Analysis of rehabilitation effects of cochlear implantation in elderly patients with prelingual deafness
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摘要: 目的 通过听觉行为分级量表(categories of auditory performance，CAP)、言语可懂度分级量表(speech intelligibility rating，SIR)以电话随访或面对面交谈的方式评估大龄语前聋患者人工耳蜗植入(cochlear implantation，CI)术后听觉及言语康复效果。方法 收集2016年12月至2021年12月于山西省人民医院耳鼻咽喉头颈外科行单侧CI的大龄语前聋患者的临床资料，将38例患者依据术前SIR评分分为A组(SIR评分1分，17例)、B组(SIR评分2分，10例)、C组(SIR评分3分，11例)，另选取19例大龄语后聋患者作为对照组(D组，19例)，通过比较4组术前、开机后6个月、开机后1年使用CAP、SIR评分评估患者听觉及言语康复效果。结果 所有患者CAP评分分别在开机后6个月与开机后1年比较，差异无统计学意义(P>0.05)，开机后6个月及1年CAP评分在A组和D组比较，差异有统计学意义(P < 0.05)；A组SIR评分在术前与开机后6个月差异有统计学意义(P < 0.05)，B组术前与开机后1年差异有统计学意义(P < 0.05)，C组和D组术前分别与开机后6个月及1年比较，差异无统计学意义(P>0.05)。结论 在听觉方面，短期内大龄语前聋患者开机后6个月为其听觉发展快速期，且术前言语基础越好，术后听觉康复效果越佳；在言语方面，术前言语基础越差的大龄语前聋患者术后越能够较早地从CI中获得言语上的提高。大龄语前聋患者可从CI中获益，即使术前言语基础极差，也并非CI的禁忌证。Abstract: Objective The auditory and speech rehabilitation effects were assessed by the Categories of Auditory Performance(CAP) and the speech intelligibility rating scale(SIR) after cochlear implantation(CI) in prelingually elderly patients by telephone follow-up or face-to-face conversation.Methods The clinical data of the prelingually deaf patients who underwent unilateral CI in the Department of Otorhinolaryngology and Head and Neck Surgery, Shanxi People's Hospital, from December 2016 to December 2021 were collected. Thirty-eight patients were divided into Group A(SIR 1, 17 cases), Group B(SIR 2, 10 cases) and Group C(SIR 3, 11 cases) according to the preoperative SIR Score. Nineteen patients with post-lingual hearing impairment were selected as the control group(Group D, 19 cases). The effects of hearing and speech rehabilitation were evaluated using CAP and SIR Scores before surgery, 6 months after startup, and 1 year after startup.Results There were no significant differences in CAP scores among the three groups of patients with prelingually deaf patients at 6 months and 1 year after startup(P>0.05), but there were significant differences between group A and group D at 6 months and 1 year after startup(P < 0.05); the SIR Score of group A had statistical difference before surgery and 6 months after startup(P < 0.05), group B had statistical difference before surgery and 1 year after startup(P < 0.05), and group C and D had no statistical difference before surgery and 6 months and 1 year after startup, respectively(P>0.05).Conclusion For the prelingually deaf elderly patients, hearing will develop rapidly 6 months after startup, and the effect of postoperative auditory rehabilitation was positively correlated with the preoperative speech ability. In the aspect of speech, the prelingually dear elderly patients who have poor preoperative speech ability could benefit more from CI early after surgery. CI is not contraindicated in prelingually deaf elderly patients, even those with poor preoperative speech function.
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表 1 大龄CI患者分组情况
指标 A组 B组 C组 D组 病例数 17 10 11 19 年龄范围/岁 7~24 7~27 8~36 7~38 平均年龄/岁 11.65±3.74 11.00±5.94 15.55±7.85 18.32±10.16 
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表 2 4组患者CAP评分组内及组间比较
M(P25，P75) 时间 A组 B组 C组 D组 术前 1.00(1.00，2.00) 2.00(2.00，2.00) 1.00(1.00，2.00) 2.00(1.00，2.00) 开机后6个月 5.00(4.50，5.00) 6.00(5.75，6.00) 6.00(5.00，6.00) 7.00(6.00，7.00) 开机后1年 5.00(5.00，6.00) 7.00(6.00，7.00) 6.00(6.00，8.00) 8.00(7.00，8.00)
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表 3 4组患者SIR评分组内比较
M(P25，P75) 时间 A组 B组 C组 D组 术前 1.00(1.00，1.00) 2.00(2.00，2.00) 3.00(3.00，4.00) 5.00(4.00，5.00) 开机后6个月 2.00(1.50，2.00) 3.00(2.00，3.00) 4.00(3.00，4.00) 5.00(4.00，5.00) 开机后1年 2.00(2.00，2.00) 3.00(3.00，3.00) 4.00(3.00，4.00) 5.00(4.00，5.00)
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