后言语识别能力的相关性。采用SAS9.4统计软件对数据进行处理分析。结果客观指标方面,语前聋组的言语识别率显著低于语后聋组[(35.4±28.0)%vs(80.9±8.0)%,t=7.67,P<0.001],而助听听阈两组间差异无统计学意义[(34.8±4.0)dB HL vs(33.1±3.7)dB HL,t=1.30,P>0.05]。主观问卷调查显示,语前聋组在高级声音感知、自信心和总均分维度不及语后聋组(P值均<0.05),而其余方面与语后聋组相比差异均无统计学意义(P值均>0.05);语前聋组各维度得分均较术前有显著改善(P值均<0.001)。语前聋组聆听生活质量的改善与言语识别率的提高有中等程度相关性(r=0.51,P=0.008),经回归分析术前佩戴助听器无效的年龄是术后言语识别率的确切影响因素(P<0.001)。结论特定的成人语前聋植入者能够适应人工耳蜗并获得不同程度的听觉收益,相较于客观听力测试结果的改善,植入者主观上感受到更加显著的听觉相关生活质量的提高。术前助听器佩戴无效的年龄是术后康复效果的重要影响因素,需要引起足够的关注。

Objective To investigate whether pre-lingual deafness adult caused by inadequate auditory compensation in childhood can benefit from cochlear implants and the related influencing factors.Methods A total of 26 prelingual deafness as experimental group[11 males and 15 females,the age of operation was(24.5±5.7)years]and 13 postlingual deafness as control group[5 males and 8 females,the age at the time of operation was(42.2±11.4)years]were recruited.Objective assessment included hearing threshold and speech recognition rate tests while wearing cochlear implants.Subjective assessment used Nijmegen Cochlear Implant Questionnaire to assess hearing-related quality of life of subjects.The changes of hearing ability in the prelingual deafness group before and after operation and the differences with the postlingual deafness group were compared,and the correlation between speech recognition ability and the age diagnosed as severe or profound deafness,the age of hearing aid invalid,and duration of wearing cochlear implant were analyzed as factor indicators.All statistical results were analyzed by SAS 9.4 software.Results In terms of objective indicators,the speech recognition rate of pre-lingual deafness was significantly lower than that of post-lingual deafness[(35.4±28.0)%vs(80.9±8.0)%,t=7.67,P<0.001],while there was no statistical difference in hearing threshold between the two groups[(34.8±4.0)dB HL vs(33.1±3.7)dB HL,t=1.30,P>0.05].The indicators in the subjective questionnaire showed that the prelingual deafness group was only weaker in advanced sound perception,confidence and total mean score than the post-lingual deafness group(P<0.05),and there was no significant difference in other aspects(P>0.05),meanwhile,all indicators of the prelingual deafness group were significantly improved compared with the preoperative level(P<0.001).There was a moderate positive correlation between the hearing quality and the speech recognition rate in the prelingual deafness group(r=0.51,P=0.008).The regression analysis showed that the invalid age of hearing aid was the exact influencing factor of speech recognition rate.Conclusions Certain prelingual deaf adults can adapt to cochlear implants and obtain different degrees of auditory assistance.Compared with the improvement of objective auditory ability assessment,the patient who received cochlear implantation gain more improvement in auditory related quality of life subjectively.The ineffective age of preoperative hearing aid is an important factor,which needs to be aroused sufficient preoperative attention.