听神经发育不良儿童人工耳蜗植入术后听觉言语能力发展规律及特点

Characteristics of the Development on the Auditory and Speech Ability of Cochlear Implantation in Children with Cochlear Nerve Deficiency

目的探讨听神经发育不良(cochlear nerve deficiency,CND)儿童人工耳蜗植入(cochlear implant,CI)术后听觉能力、言语能力的变化特点及发展规律,为此类儿童的诊治和康复提供参考。方法使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(categories of auditory performance,CAP)和言语可懂度分级(speech intelligibility rating,SIR)四个问卷量表,对42例内耳结构正常伴CND的CI儿童(A组)和189例内耳结构正常且听神经发育正常的CI儿童(B组)分别在术前、开机后1、3、6、9、12、24和36个月进行听觉言语能力评估。结果两组患儿4个问卷得分均随着开机时间的延长而逐渐提高,且B组比A组增长趋势明显。IT-MAIS评估结果显示,在开机后6、9个月时两组得分差异有统计学意义(P<0.05);MUSS评估结果显示,在开机后24、36个月时两组得分差异有统计学意义(P<0.05);CAP结果显示,在开机后6、9、12、24个月时两组得分差异有统计学意义(P<0.05);SIR结果显示,在术前(开机)、开机后9、12、24和36个月时两组得分差异有统计学意义(P<0.05)。结论CND儿童人工耳蜗植入术后听觉和言语能力均随术后时间的延长呈增长趋势,且发展趋势与听神经发育正常的CI儿童相同,但是发展速度滞后。CND的CI儿童听觉能力在开机后36个月可以接近或达到听神经发育正常的CI儿童,但言语能力与听神经发育正常CI儿童仍有较大差距。

Objective To evaluate the auditory and speech ability of cochlear implantation(CI)in children with cochlear nerve deficiency(CND),and compare the similarities and difference on the auditory and speech ability between CI children with CND and CI children with normal cochlear nerve.Methods The subjects were divided into two groups:group A with CND and normal inner ear structure(n=42),group B with normal cochlear never and normal inner ear structure(n=189).Their auditory and speech abilities were estimated at different time points after switch-on(0th,1st,3rd,6th,9th,12th,24th and 36th 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.Results The four questionnaire scores of the two groups enhanced gradually with increase in CI usage duration.The increase trend of group B was more obvious than that of group A.For the IT-MAIS scores of the two groups,there was a significant difference at 6 month and 9 month after switch-on(P<0.05).For the MUSS scores of the two groups,there was a significant difference at 24 month and 36 month after switch-on(P<0.05).For the CAP scores of the two groups,there was a significant difference at 6 month,9 month,12 month and 24 month after switch-on(P<0.05).For the SIR scores of the two groups,there was a significant difference at 0 month,9 month,12 month,24 month and 36 month after switch-on(P<0.05).Conclusion The auditory and speech ability of CI children with CND enhanced gradually with increase in CI usage duragion.CI children with CND had delayed but similar development tread of auditory and speech abilities,compared to those with normal cochlear nerve.The auditory ability of the CI children with CND was similar to those with normal cochlear never at 36 month after switch-on,but there was still a gap in speech ability.Cochlear implantation could improve the auditory and speech ability of children with cochlear nerve deficiency.