儿童人工耳蜗植入后康复效果及影响因素研究

发布时间：2018-08-02 12:38

【摘要】：背景:人工耳蜗植入(cochlear implants,CI)是治疗儿童重-极重度感音神经性耳聋(sensorineural hearing loss,SNHL)的主要措施,通过术后良好的听力语言康复训练能显著提高患儿听觉言语水平,恢复儿童社会生活能力。影响聋儿康复训练效果的因素很多,目前对于CI后康复效果的影响因素仍不十分清楚。目的:探讨重-极重度SNHL儿童CI后的康复效果及影响因素。方法:回顾性分析2013年1月-2015年1月于吉林大学第一医院耳鼻咽喉头颈外科行CI并在吉林省聋儿康复中心行术后康复治疗的113例重-极重度SNHL患儿的临床和康复资料。采用听觉行为分级标准(categories of auditory performance,CAP)、言语可懂度分级标准(speech intelligibility rating,SIR)和听觉、语言能力评估标准评价患儿听觉言语康复效果。探讨植入年龄、植入耳、术前助听器佩戴方式、家庭训练时间以及父母对康复训练知识和方法的掌握程度与康复训练1年时语言听力发展之间的关系。结果：康复训练1年后,(1)患儿CAP、SIR、语龄及听觉能力均较术前明显改善。(2)CAP在2-4岁年龄组增长了4(0-5),高于2岁及以下年龄组的3(0-5);语龄在2-4岁年龄组增长了27.60(0-42)月,高于2岁及以下年龄组的21.60(0-36)月;语龄发育延迟在2岁及以下年龄组、2-4岁年龄组以及4-7岁年龄组分别为12.00(0-36)月、21.60(6-60)月和36.00(30-66)月,三组间差异均有统计学意义(p0.05,p0.05,p0.05)。(3)植入耳地选择对术后康复效果无影响。(4)家庭训练时间0-1 h组与1-2 h组及2-3 h组比较,在CAP、SIR、康复后语龄、语龄增长及听觉能力发展方面差异均有统计学意义,但1-2 h组与2-3 h组之间无显著性差别。(5)父母对康复知识和方法的掌握程度,不熟悉组、较熟悉组和熟悉组比较,在CAP、康复后语龄及语龄增长方面,三组间比较差异均有统计学意义;不熟悉组与较熟悉组和熟悉组比较,在SIR及听觉能力发展方面差异均有统计学意义。(6)术前佩戴助听器情况,未佩戴组与单耳佩戴组及双耳佩戴组比较,在CAP、SIR及听觉能力发展方面差异均有统计学意义;未佩戴组、单耳佩戴组和双耳佩戴组比较,在康复后语龄增长方面,三组间比较差异均有统计学意义(p0.05,p0.05,p0.05)。结论:(1)康复训练能提高人工耳蜗植入后聋儿听觉和言语能力;(2)儿童重-极重度感音神经性聋人工耳蜗植入的适宜年龄为2-4岁;(3)植入耳地选择对听力语言康复效果无明显影响;(4)家庭训练对康复效果有积极作用,患儿家庭应了解掌握一定的康复训练知识与方法,合适的家结果:庭康复训练非常必要;(5)聋儿人工耳蜗植入前应佩戴单耳助听器接受听力语言干预。
[Abstract]:Background: cochlear implantation (cochlear implants CI) is the main method for the treatment of severe and severe sensorineural hearing loss (sensorineural hearing) in children. There are many factors influencing the rehabilitation effect of deaf children. Objective: to investigate the rehabilitation effect and influencing factors of CI in children with severe and severe SNHL. Methods: the clinical and rehabilitative data of 113 children with severe and severe SNHL who were treated with CI in otolaryngology and head and neck surgery in the first Hospital of Jilin University from January 2013 to January 2015 were analyzed retrospectively. Auditory behavior rating standard (categories of auditory), speech intelligibility grading standard (speech intelligibility rating Sir) and hearing and language ability assessment criteria were used to evaluate the effect of auditory speech rehabilitation in children. To explore the relationship between the age of implantation, ear implantation, hearing aid wear before operation, family training time, and parental knowledge and methods of rehabilitation training and the development of language and hearing during one year of rehabilitation training. Results: after 1 year of rehabilitation training, (1) the age, language age and hearing ability of the children were significantly improved compared with those before the operation. (2) CAP increased by 4 (0-5) in the 2-4 age group, higher than 3 (0-5) in the 2-4 age group, and 27.60 (0-42) months in the 2-4 age group. The age delay was 21.60 (0-36) months and 12.00 (0-36) months and 36.00 (30-66) months in the 2-4 and 4-7 age groups, respectively. There were significant differences among the three groups (p0.05p0.05p0.05). (3) the choice of ear implantation had no effect on postoperative rehabilitation. (4) the family training time of 0-1h group was higher than that of 1-2 h group and 2-3 h group. There were significant differences in age growth and auditory ability development, but there was no significant difference between 1-2 h group and 2-3 h group. (5) the degree of parental mastery of rehabilitation knowledge and methods, unfamiliar group, familiar group and familiar group were compared. In the aspect of language age and language age increase after rehabilitation, the differences among the three groups were statistically significant, and the differences in SIR and hearing ability development between the unfamiliar group and the familiar group were statistically significant. (6) the hearing aids were worn before operation. There were significant differences in CAPS-IR and auditory ability development between the unworn group, monaural group and binaural group, and the age of speech after rehabilitation in the non-wearing group, monaural group and binaural group, the difference of CAPS-Sir and auditory ability development was significant in the non-wearing group, monaural group and binaural group, respectively. The differences among the three groups were statistically significant (p 0.05, P 0.05). Conclusion: (1) rehabilitation training can improve the hearing and speech ability of deaf children after cochlear implantation, (2) the appropriate age for cochlear implantation in children with severe and severe sensorineural hearing loss is 2-4 years, and (3) the effect of ear placement on hearing and speech rehabilitation. (4) Family training has positive effect on rehabilitation. Children's families should know and master certain knowledge and methods of rehabilitation training, the appropriate home results: court rehabilitation training is very necessary; (5) deaf children should wear monaural hearing aids to receive hearing and speech intervention before cochlear implantation.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R764.9

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