不同助听模式下儿童言语康复效果分析

Effects of Different Hearing Intervente Modes on the Speech Rehabilitation in Children

孙琴枝;张标新;葛蕾;胡翠霞;朱子秀;沙沙;王娟;

1:安徽医科大学第一附属医院耳鼻咽喉头颈外科

2:安徽医科大学

3:安徽医科大学第一附属医院生殖中心

4:安徽合肥锦雯言语康复中心

摘要
目的 探讨不同助听模式下儿童言语康复效果。方法 44例听障儿童按助听模式分为助听器(hearing aid, HA)组(HA组)14例,单侧人工耳蜗植入(cochlear implantation, CI)组(CI组)21例,双耳双模式组(CI+HA组)9例,分别于康复训练前、训练6、12、18、24个月后采用听障儿童语言能力评估标准及言语可懂度分级(speech intelligibility rating, SIR)比较不同助听模式下三组儿童的言语康复效果。结果 (1)在康复训练18、24个月时HA组和CI+HA组儿童语音清晰度及表达能力优于CI组,康复12个月时语法能力优于CI组,在康复12、18个月时理解能力优于CI组(P<0.05)。(2)康复12个月时,三组儿童词汇量、理解能力、语音清晰度、语法能力、表达能力、交往能力均较康复前显著提升(P<0.05)。(3)康复6个月时CI组和CI+HA组语法能力即较康复前显著改善(P<0.05);而康复12个月时HA组才明显改善,进步速度明显低于CI组和CI+HA组。(4)与康复前相比,三组儿童在康复6个月后SIR得分均显著提升(P<0.05),随康复时间延长效果更明显;而不同助听模式儿童SIR评分差异无统计学意义(P>0.05)。(5)三组儿童总体平均语言年龄与SIR得分呈显著正相关(R=0.862,P<0.01)。结论 CI+HA双模式助听对于极重度听障儿童是较好的听力补偿方式;双耳残余听力较佳时,HA仍是提高其言语能力的适用选择;无论何种助听模式,均需早期联合康复干预,最大程度改善儿童言语能力。
关键词
助听模式;儿童;语言能力;言语可懂度
基金项目(Foundation):
安徽医科大学自然科学研究类项目(2020xkj156)
作者
孙琴枝;张标新;葛蕾;胡翠霞;朱子秀;沙沙;王娟;
参考文献

1 Deep N,Dowling E,Jethanamest D,et al.Cochlear implantation:an overview[J].Journal of Neurological Surgery Part B:Skull Base,2019,80(2):169-177.

2 孔颖,王树峰.听障儿童的双模式干预[J].中国听力语言康复科学杂志,2020,18(3):190-194.

3 Zeitler DM,Sladen DP,Dejong MD,et al.Cochlear implantation for single-sided deafness in children and adolescents[J].International Journal of Pediatric Otorhinolaryngology,2019,118:128-133.

4 Erdem BK,Ciprut A.Evaluation of speech,spatial perception and hearing quality in unilateral,bimodal and bilateral cochlear implant users[J].Turk Arch Otorhinolaryngol,2019,57(3):149-153.

5 Elizabeth MF.Pediatric audiologic rehabilitation from infancy to adolescence[M].2nd.NewYork:Thieme Medical Publishers Inc,2013.44-62.

6 孙喜斌.听力障碍儿童听觉、语言能力评估标准及方法[CD].北京:三辰影库音像出版社,2009.

7 Nikolopoulos TP,Archbold SM,Gregory S.Young deaf children with hearing aids or cochlear implants:early assessment package for monitoring progress[J].Int J Pediatr Otorhinolaryngol,2005,69(2):175-186.

8 Galvin KL,Noble W.Adaptation of the speech,spatial,and qualities of hearing scale for use with children,parents,and teachers[J].Cochlear Implants Int,2013,14(3):135-141.

9 Wang YY,Shafto Carissa L,Houston Derek M.Attention to speech and spoken language development in deaf children with cochlear implants:a 10-year longitudinal study[J].Dev Sci,2018,21(6):e12677-e12688.

10 Hoppe U,Hocke T,Digeser F.Bimodal benefit for cochlear implant listeners with different grades of hearing loss in the opposite ear[J].Acta Otolaryngol,2018,138(8):713-721.

11 Cupples L,Ching TYC,Button L,et al.Language and speech outcomes of children with hearing loss and additional disabilities:identifying the variables that influence performance at five years of age[J].Int J Audiol,2018,57(sup2):S93-S104.

12 Holt RF,Beer J,Kronenberger WG,et al.Family environment in children with hearing aids and cochlear implants:associations with spoken language,psychosocial functioning,and cognitive development[J].Ear & Hearing,2020,41(4):762-774.

13 Chiossi JSC,Hyppolito MA.Effects of residual hearing on cochlear implant outcomes in children:a systematic-review[J].Int J Pediatr Otorhinolaryngol,2017,100(9):119-127.

14 Percy-Smith L,Hallstr?m M,Josvassen JL,et al.Differences and similarities in early vocabulary development between children with hearing aids and children with cochlear implant enrolled in 3-year auditory verbal intervention[J].Int J Pediatr Otorhinolaryngol,2018,108(5):67-72.

15 Castellanos I,Kronenberger WG,Beer J,et al.Preschool speech intelligibility and vocabulary skills predict long-term speech and language outcomes following cochlear implantation in early childhood[J].Cochlear Implants Int,2014,15(4):200-210.

16 魏薇,文骏雄,胡月,等.语前聋患儿人工耳蜗植入后三年内语言能力发展规律[J].听力学及言语疾病杂志,2019,27(5):528-532.

17 Zhang X,Weng Y,Liang M,et al.Auditory and speech function after cochlear implantation in prelingually deaf children with white matter lesions[J].Developmental Medicine & Child Neurology,2018,61(6):680-688.

18 Tomblin JB,Harrison M,Ambrose SE,et al.Language outcomes in young children with mild to severe hearing loss[J].Ear Hear,2015,36 (Suppl 1):76S-91S.

19 Holzinger D,Dall M,Sanduvete-Chaves S,et al.The impact of family environment on language development of children with cochlear implants:a systematic review and meta-analysis[J].Ear Hear,2020 ,41(5):1077-1091.

20 Chen Y,Huang M,Li B,et al.Bimodal stimulation in children with bilateral profound sensorineural hearing loss:a suitable intervention model for children at the early developmental stage[J].Otol Neurotol,2020,41(10):1357-1362.