语前聋儿童耳蜗植入两年内的听觉、言语识别和词汇能力发展
发布时间：2019-02-28 18:57
【摘要】：随着我国经济的发展和慈善机构的努力,人工耳蜗对聋儿已成为一种常见的干预措施,且其数量预计在未来几年将迅速增长。而这些耳蜗植入患儿的康复成效也越来越得到广泛关注。本课题主要探索语前聋儿童人工耳蜗植入术后早期的听觉发展、言语识别和词汇能力的发展;并观察术前使用助听器对不同植入年龄儿童术后康复成效的影响;同时探讨现行中文评估听障儿童听觉、言语及语言能力测试工具的可行性。本课题共有83例重度-极重度语前聋婴幼期患儿参与本次研究。使用婴幼儿／有意义听觉整合量表问卷(MAIS/IT-MAIS),普通话早期言语感知测试(MESP)、普通话儿童言语能力测试(MPSI)等闭合式言语识别测试，，以及普通话汉语沟通发展量表(CCDI)、普通话表达与理解词汇量测试(MERVT)等词汇量测评工具,由经过培训的听力学专业人员对患儿术后的听觉、言语识别及语言能力进行评估。分别在术前和开机后3、6、1年及2年时对受试患儿进行评估。问卷评估采用面对面问询打分的方式,由患儿家长或监护人回答问卷;闭合项言语识别及词汇量测试为患儿在评估人员陪同下进行测试。评估人员记录测试结果并进行统计学分析。通过随访观察比较发现,耳蜗植入术后早期的听觉发育、言语识别及语言能力的发展随康复时间延长而逐步提高。各年龄受试儿童的MAIS/IT-MAIS得分随着康复时间的延长,均呈现相似的增长趋势;术前助听器使用经验多的儿童,其MAIS/IT-MAIS得分高于未使用助听器或使用经验少的儿童。MESP测试显示,患儿的言语察觉能力优先于言语识别能力,但患儿的言语识别能力也随着人工耳蜗使用时长而有明显提高,在术后2年内差距逐渐缩小;各亚测试项的难度呈现较明显的渐次增大的层级。MPSI在开机2年时,全部受试儿童才能完成安静条件下的测试,且随着语竞比的降低,能完成该测试的儿童的比例显著下降。术后早期的词汇量的发展随康复时间延长而逐步提高;耳蜗植入儿童术后词汇能力不断提高,且表现为理解性词汇先于表达性词汇发展。大龄有助听器使用经验的儿童,其听觉、言语识别和语言能力均优于小龄儿童及大龄缺乏助听器使用经验的儿童。研究结果表明,耳蜗植入术后2年儿童即发展出一定的听觉、言语识别和语言能力;其听觉-言语-语言的发展既有一定的先后次序,又表现出协同并进的趋势,即首先发展出一定的听力及言语识别能力,随后词汇的理解和表达能力才得以快速提高,词汇理解能力要先于表达能力的发展。小龄儿童耳蜗植入术前可选择性佩戴助听器,而大龄儿童应在术前佩戴助听器以尽早地接触声音。术后2年大部分耳蜗植入后儿童其听觉、言语识别和语言能力已优于2岁的健听儿童。中文版IT-MAIS/MAIS、MESP、MPSI、CCDI及MERVT是评估植入后小儿早期听觉、言语识别和语言能力的可用工具。
[Abstract]:With the development of China's economy and the efforts of charity, cochlear implant for deaf children has become a common intervention, and its number is expected to increase rapidly in the next few years. And the rehabilitation effect of these cochlear implant children has been paid more and more attention. The purpose of this study was to explore the early development of hearing, speech recognition and vocabulary in children with prelingual deafness after cochlear implantation, and to observe the effects of hearing aids on postoperative rehabilitation of children of different implantation ages. At the same time, the feasibility of the current Chinese assessment tools for hearing, speech and language abilities of children with hearing impairment was discussed. A total of 83 infants with severe-to-extreme prelingual deafness were involved in this study. Using the Infant / meaningful auditory Integration scale (MAIS/IT-MAIS), (MESP), early speech perception Test (MESP), (MPSI) and other closed speech recognition tests. And the Putonghua Chinese Communication Development scale (CCDI), Putonghua expression and comprehension Vocabulary Test (MERVT), and other vocabulary assessment tools, which were used by trained audiology professionals to assess the hearing of children after operation. Speech recognition and language ability assessment. The children were evaluated before and 3, 6, 1 and 2 years after startup. The questionnaire was evaluated by face-to-face inquiry and answered by the parents or guardians, and the closed item speech recognition and vocabulary size test was carried out with the aid of the evaluator. The evaluators recorded the test results and performed statistical analysis. Through the follow-up observation and comparison, it was found that the development of auditory development, speech recognition and language ability in the early stage after cochlear implantation was gradually improved with the prolongation of rehabilitation time. The MAIS/IT-MAIS scores of children of all ages showed a similar increasing trend with the prolongation of rehabilitation time. The MAIS/IT-MAIS score of children with more experience using hearing aid before operation was higher than that of children without hearing aid or less experience. MESP test showed that the ability of speech detection was superior to speech recognition ability in children who had more experience in using hearing aids before operation than in children with less experience in using hearing aids. However, the speech recognition ability of the children also improved with the duration of cochlear implantation, and the gap gradually narrowed within 2 years after operation. When MPSI was started for 2 years, all the children were able to complete the quietness test, and the proportion of children who could complete the test decreased significantly with the decrease of the ratio of words to contests. 2 years after the MPSI was turned on, all the children were able to complete the test under the quiet condition, and the proportion of the children who could complete the test decreased significantly. The development of vocabulary in early postoperative period was gradually improved with the prolongation of rehabilitation time, and the vocabulary ability of cochlear implant children was improved, which showed that comprehensible vocabulary was prior to the development of expressive vocabulary in children after cochlear implantation. The hearing, speech recognition and language abilities of older children with hearing aid experience are better than those of young children and those who lack hearing aid experience. The results showed that children developed hearing, speech recognition and language abilities 2 years after cochlear implantation. The development of hearing, speech and language not only has a certain sequence, but also shows the trend of cooperation, that is, to develop a certain ability of listening and speech recognition, and then to improve quickly the comprehension and expression of vocabulary. Vocabulary comprehension ability should precede the development of expression ability. Young children may wear hearing aids before cochlear implantation, while older children should wear hearing aids before implantation in order to contact sound as soon as possible. The hearing, speech recognition and language ability of most children after cochlear implantation 2 years after operation were better than those of 2-year-old deaf children. Chinese versions of IT-MAIS/MAIS,MESP,MPSI,CCDI and MERVT are useful tools for evaluating early hearing, speech recognition and language abilities in children after implantation.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R764.9
本文编号：2432077
[Abstract]:With the development of China's economy and the efforts of charity, cochlear implant for deaf children has become a common intervention, and its number is expected to increase rapidly in the next few years. And the rehabilitation effect of these cochlear implant children has been paid more and more attention. The purpose of this study was to explore the early development of hearing, speech recognition and vocabulary in children with prelingual deafness after cochlear implantation, and to observe the effects of hearing aids on postoperative rehabilitation of children of different implantation ages. At the same time, the feasibility of the current Chinese assessment tools for hearing, speech and language abilities of children with hearing impairment was discussed. A total of 83 infants with severe-to-extreme prelingual deafness were involved in this study. Using the Infant / meaningful auditory Integration scale (MAIS/IT-MAIS), (MESP), early speech perception Test (MESP), (MPSI) and other closed speech recognition tests. And the Putonghua Chinese Communication Development scale (CCDI), Putonghua expression and comprehension Vocabulary Test (MERVT), and other vocabulary assessment tools, which were used by trained audiology professionals to assess the hearing of children after operation. Speech recognition and language ability assessment. The children were evaluated before and 3, 6, 1 and 2 years after startup. The questionnaire was evaluated by face-to-face inquiry and answered by the parents or guardians, and the closed item speech recognition and vocabulary size test was carried out with the aid of the evaluator. The evaluators recorded the test results and performed statistical analysis. Through the follow-up observation and comparison, it was found that the development of auditory development, speech recognition and language ability in the early stage after cochlear implantation was gradually improved with the prolongation of rehabilitation time. The MAIS/IT-MAIS scores of children of all ages showed a similar increasing trend with the prolongation of rehabilitation time. The MAIS/IT-MAIS score of children with more experience using hearing aid before operation was higher than that of children without hearing aid or less experience. MESP test showed that the ability of speech detection was superior to speech recognition ability in children who had more experience in using hearing aids before operation than in children with less experience in using hearing aids. However, the speech recognition ability of the children also improved with the duration of cochlear implantation, and the gap gradually narrowed within 2 years after operation. When MPSI was started for 2 years, all the children were able to complete the quietness test, and the proportion of children who could complete the test decreased significantly with the decrease of the ratio of words to contests. 2 years after the MPSI was turned on, all the children were able to complete the test under the quiet condition, and the proportion of the children who could complete the test decreased significantly. The development of vocabulary in early postoperative period was gradually improved with the prolongation of rehabilitation time, and the vocabulary ability of cochlear implant children was improved, which showed that comprehensible vocabulary was prior to the development of expressive vocabulary in children after cochlear implantation. The hearing, speech recognition and language abilities of older children with hearing aid experience are better than those of young children and those who lack hearing aid experience. The results showed that children developed hearing, speech recognition and language abilities 2 years after cochlear implantation. The development of hearing, speech and language not only has a certain sequence, but also shows the trend of cooperation, that is, to develop a certain ability of listening and speech recognition, and then to improve quickly the comprehension and expression of vocabulary. Vocabulary comprehension ability should precede the development of expression ability. Young children may wear hearing aids before cochlear implantation, while older children should wear hearing aids before implantation in order to contact sound as soon as possible. The hearing, speech recognition and language ability of most children after cochlear implantation 2 years after operation were better than those of 2-year-old deaf children. Chinese versions of IT-MAIS/MAIS,MESP,MPSI,CCDI and MERVT are useful tools for evaluating early hearing, speech recognition and language abilities in children after implantation.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R764.9
【共引文献】
相关期刊论文 前4条
1 张东利;刘勇智;;听障患儿人工耳蜗植入术后听觉言语评估方法[J];临床耳鼻咽喉头颈外科杂志;2013年13期
2 刘霞;赵慧莉;宋诗弦;;儿童人工耳蜗植入术的护理研究进展[J];护理学杂志;2014年10期
3 梁思玉;郑芸;李刚;;改良版汉语沟通发展量表短表在儿童听力康复中的临床价值[J];临床耳鼻咽喉头颈外科杂志;2014年01期
4 郑芸;李刚;;新生儿听力筛查:0136F经验谈[J];临床耳鼻咽喉头颈外科杂志;2014年22期
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