听障婴幼儿人工耳蜗术后听觉能力发育规律

The Development of Auditories Ability for infants after Cochlear Implantation

目的使用婴幼儿有意义听觉整合量表(infant-toddler meaningful auditory integration scale,IT-MAIS)研究0~3岁听障婴幼儿人工耳蜗植入后听觉能力变化,总结其发育规律,探讨植入年龄对患儿人工耳蜗术后5年内听觉能力发育的影响,为康复提供临床资料。方法共有518例极重度语前聋婴幼儿参加人工耳蜗植入术后为期5年的追踪随访,人工耳蜗植入年龄9~36个月。根据植入年龄将患儿分3组:A组,植入年龄≤12个月(121例);B组,植入年龄13~24个月(277例);C组,植入年龄25~36个月(120例)。分别在术前及术后开机1、2、3、6、9、12、18、24、30、36、42、48、54、60个月由经过培训的听力学专业人员使用IT-MAIS量表对患儿术后的听觉能力、发音能力、察觉能力及理解能力进行评估。结果患儿IT-MAIS总分在术前和术后开机1、2、3、6、9、12、18、24、30个月之间差异有统计学意义(P<0.05),开机36、42、48、54、60个月之间差异无统计学意义(P>0.05);患儿发音能力得分在术前和术后开机1、2、3、6、9、12、18个月之间差异有统计学意义(P<0.05),开机30、36、42、48、54、60个月之间得分无统计学意义;患儿的察觉能力得分在术前和术后开机1、2、3、6、9、12、18、24、30个月之间差异有统计学意义(P<0.05),开机后36、42、48、54、60个月之间差异无统计学意义(P>0.05);患儿的理解能力得分在术前和术后开机1、2、3、6、9、12、18、24、30个月之间差异有统计学意义(P<0.05),开机后36、42、48、54、60个月之间差异无统计学意义(P>0.05)。在术前和术后开机1、2、3、6、9、12、18、24个月时患儿的发音能力、觉察能力和理解能力得分间的差异具有统计学意义(P<0.05),术后开机30、36、42、48、54、60个月时,3种能力间的差异无统计学意义(P>0.05)。A、B、C 3组患儿的IT-MAIS总分在术前和术后开机1个月间差异有统计学意义(P<0.05),而开机2个月以后各评估点间差异均无统计学意义(P>0.05)。结论听障婴幼儿在人工耳蜗植入术后听觉能力随开机时间的延长逐步提高,开机30个月内听觉能力发育有显著增加。植入年龄对3岁以内人工耳蜗植入患儿的术后早期听觉发育影响不显著。

Objective The purpose of the study is to evaluate the auditory performance of infants with cochlear implants,to summarize the development of auditory abilities,investigate the effects of age at cochlear implantation on auditory ability within five years after surgery and provide a reference for their rehabilitation program.Method 518 infants with pre-lingually profound hearing loss participated in the study,ranging in age at cochlear implantation from 9 to 36 months.The infants with cochlear implants were divided into three groups according to their ages at implantation.The infants in Group A were implanted under 12 months of age.The infants in Group B were implanted between 13 and 24 months of age.The infants in Group C were implanted between 25 and 36 months of age.Infant-Toddler Meaningful Auditory Integration Scale(IT-MAIS)was used to evaluate the auditory ability including vocalization behavior,spontaneous alerting to sound and deriving meaning from sound.Result The overall scores of IT-MAIS for infants improved with time after cochlear implantation,and rapidly increased with time in first 30 months after switch-on as a whole.Specifically the score of vocalization behavior rapidly improved with time in 18 months after switch-on.The score of spontaneous alerting to sound and deriving meaning from sound rapidly improved with time in 30 months after switch-on.The difference among the skills of vocalization behavior,spontaneous alerting to sound and deriving meaning from sound was significant in first 24 months after switch-on.Significance was observed in overall scores of IT-MAIS among these three groups in pre-operation and 1 month after switch-on.However,there were no significant differences in other intervals after switch-on.Conclusion The auditory performance of infants developed gradually with the time of switch-on after cochlear implantation,including vocalization behavior,spontaneous alerting to sound and deriving meaning from sound.Most of infants demonstrated rapid improvement in auditory ability within first 30 months after switch-on.The auditory ability for infants within 3 years after cochlear implantation developed rapidly at the early stage regardless of the age of cochlear implantation.