人工耳蜗植入年龄对患儿听觉言语变化规律的影响

Effects of Age at Cochlear Implantation on Hearing and Speech Development in Children

目的 探究双耳重度感音神经聋(sensorineural hearing loss,SNHL)患儿人工耳蜗植入(cochlear implantation,CI)后听觉言语变化规律及影响因素。方法 前瞻性选取2018年1月至2021年6月于河南科技大学第二附属医院耳鼻咽喉科行单侧CI治疗的患儿216例,符合纳入、排除标准203例,人工耳蜗开机后漏诊32例,最终纳入171例。R软件spline函数拟合术后24个月听觉能力轨迹;多变量线性混合回归模型动态分析影响听能发育的协变量;Cox模型明确年龄与听能发育的关联性;E值法行敏感性检验;Spearman秩相关分析年龄与语言交流相关性。结果 CI植入后患儿语前听能恢复轨迹为Y=16.14+10.89X-0.54X2+0.01X3(0≤X≤24)。CI植入前协变量为听阈、语言模仿能力和术前佩戴助听器,CI植入后6~12月协变量为语言模仿能力和术后佩戴助听器,CI植入后24月协变量为术后佩戴助听器和语训时长。经Cox模型调整后,植入年龄与听能发育程度存在显著负关联效应(HR=2.07,95%CI:1.81~2.30)。在CI植入后3~24月,患儿轮流交流能力、主动交流能力、视觉交流能力和听觉注意力逐步提高,并与年龄呈负相关性。结论 CI植入年龄越早SNHL患儿术后听觉言语发育越好,早发现早治疗是提高患儿术后听力恢复、语言发展的重要措施。

Objective To report the pattern of auditory-verbal changes after cochlear implantation (CI) in children with sensorineural hearing loss (SNHL) and influencing factors.Methods Children with SSNHL who underwent unilat‐eral CI in our hospital from January 2018 to June 2021 (n=171) were selected.The spline function was fitted to the tra‐jectory of postoperative auditory ability at 24 months using the Rsoftware.Multivariate linear mixed regression models were used to dynamically analyze covariates affecting auditory ability development.Multifactorial Cox modeling was used to clarify the association between age and auditory development.Sensitivity tests were performed using the E-val‐ue method.Age and verbal communication correlations were analyzed by Spearman's rank correlation.Results The tra‐jectory of prespeech auditory recovery in children after CI implantation was Y=16.14+10.89X-0.54X2+0.01X3 (0≤X≤24).The pre-CI implantation covariates were hearing thresholds,speech imitation ability and use of hearing aids.The post-CI implantation covariates were speech imitation and postoperative use of hearing aids at 6 to 12 months,and post‐operative use of hearing aids and time of speech training at 24 months.After adjustment for Cox modeling,there was a significant negative association between age at implantation and auditory development (HR=2.07,95%CI:1.81-2.30).Between 3 and 24 months after CI implantation,active communication skills and auditory attention gradually improved and were negatively correlated with age.Conclusion The earlier the age of CI implantation,the better the postoperative auditory and speech development for children with SNHL.Early detection and intervention are important to improve post-CI hearing recovery and language development in children.