语前聋儿童人工耳蜗植入术后听觉言语识别能力的发展规律及其影响因素

Development Rules and Influencing Factors of Auditory Speech Recognition in Children with Prelingual Deafness After Cochlear Implantation

目的探讨语前聋儿童人工耳蜗植入(CI)术后听觉及言语识别能力的康复规律及其影响因素。方法选取2019年1月至2020年1月郑州市第三人民医院耳鼻咽喉头颈外科收治的83例重度或极重度感音神经性耳聋患儿为研究对象,所有入组患儿均接受单侧人工耳蜗植入术,手术均由同一医生完成,均采用奥地利Medel人工耳蜗。分别于术前及术后开机3、6、12、18、24个月时应用婴幼儿有意义听觉整合量表(ITMAIS)或者有意义听觉整合量表(MAIS)评估患儿的听觉能力,并与同龄正常听力儿童ITMAIS/MAIS量表评分对比。另外,应用普通话早期言语感知测试量表(MESP)评估患儿言语识别能力,并分析患儿听觉及言语识别能力的影响因素。结果语前聋人工耳蜗植入儿童在开机24个月内ITMAIS/MAIS平均得分总体多个时间点比较,差异有统计学意义(P<0.05),开机后第3、6、12、18、24个月相邻的2个评估时间点ITMAIS/MAIS平均得分比较差异有统计学意义(P<0.05)。与相同年龄阶段的健听儿童ITMAIS/MAIS平均得分比较,在开机后第18、24个月差异有统计学意义(P<0.05),其他评估时间点差异无统计学意义。在开机12个月时能完成MESP最高级别测试的儿童有20.4%,到开机24个月时能完成MESP最高级别测试的儿童达到71.0%,随着人工耳蜗植入开机时间的延长能完成MESP更高级别测试的儿童比例呈持续增长趋势,且差异有统计学意义(P<0.05)。多因素分析结果显示,影响术后开机12个月ITMAIS/MAIS评分的相关因素有植入年龄、术前佩戴助听器、父母教育程度(P<0.05),影响术后开机24个月ITMAIS/MAIS评分的相关因素有植入年龄、父母受教育程度(P<0.05)。影响术后开机12个月和24个月MESP的相关因素有植入年龄、父母受教育程度(P<0.05)。结论语前聋儿童人工耳蜗植入后听觉言语能力在24个月内得到快速提升,并与正常儿童水平相似,术前佩戴助听器、父母受教育程度、植入年龄是影响CI儿童术后24个月听觉言语能力的主要影响因素。

Objective To explore the rehabilitation regularity and influencing factors of hearing and speech recognition in children with prespeech deafness after cochlear implantation(CI).Methods A total of 83 children with severe or profound sensorineural hearing loss who were admitted to the Department of Otorhinolaryngology Head and Neck Surgery of the Third People’s Hospital of Zhengzhou from January 2019 to January 2020 were selected as the research objects.All the enrolled children received unilateral cochlear implantation,and the operation was completed by the same doctor,and all of them used the Austrian Medel cochlear implant.Infant-toddler meaningful auditory integration scale(ITMAIS)or meaningful auditory integration scale(MAIS)was used to evaluate the auditory ability of children before operation and at 3,6,12,18,and 24 months after operation,and the scores were compared with those of normal hearing children of the same age.In addition,Mandanrin early speech perception(MESP)was used to evaluate the children’s speech recognition ability,and the influencing factors of hearing and speech recognition ability were analyzed.Results The average ITMAIS/MAIS score of CI children with prelinguistic deafness was significant in the comparison of multiple time points within 2 years after starting the machine(P<0.05),and the average ITMAIS/MAIS score of two adjacent evaluation time points at 3,6,12,18 and 24 months after starting the machine was different(P<0.05).Compared with the average ITMAIS/MAIS scores of healthy hearing children of the same hearing age,there were differences at 18 months and 24 months after starting the machine(P<0.05),but there were no differences at other assessment time points.There were 20.4%of children who could complete the highest level MESP test at 12 months and 71.0%who could complete the highest level MESP test at 24 months.The proportion of children who could complete the higher level MESP test continued to increase with the extension of CI startup time,and the difference was statistically significant(P<0.05).The related factors affecting the ITMAIS/MAIS score at 12 months after switcheroo were implantation age,hearing aid wearing before switcheroo and parental education level(P<0.05),and the related factors affecting the ITMAIS/MAIS score at 24 months after switcheroo were implantation age and parental education level(P<0.05).The related factors affecting MESP at 12 and 24 months after operation were implantation age and parents’education level(P<0.05).Conclusion The hearing and speech ability of prelingual deaf children after CI improves rapidly within two years and is similar to that of normal children.Hearing aid wearing before operation,parents education level and implantation age are the main factors affecting the hearing and speech ability of children with CI two years after operation.