大龄语前聋患者人工耳蜗植入术后长期康复效果分析
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摘要
目的探讨大龄语前聋患者人工耳蜗植入术后的听力、言语、生活质量等方面的长期康复效果。方法选取了68例2012年-2016年在中南大学湘雅医院耳鼻咽喉头颈外科行单侧人工耳蜗植入术的语前聋患者为研究对象,其中7岁及7岁以上患者34例,为本次研究的研究组(A组),6岁及6岁以下患者34例,为本次研究的对照组(B组)。利用CAP量表、SIR量表、声场听阈、言语识别率以及生活质量相关问卷等对其术后听力、言语、生活质量等方面进行长期随访观察。结果所有植入人工耳蜗的患者术后2年均可观察到听觉言语能力及生活质量的提高。两组患者术后2年的声场听阈无明显差异。术后24个月CAP得分、SIR得分及言语识别率方面,低龄对照组均要优于大龄研究组;但术后3个月及6个月的CAP评分以及3个月的SIR评分,研究组要优于对照组。结论大龄语前聋患者植入人工耳蜗后可以获得听觉、言语及生活质量等方面的提高。因此术前进行听力、心理、期待值等多方面综合评估,人工耳蜗植入也能成为大龄语前聋患者改善听觉言语障碍及日常生活的有效选择。
Objective To report long-term outcomes in hearing and speech rehabilitation and in quality of life after cochlear implantation in later-implanted patients with prelingual deafness. Methods A retrospective review was conducted in prelingually deafened patients, who received cochlear implants at Xiangya Hospital, Central South University, between 2012 and 2016. Patients implanted at 7 years of age or older(n=34, the experimental group) were compared to patients implanted at 6 years of age or younger(n=34, the control group). Hearing and speech rehabilitation parameters, including CAP, SIR, hearing threshold, word recognition score, as well as quality of life inventory scores were compared.Results CAP, SIR, hearing thresholds, word recognition scores and quality of life scores improved in all patients. Hearing thresholds improvement was similar in both groups after cochlear implantation. CAP, SIR and word recognition scores were better in the experimental group than in the control group at 3 and 6 months after cochlear implantation, although the scores were better in the control group at 12 and 24 months. Conclusion Later-implanted patients with prelingual deafness can acquire improvement in hearing, speech and quality of life after cochlear implantation. With careful candidate selection, cochlear implantation is beneficial in older prelingually deaf patients.
Objective To report long-term outcomes in hearing and speech rehabilitation and in quality of life after cochlear implantation in later-implanted patients with prelingual deafness. Methods A retrospective review was conducted in prelingually deafened patients, who received cochlear implants at Xiangya Hospital, Central South University, between 2012 and 2016. Patients implanted at 7 years of age or older(n=34, the experimental group) were compared to patients implanted at 6 years of age or younger(n=34, the control group). Hearing and speech rehabilitation parameters, including CAP, SIR, hearing threshold, word recognition score, as well as quality of life inventory scores were compared.Results CAP, SIR, hearing thresholds, word recognition scores and quality of life scores improved in all patients. Hearing thresholds improvement was similar in both groups after cochlear implantation. CAP, SIR and word recognition scores were better in the experimental group than in the control group at 3 and 6 months after cochlear implantation, although the scores were better in the control group at 12 and 24 months. Conclusion Later-implanted patients with prelingual deafness can acquire improvement in hearing, speech and quality of life after cochlear implantation. With careful candidate selection, cochlear implantation is beneficial in older prelingually deaf patients.
引文
1 Nikolopoulos T P,O'Donoghue G M,Archbold S,Age at implantation:its importance in pediatric cochlear implantation.[J].The Laryngoscope,1999,Vol.109(4),pp.595-599Wiley
2 Valencia DM,Rimell FL Friedman BJ,et al.Cochlear implantation in infants less than 12 months of age.[J]Int J Pediatr Otorhinolaryngol,2008,72:767-73
3 DEttman SJ,Pinder D,Briggs IL,et al.Communication development in children who receive the cochlear implant younger than12 months:risk versus benefits.[J].Ear Hear,2007,28:11S-18S.
4中华医学会耳鼻咽喉头颈外科学分会.人工耳蜗植入工作指南(2013)[J].中华耳鼻咽喉头颈外科杂志,2014,(2):89-95Chinese Medical Association,otorhinolaryngology head and neck surgery branch.Cochlear implant guidelines(2013)[J].China JOtorhinolaryngol Head Neck Surg,2014,(2):89-95
5孙喜斌,于丽玫,曲成毅,等.中国听力残疾构成特点及康复对策[J].中国听力语言康复科学杂志,2008(02):21-24.Sun XB,Yu LM,Qu CY,et al.An epidemiological study on the hearing-impaired population identified in China and proposed intervention strategies[J].Chinese Scientific Journal of Hearing andSpeech Rehabilitation,2008(02):21-24.
6 Moore,JK and F.H.Linthicum,Jr.(2007)."The human auditory system:a timeline of development."Int J Audiol 46(9):460-478.
7 Nikolopoulos,TP,S.M.Archbold,S.Gregory,Young deaf children with hearing aids or cochlear implants:early assessment package for monitoring progress.[J].Int J Pediatr Otorhinolaryngol,2005.69(2):p.175-86.
8 Hindetink JB,Krabbe PF,Van Den Brock P.Development and application of a health-related quality-of-life instrument for adults witIl cochlear implants:the Nijmegen cochlear implant questionnaire.[J].Otolaryngol Head Neck Surg,2000,123:756-765.
9董瑞娟,刘博,彭晓霞,等.Nijmegen人工耳蜗植入量表中文版信度和效度评价.[J].中华耳鼻咽喉头颈外科杂志,2010(10):818-823Dong RJ,Liu B,Peng,et al,The reliability and validity of Chinese version of Nijmegen Cochlear Implant Questionnaire.[J]China JOtorhinolaryngol Head Neck Surg,2010(10):818-823
10 Fryauf BH,Tyler RS,Kelsay DM,etal.Cochlear implant use by prelingually deafened Children:the influences of age at implant and length Ofdevice use[J].J Speech Lang Hear Res,1997,40:183-1993.
11 De Raeve L,A longitudinal study on auditory perception and speech intelligibility in deaf children implanted younger than 18months in comparison to those implanted at later ages.[J]Otol Neurotol,2010.31(8):p.1261-7.
12 Galvin KL,KC Hughes,M.Mok,Can adolescents and young adults with prelingual hearing loss benefit from a second,sequential cochlear implant?[J]Int J Audiol,2010.49(5):368-377.
13杨琛,黄维平,尹中普,等.语前聋患儿人工耳蜗植入术后早期听觉言语能力评估[J].临床耳鼻咽喉头颈外科杂志,2015,29(08):740-742.Yang Z,Huang WP,Yin ZP,et al,Evaluation of early hearing and speech ability in children with prelingual deafness after cochlear implantation[J].Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2015,29(08):740-742.
14 Teoh,S.W.,Pisoni,D.B.,Miyamoto,R.T.2004a.Cochlear implantation in adults with prelingual deafness.Part I.clinical results.[J].The Laryngoscope,114(9):1536-1540.
15冯永.大龄语前聋患者的人工耳蜗植入--一个不容忽略的群体[J].中国耳鼻咽喉颅底外科杂志,2015,21(03):175-177.Feng Y,Cochlea implantation in older patients with prelingual deafness--a group that should not be neglected[J].Chinese Journal of Otorhinolaryngology-skull Base Surgery,2015,21(03):175-177.
16钱宇虹,解飞,黄以乐.多通道人工耳蜗植入患者声场听阈测试结果分析[J].听力学及言语疾病杂志,2000(04):196-198.Qian YH,Xie F,Huang YL.Analysis of acoustic threshold test results in patients with multi-channel cochlear implant[J].Journal of Audiology and Speech Pathology,2000(04):196-198.
17 Maria-Izabel Kos,Marielle Deriaz,Jean-Philippe Guyot,et al,What can be expected from a late cochlear implantation?[J].International Journal of Pediatric Otorhinolaryngology,2008,73(2).
18于萍.儿童言语和语言障碍的研究现状[J].中华耳科学杂志,2013,11(03):408-412.Yu P.Research status of speech and language disorders in children[J].Chinese Journal of Otology,2013,11(03):408-412.
19 Zwolan TA,Ashbaugh CM,Alarfaj A,et al,Pediatric cochlear implant patient performance as a function of age at implantation.[J].Otol Neurotol.2004 Mar;25(2):112-20.
20张华,王靓,王硕,等.人工耳蜗植入的言语评估[J].中华耳鼻咽喉科杂志,2004(02):64-67Zhang H,Wang L,Wang S,et al,Speech and language evaluation of cochlear implants[J].China J Otorhinolaryngol Head Neck Surg,2004(02):64-67
2 Valencia DM,Rimell FL Friedman BJ,et al.Cochlear implantation in infants less than 12 months of age.[J]Int J Pediatr Otorhinolaryngol,2008,72:767-73
3 DEttman SJ,Pinder D,Briggs IL,et al.Communication development in children who receive the cochlear implant younger than12 months:risk versus benefits.[J].Ear Hear,2007,28:11S-18S.
4中华医学会耳鼻咽喉头颈外科学分会.人工耳蜗植入工作指南(2013)[J].中华耳鼻咽喉头颈外科杂志,2014,(2):89-95Chinese Medical Association,otorhinolaryngology head and neck surgery branch.Cochlear implant guidelines(2013)[J].China JOtorhinolaryngol Head Neck Surg,2014,(2):89-95
5孙喜斌,于丽玫,曲成毅,等.中国听力残疾构成特点及康复对策[J].中国听力语言康复科学杂志,2008(02):21-24.Sun XB,Yu LM,Qu CY,et al.An epidemiological study on the hearing-impaired population identified in China and proposed intervention strategies[J].Chinese Scientific Journal of Hearing andSpeech Rehabilitation,2008(02):21-24.
6 Moore,JK and F.H.Linthicum,Jr.(2007)."The human auditory system:a timeline of development."Int J Audiol 46(9):460-478.
7 Nikolopoulos,TP,S.M.Archbold,S.Gregory,Young deaf children with hearing aids or cochlear implants:early assessment package for monitoring progress.[J].Int J Pediatr Otorhinolaryngol,2005.69(2):p.175-86.
8 Hindetink JB,Krabbe PF,Van Den Brock P.Development and application of a health-related quality-of-life instrument for adults witIl cochlear implants:the Nijmegen cochlear implant questionnaire.[J].Otolaryngol Head Neck Surg,2000,123:756-765.
9董瑞娟,刘博,彭晓霞,等.Nijmegen人工耳蜗植入量表中文版信度和效度评价.[J].中华耳鼻咽喉头颈外科杂志,2010(10):818-823Dong RJ,Liu B,Peng,et al,The reliability and validity of Chinese version of Nijmegen Cochlear Implant Questionnaire.[J]China JOtorhinolaryngol Head Neck Surg,2010(10):818-823
10 Fryauf BH,Tyler RS,Kelsay DM,etal.Cochlear implant use by prelingually deafened Children:the influences of age at implant and length Ofdevice use[J].J Speech Lang Hear Res,1997,40:183-1993.
11 De Raeve L,A longitudinal study on auditory perception and speech intelligibility in deaf children implanted younger than 18months in comparison to those implanted at later ages.[J]Otol Neurotol,2010.31(8):p.1261-7.
12 Galvin KL,KC Hughes,M.Mok,Can adolescents and young adults with prelingual hearing loss benefit from a second,sequential cochlear implant?[J]Int J Audiol,2010.49(5):368-377.
13杨琛,黄维平,尹中普,等.语前聋患儿人工耳蜗植入术后早期听觉言语能力评估[J].临床耳鼻咽喉头颈外科杂志,2015,29(08):740-742.Yang Z,Huang WP,Yin ZP,et al,Evaluation of early hearing and speech ability in children with prelingual deafness after cochlear implantation[J].Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2015,29(08):740-742.
14 Teoh,S.W.,Pisoni,D.B.,Miyamoto,R.T.2004a.Cochlear implantation in adults with prelingual deafness.Part I.clinical results.[J].The Laryngoscope,114(9):1536-1540.
15冯永.大龄语前聋患者的人工耳蜗植入--一个不容忽略的群体[J].中国耳鼻咽喉颅底外科杂志,2015,21(03):175-177.Feng Y,Cochlea implantation in older patients with prelingual deafness--a group that should not be neglected[J].Chinese Journal of Otorhinolaryngology-skull Base Surgery,2015,21(03):175-177.
16钱宇虹,解飞,黄以乐.多通道人工耳蜗植入患者声场听阈测试结果分析[J].听力学及言语疾病杂志,2000(04):196-198.Qian YH,Xie F,Huang YL.Analysis of acoustic threshold test results in patients with multi-channel cochlear implant[J].Journal of Audiology and Speech Pathology,2000(04):196-198.
17 Maria-Izabel Kos,Marielle Deriaz,Jean-Philippe Guyot,et al,What can be expected from a late cochlear implantation?[J].International Journal of Pediatric Otorhinolaryngology,2008,73(2).
18于萍.儿童言语和语言障碍的研究现状[J].中华耳科学杂志,2013,11(03):408-412.Yu P.Research status of speech and language disorders in children[J].Chinese Journal of Otology,2013,11(03):408-412.
19 Zwolan TA,Ashbaugh CM,Alarfaj A,et al,Pediatric cochlear implant patient performance as a function of age at implantation.[J].Otol Neurotol.2004 Mar;25(2):112-20.
20张华,王靓,王硕,等.人工耳蜗植入的言语评估[J].中华耳鼻咽喉科杂志,2004(02):64-67Zhang H,Wang L,Wang S,et al,Speech and language evaluation of cochlear implants[J].China J Otorhinolaryngol Head Neck Surg,2004(02):64-67