双侧蜗神经发育不良患儿人工耳蜗植入后听觉言语康复效果及影响因素分析

Analysis of the effect and influencing factors of auditory and speech rehabilitation after cochlear implantation in children with bilateral cochlear deficiency

张晓;杨扬;刘薇;刘瀚迪;陈敏;马宁;刘冰;邵剑波;刘海红;郑军;张杰

1:国家儿童医学中心

2:首都医科大学附属北京儿童医院耳鼻咽喉头颈外科

3:儿童耳鼻咽喉头颈外科疾病北京市重点实验室

4:首都医科大学附属北京同仁医院耳鼻咽喉头颈外科

摘要
目的 分析双侧蜗神经发育不良(cochlear nerve deficiency, CND)患儿人工耳蜗植入(cochlear impant, CI)后听觉言语康复效果及其影响因素。方法 以20例双侧CND患儿为研究对象,其中,5例双侧植入,15例单侧植入;颞骨CT显示蜗孔狭窄14例,蜗孔闭锁6例;伴其他内耳畸形8例,不伴其他内耳畸形12例;内听道MRI显示1根神经5例,2根神经6例,3根神经8例,4根神经1例;术中EABR未引出6例,EABR引出14例。采用听觉能力分级(categories of auditory performance, CAP)、言语可懂度分级标准(speech intelligibility rating, SIR)对受试者术后听觉及言语能力进行评估。结果 (1)蜗孔狭窄患儿的CAP(P<0.001)、SIR(P<0.001)评分均高于蜗孔闭锁者;(2)内听道内神经根数越多,CAP(P=0.003)、SIR(P=0.008)得分越高;(3)术中能引出EABR患儿的CAP得分高于未引出患儿(P=0.030),SIR得分差异无统计学意义(P=0.14);(4)双侧CI者与单侧CI者、不伴其他内耳畸形者与伴其他内耳畸形者的CAP和SIR差异无统计学意义(P>0.05)。结论 双侧蜗神经发育不良患儿CI术后听觉能力提高显著,但言语发育欠佳,且术后听觉言语能力与蜗孔狭窄情况、内听道神经根数及术中是否引出EABR有关。
关键词
儿童;蜗神经发育不良;人工耳蜗植入;听觉及言语能力
基金项目(Foundation):
首都医科大学附属北京儿童医院苗圃计划(3-1-014-01-38)
作者
张晓;杨扬;刘薇;刘瀚迪;陈敏;马宁;刘冰;邵剑波;刘海红;郑军;张杰
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