学龄前儿童人工耳蜗植入术后听觉康复及智力发育研究

发布时间：2019-03-09 17:42

【摘要】：目的：探讨学龄前儿童单侧人工耳蜗植入术后听觉言语康复效果和智力发育改善的相关因素,并分析比较我国标准化言语康复评估程序与国际通用评估方法评估结果的一致性。方法：2006年1月至2013年4月,我科共对359例学龄前小于7岁儿童行单侧人工耳蜗手术。其中临床资料、耳聋基因检测结果、术后1年的听觉言语康复和智力发育随访资料完整者165例,同时采用言语识别率、语言年龄、听觉行为分级(Categories of Auditory Performance,CAP)、言语可懂度分级(Speech Intelligibility Rating, SIR),按年龄、基因型、人工耳蜗植入体型号、有无助听器佩戴史以及有无EVAS分组研究其的听觉言语康复效果,并采用希-内智力评估及智力发育情况。结果：1.165例学龄前CI儿童中GJB2基因突变者48例(48/165,29.1%),SLC26A4突变者10例(10/165,6.06%),mt12sRNA突变者2例(2/165,1.2%)。2.165受试者言语识别率与CAP得分正性相关(r=0.405,p0.01),语言年龄与SIR得分正相关性(r=0.384,p0.01)。3.165例学龄前CI儿童听觉言语能力在术后12月内均快速提高,言语识别率在康复12个月时平均值分别达到了85.3%,语言年龄达到：2.5岁,CAP达到：4.5,SIR达到：3.1。4.植入年龄为1～3岁CI儿童术后1年的听觉言语康复速度明显快于4～6岁儿童；GJB2基因突变CI儿童的听觉言语康复及智力发育评估得分均高于非GIB2突变者；EVAS的CI儿童听觉言语康复及智力发育与非EVAS的CI儿童无差异；不同型号的人工耳蜗植入体对CI儿童的听觉言语康复影响不同,对智力发育影响无差异；助听器佩戴经验对学龄前CI儿童术后1年的听觉能力有影响,对其言语能力及智力发育无影响。5.2～5岁儿童单侧CI术后1年希-内智力评分明显高于同龄未手术听障儿童。结论：1.CAP、SIR与言语识别率、语言年龄在评估听觉言语康复效果上具有较好的一致性,都可作为中国儿童CI术后康复效果的评估方法。2.GJB2基因突变的CI儿童的听觉语言康复及智力发育优于非GJB2突变者；3. EVAS儿童CI术后康复效果与无前庭水管扩大患儿无明显差异。
[Abstract]:Aim: to investigate the related factors of auditory speech rehabilitation and mental development improvement in preschool children after unilateral cochlear implantation, and to analyze and compare the consistency between the evaluation procedure of standardized speech rehabilitation in China and the international evaluation methods. Methods: from January 2006 to April 2013, 359 preschool children under 7 years of age underwent unilateral cochlear surgery. Among them, clinical data, deafness gene test results, auditory speech rehabilitation and intellectual development follow-up data of 1 year after operation were complete in 165cases, and speech recognition rate, language age, auditory and behavioral grade (Categories of Auditory Performance,CAP were also used. Speech intelligibility grade (Speech Intelligibility Rating, SIR), was divided into four groups: age, genotype, cochlear implant type, hearing aid wearing history and EVAS group to study the effect of auditory speech rehabilitation. At the same time, the intelligence evaluation and the development of intelligence were adopted. Results: among the 1.165 preschool CI children, 48 (48 / 165, 29.1%) had GJB2 mutation and 10 (10 / 165, 6.06%) had SLC26A4 mutation. The speech recognition rate was positively correlated with the CAP score (r = 0.405, p0.01), and the language age was positively correlated with the SIR score (r = 0.384, P < 0.01) in 2.165 subjects with mt12sRNA mutation (2 / 165, 1.2%). (P0. 01). The auditory speech ability of 3.165 preschool CI children increased rapidly within 12 months after operation, the average speech recognition rate reached 85. 3% after 12 months of rehabilitation, and the language age was 2. 5 years old. CAP: 4.5, Sir: 3.1.4. The rate of auditory speech rehabilitation in CI children aged 1 to 3 years after operation was significantly faster than that in children aged 4 to 6 years, and the scores of auditory speech rehabilitation and intelligence development in CI children with GJB2 gene mutation were higher than those in non-GIB2 mutation children. There was no difference in auditory speech rehabilitation and intellectual development between CI children with EVAS and non-EVAS children with CI, and the effects of cochlear implants on auditory speech rehabilitation and intelligence development in CI children were not different from those in non-EVAS children, and there was no difference in the effects of cochlear implants on hearing and speech rehabilitation in CI children. Hearing aid wearing experience has an impact on the hearing ability of preschool CI children 1 year after operation. There was no effect on speech ability and intelligence development in 5-year-old children with unilateral CI. The score was significantly higher in 5-year-old children than that in unoperated children with hearing impairment at one year after operation. CAP, Sir and speech recognition rate, language age have good consistency in evaluating the effect of auditory speech rehabilitation. 2. 2. The hearing and speech rehabilitation and intelligence development of CI children with GJB2 gene mutation were better than those without GJB2 mutation; 2. CI children with GJB2 gene mutation had better hearing and speech rehabilitation and intelligence development than those without GJB2 mutation. 3. There was no significant difference between EVAS children and children without vestibular aqueduct enlargement after CI.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R764.9

【参考文献】