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摘要: 目的 评估人工耳蜗植入(CI)儿童听力重建后的远期效果，为临床诊疗咨询提供更多指导意见。方法 共招募到使用CI超过5年、符合纳入标准的CI儿童15例(CI组)，现干预模式为单侧CI。客观听觉能力评估包括佩戴CI的助听听阈、安静环境以及噪声环境下的双音节词和短句言语识别率，以10例同龄健听儿童为正常听力组，比较两组间听阈和言语识别率的差异，并比较CI组儿童言语识别率在安静环境与噪声环境下的差异。生活质量评估使用《中文版人工耳蜗植入儿童家长观点调查问卷》(MPP)，另以17例植入年龄相似、使用时间为1年的单侧CI儿童作为CI对照组，比较不同康复时间问卷中各维度得分的差异。结果 虽然CI组各测试频率的助听听阈均进入言语香蕉图，平均听阈均值小于35 dB HL，且在安静环境下双音节词与短句的识别率均超过80%，但与正常听力组相比，各测试项均处于劣势，尤其是噪声环境下的识别率，组间比较均差异有统计学意义(P < 0.05)。言语噪声对识别率影响显著，CI组安静环境下的各项识别率得分均高于噪声环境(双音节词t=18.81、P < 0.001，短句t=16.48、P < 0.001)。生活质量的比较中，在“对孩子的支持”维度，CI组和CI对照组都可以获得较好的收益，组间比较差异无统计学意义(P>0.05)；其余维度的组间比较中，CI组获益更加显著，得分均高于CI对照组且差异有统计学意义(P < 0.05)。结论 听障儿童植入人工耳蜗的远期获益显著，其具备了较好的听觉语言能力、能够融入正常社会生活，但与同龄健听儿童相比仍存在差距，还需要全社会力量的关爱和共同参与，并给予CI儿童全生命周期的听觉保障。Abstract: Objective To investigate the long-term rehabilitation outcomes of children with cochlear implants(CI) and provide constructive guidance for clinical application.Methods Fifteen children with unilateral CI over 5 years(CI group) were recruited. Ten children with normal hearing were recruited as the healthy control group. The project collected aided sound-field hearing thresholds and speech recognition scores using disyllabic words and C-HINT sentences with and without speech noise for 15 children with unilateral CI. In addition, children's guardians were requested to fill out the Mandarin Parental Perspectives questionnaire(MPP) in order to evaluate the hearing aspects of quality of life. MPP results from the 15 children were then compared with previous responses from 17 unilateral CI children whose overall CI wearing time was one year(CI control group).Results The aided pure-tone average(PTA) of the recruited children was below 35 dB HL, all children reached 80% for the speech recognition test in a quiet environment, yet their performance decreased in a noisy environment. Regarding the hearing aspects of the MPP questionnaire results, recruited children demonstrated better results than those from CI control group(P < 0.05). Speech noise had a significant impact on the recognition rate, and the CI group had higher recognition rate scores in the quiet environment than in the noise environment(two-syllable words t=18.81, P < 0.001, short sentences t=16.48, P < 0.001). In the comparison of quality of life, in the dimension of "support for children", both the CI group and the CI control group can obtain better benefits, and there is no statistically significant difference between the groups(P>0.05). The CI group benefited more significantly, and the scores were higher than those of the CI control group(P < 0.05).Conclusion The long-term hearing outcome of children with CI is adequate for daily communication, but there is still a gap compared with hearing children of the same age, and they still need support from the entire society.
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Key words:
- cochlear implant /
- child /
- hearing aspect of qol /
- long-term follow up
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表 1 各组临床资料
组别 例数 性别/例 受访年龄/岁 CI植入年龄/岁 CI使用时间/年 男 女 CI组 15 7 8 10.40±1.12 1.98±0.51 8.42±1.07 CI对照组 17 9 8 2.97±0.56 1.86±0.50 1.11±0.19 正常听力组 10 6 4 8.87±1.69 - - 
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表 2 CI儿童不同使用时间的生活质量比较
分 组别 例数 交流能力 基本功能 自立能力 幸福感 社会关系 教育 植入的效果和影响 对孩子的支持 CI组 13 23.77±4.13 24.62± 3.15 14.62±1.71 21.54± 2.70 28.85±4.00 27.77± 3.37 23.92±3.77 24.31± 1.89 CI对照组 17 16.41±3.43 21.59± 2.50 12.29±2.05 18.65± 2.29 25.18±3.40 22.76± 1.72 20.76±2.82 23.12± 3.30 t值 -5.334 -2.937 -3.291 -3.175 -2.732 -5.308 -2.628 -1.161 P值 < 0.001 0.007 0.003 0.004 0.011 < 0.001 0.014 0.255
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表 3 CI组与正常听力组儿童的听觉能力比较
组别 例数 平均听阈/dB HL 安静环境/% 噪声环境/% 双音节词 短句 双音节词 短句 CI组 15 32.75±4.18 82.47±10.52 91.40±8.66 27.20±10.84 59.73±10.57 正常听力组 10 -5.75±4.01 100±0 100±0 96.50±4.12 100±0 t值 -22.939 6.454 3.847 22.443 14.751 P值 < 0.001 < 0.001 0.002 < 0.001 < 0.001
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| 引用本文: |
杨烨, 高珺岩, 姜耀锋, 等. 人工耳蜗植入儿童听觉效果的远期获益[J]. 临床耳鼻咽喉头颈外科杂志, 2023, 37(3): 197-200. doi: 10.13201/j.issn.2096-7993.2023.03.008
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| Citation: |
YANG Ye, GAO Junyan, JIANG Yaofeng, et al. Long-term hearing outcomes of children with cochlear implant[J]. J Clin Otorhinolaryngol Head Neck Surg, 2023, 37(3): 197-200. doi: 10.13201/j.issn.2096-7993.2023.03.008
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