婴幼儿有意义听觉整合量表对人工耳蜗植入幼儿康复效果的评估

目的研究婴幼儿有意义听觉整合量表(infant-toddler meaningful auditory integration scale,IT-MAIS)对早期植入人工耳蜗(cochlear implant,CI)幼儿康复效果评估的价值。方法使用ITMAIS对开机年龄在18个月以内的12名人工耳蜗植入幼儿(CI组)于开机时及开机后3、6、12个月分别进行评估,并将其得分与同龄健听幼儿(健听组)得分比较。结果开机时CI组的听觉发育总体能力、声音察觉能力和声音识别能力得分分别为10.8%±7.6%、16.6%±12.6%、1.1%±2.4%,开机后1年时分别为78.0%±11.2%、76.6%±16.1%、80.0%±19.8%。从开机时到开机后1年内,CI组ITMAIS得分(即其对言语声的察觉和识别能力)值升高迅速且发展速度超过同龄健听幼儿,在开机1年时ITMAIS得分已达健听儿童水平。结论早期植入CI幼儿随着年龄增长,其听觉发育能力可接近同龄健听幼儿,ITMAIS可简单、有效地评估其初期康复效果。     

重度聋幼儿助听器助听效果的评价

应用功能增益法评估 4 4名重度聋幼儿配戴助听器后的助听效果 ,追踪观察三年 ,全部患儿的助听效果均较初诊时好 (P <0 .0 5 ) ,其中双耳配戴助听器患儿较单耳配戴者效果更好     

助听器干预对西藏高原地区听障患者的疗效分析

目的 探讨助听器干预对久居(超过40年)西藏高原地区听障患者的疗效情况。方法 选取49例(63耳)助听器佩戴者进行分析，包括听力情况、听阈、助听器后言语及助听器效果国际问卷主观感受相关分析等，并对助听器补偿效果进行了综合评价。结果 63耳中，中度听力损失34耳，重度听力损失25耳，极重度听力损失4耳。其中单耳35例，问卷平均得分(20.34±4.39)分；双耳14例，问卷平均得分(27.07±4.16)分；双耳得分高于单耳分数。助听言语分辨率与问卷主观评估呈正相关(r=0.528,P<0.01)。助听阈值显示大多数患耳未得到最佳的听力补偿，但助听器干预前后听力比较具有统计学意义(P<0.05),高频听力补偿更为明显。助听后言语测听显示，助听后言语最大分辨率较助听前高(P<0.05)。结论 高原地区听障者对助听器的使用客观听力参数与主观评价相对一致，助听效果较为显著而且双耳验配较单耳验配更具优势，总体助听效果持肯定态度。     

老年人助听器配戴效果的问卷评估

目的评估老年人配戴助听器的效果。方法采用日常生活助听满意度问卷(the satisfaction with amplification in daily life,SADL)和患者导向的听觉改善分级(client oriented scale of improvement,COSI)问卷门诊或电话随访62例老年助听器配戴者(年龄62～87岁,平均73.45±5.54岁,配戴助听器时间为6周左右)的主观效果,包括配戴助听器后听力残疾的改善程度、最终能力和满意度等,并将SADL问卷结果与Cox等1999年建立的标准值作比较;比较耳背式与耳内式、双耳与单耳助听器配戴效果的差异。结果 62例受试者SADL问卷总平均分4.97±0.35,积极作用4.38±0.51,服务与花费4.55±0.39,负面作用5.82±0.68,个人形象5.88±0.60分;COSI问卷改善程度的得分为3.05±0.57,最终能力3.54±0.45分(分值越高代表效果越好)。SADL问卷在负面作用方面的得分高于Cox的标准,耳背式助听器在个人形象方面的得分低于耳内式助听器,在负面作用方面的得分高于耳内式,差异均有统计学意义(P<0.05)。单双耳配戴助听器后SADL和COSI问卷的得分差异均无统计学意义。结论 SADL和COSI问卷作为评估老年人助听器配戴效果的有效方法,简单易懂、耗时短;对于老年人,耳背式助听器在负面作用方面好于耳内式,个人形象方面差于耳内式助听器。     

不同听觉补偿方式下听障儿童的听觉言语康复效果比较

目的比较选配助听器与人工耳蜗植入术后听障儿童的听觉言语康复效果,探讨不同听觉补偿方式对其听觉言语康复效果的影响。方法选取32例6~43月龄选配助听器或人工耳蜗植入后的重度及极重度感音神经性语前聋患儿为研究对象,其中助听器组18名,人工耳蜗组14名,两组的听力损失程度无统计学差异,均在干预1年内进行相同的听觉言语康复训练,使用声场测听测试助听听阈;使用婴幼儿有意义听觉整合量表评估干预前及干预后3、6、9、12个月时的听觉能力;采用《听障儿童听觉言语能力评估》测试两组康复训练前后的言语能力。结果两组患儿助听听阈均优于助听前,但人工耳蜗组各频率助听听阈显著优于助听器组(P<0.05);两组听觉能力得分均随听觉补偿时间的延长而提高(P<0.05);助听器组在干预后9个月的听觉能力得分明显高于干预前、干预3个月及干预6个月(P<0.05);人工耳蜗组在术后6个月的听觉能力得分高于术前及术后3个月(P<0.05);人工耳蜗组在干预后6、9、12个月的听觉能力得分均高于助听器组(P<0.05);两组助听后康复级别及言语年龄均高于助听前,人工耳蜗组康复级别及言语年龄均高于助听器组(P<0.05)。结论对于极重度以上感音神经性聋婴幼儿,人工耳蜗植入者听觉言语康复效果优于助听器选配者。     

双耳双模式助听儿童情感语调感知特征

目的探讨单侧人工耳蜗植入儿童对侧配戴助听器能否提升其情感语调识别能力,不同的情绪语调识别是否存在难度差异。方法选取35例(男15例,女20例)双耳双模式助听的重度、极重度感音神经性听力损失儿童,组内比较单侧人工耳蜗助听状态和双模式助听两种状态下儿童的情感语调识别特征。结果双耳双模式助听状态下听障儿童的语调得分极显著高于单侧人工耳蜗助听状态(P<0.01),识别率总体提升了16.65%。开心语调提升了20.59%,生气语调提升了19.21%,难过语调提升了13.23%。个体数据分析发现,有82.85%的儿童体现出双耳双模式优势。两种助听状态下,生气语调识别得分显著高于开心和难过(P<0.05),双耳双模式助听状态下,23.53%的儿童会将开心感知为难过语调,22.79%的儿童会将难过感知为开心语调。结论相比于单侧人工耳蜗植入,儿童通过双模式助听可以获得情感语调感知优势;两种助听模式下,生气语调的识别均比开心和难过容易,开心和难过语调容易混淆。频率变化可能是儿童感知情感语调的重要线索,提示在康复训练中应予以重视。     

不同助听模式下儿童言语康复效果分析

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...     

助听器效果国际性调查问卷在助听器效果评估中的应用

目的 探讨助听器效果自我评估问卷在助听器效果评估中的作用.方法 对76例助听器使用者,使用助听器效果国际性调查问卷(the international outcome inventory for hearing aids,IOI-HA)通过面对面问答或电话随访的方式,进行助听器效果及满意度评估.结果 89.5%的使用者认为助听器对他们有帮助,可以解决目前的听力障碍问题;97.3%的使用者认为使用助听器后生活质量有提高.小于60岁的使用者得分高于大于等于60岁者,差异有显著统计学意义(P<0.01);每天使用助听器时间大于8小时的使用者得分高于小于等于8小时者.差异有显著统计学意义(P<0.01);使用助听器时间大于6个月的使用者得分高于小于等于6个月者,差异有显著统计学意义(P<0.01).结论 助听器效果国际性调查问卷可以对助听器效果及满意度进行评估,由于它测试时间短,易操作,可作为配戴助听器后一个可靠的主观效果评估手段.     

听障婴幼儿听觉干预后短期听觉语言能力评估

目的探讨不同助听设备及康复时间与听障婴幼儿听觉语言能力的关系,初步分析国内研发的评估方法与国际通用评估方法的关系。方法共选取47例13-36月龄重度或极重度感音神经性聋婴幼儿为观察对象,按助听设备类型将其分为助听器组(25例)与人工耳蜗组(22例),采用《听力障碍儿童听觉、语言能力评估标准及方法》分别在听觉干预的不同阶段(听觉干预0个月、3个月、6个月、9个月和12个月)评估受试者言语听觉能力与语言能力,同时通过问卷方式获得其听觉行为分级标准(categories of au-ditory performance,CAP)、言语可懂度分级标准(speech intelligibility rating,SIR)、婴幼儿有意义听觉整合量表(infant-toddler meaningful auditory integration scale,IT-MAIS)、有意义言语使用量表(meaningful use ofspeech scale,MUSS)和《小龄儿童听觉发展问卷》(Littl EARS Auditory Questionnaire)得分。结果经重复测量方差分析显示,随着听觉干预时间的推移,重度或极重度感音神经性聋婴幼儿言语听觉和语言能力逐渐提高。助听器组和人工耳蜗组在一年内言语听觉和语言能力差异无统计学意义。运用相关性分析得知,言语识别率与CAP、IT-MAIS和Littl EARS得分之间分别具有显著的线性相关,语言年龄与SIR得分之间有显著的线性相关,与MUSS得分之间无显著的线性相关。结论重度或极重度感音神经性聋婴幼儿助听听阈进入言语香蕉图范围的前提下,助听设备对其一年内言语听觉和语言能力的影响不存在差异。国内研发的评估方法与国际通用评估方法有一定程度的关联,可互为参考,但不可完全相互替代。     

自适应动态范围优化技术临床应用效果探讨

目的比较宽动态范围压缩线路(wide dynamic range compression,WDRC)助听器和自适应动态范围优化线路(adaptive dynamic range opti mization,ADRO)助听器的助听性能。方法选择具有2年以上WDRC线路助听器配戴史的中重度感音神经性听力损失青年人9名(13耳),分别配戴WDRC线路助听器和ADRO线路助听器,经8周适应期后,通过问卷调查和言语识别率测试对不同压缩线路助听器的助听效果进行评估。结果问卷调查结果显示,受试者配戴WDRC线路助听器在适宜交谈的安静环境(EC)、具有背景噪声的环境(BN)、存在回响和混响的环境(RV)、令人厌恶的或突然的声音(AV)的聆听困难度(不适度)的得分分别为20.2%、33.5%、45.6%、38.9%;配戴ADRO线路助听器在EC、BN、RV、AV的聆听困难度(不适度)的得分分别为17.9%、35.4%、53.6%、46.9%。言语识别率测试结果则显示,无论是处于安静环境或噪声环境,针对不同强度的声音信号,受试者配戴ADRO线路助听器所记录的言语识别率较配戴WDRC线路助听器所记录的言语识别率平均可提高8%~10%(P值均<0.05)。结论自适应动态范围优化线路助听器的助听性能优于宽动态范围压缩线路助听器。     

Outcome assessment alternatives for young children during the first 12 months after pediatric hearing-aid fittings

Abstract

Objective: Perform longitudinal evaluations of young children during the first 12 months after initial hearing-aid fitting. Document evidence of early prelingual auditory development (EPLAD), identify factors that affect EPLAD, and define performance milestones that can guide best practices. Design: Unblinded, prospective, within-subject, repeated-measures design. Audiological measures and measures of EPLAD were taken at baseline, 3, 6, and 12 months after hearing-aid fitting. Study sample: Subjects were 45 pediatric patients initially fitted with hearing aids between 1 and 5.5 years of age. Four groups were formed for analysis purposes based on severity of hearing loss (moderate-to-severe and profound) and initial fitting age (≤?30 months and >?30 months). Results: All groups exhibited statistically significant increases in EPLAD within six months of hearing-aid fitting, and those with profound losses exhibited further statistically significant improvement between six and 12 months. Similar EPLAD levels were reached at 12 months regardless of severity of hearing loss. The EPLAD trajectory is similar to that following early cochlear implantation. Conclusions: Measures of EPLAD provide a means of evaluating outcomes following early pediatric hearing-aid intervention, supplementing behavioral audiological measures.     

Initial classification of pediatric hearing impairment using behavioral measures of early prelingual auditory development

Objective: Determine the sensitivity, specificity, and accuracy of pediatric hearing loss classification using behavioral evidence of early prelingual auditory development (EPLAD). Validate behavioral measures of EPLAD. Design: EPLAD was assessed in a prospective sample of hearing-impaired children using the infant-toddler meaningful auditory integration scale (ITMAIS/MAIS). Hearing losses were classified using tone-burst auditory brainstem response (ABR) and ITMAIS/MAIS scores. This process was repeated in a second retrospective sample. Study sample: The prospective sample was comprised of 139 hearing-impaired children under five years of age. Approximately equal proportions of mild-moderate, severe, and profound losses were included. The second retrospective sample was comprised of case records for 144 hearing-impaired children meeting the same selection criteria. This sample contained more than 80% profound losses. Results: EPLAD trajectories reached different asymptotes after two years of age, depending on the severity of hearing loss, allowing children over this age to be classified. The sensitivity of EPLAD classifications was over 90%; specificity was over 82%; and accuracy was over 88%. Conclusions: Behavioral evidence of EPLAD provides an initial means of classifying pediatric hearing losses which can facilitate initial treatment options prior to diagnostic evaluation with tone-burst ABR.     

小龄耳聋儿童听觉能力发展问卷评估

目的评估选配助听器和人工耳蜗植入儿童的听觉能力,为制定合理的康复训练计划提供资料和依据。方法调查对象为50名语前聋儿童(患儿组),其中使用人工耳蜗和助听器者各25名;生理年龄为3至65个月,平均28±14个月;听力年龄为0至21个月,平均8±5个月。使用小龄儿童听觉发展测评工具中的《小龄儿童听觉发展问卷之评价儿童听觉行为的父母问卷》进行调查,问卷由家长填写,结果与引自小龄儿童听觉发展测评工具中听力正常儿童的正常值进行对比分析。结果患儿选配助听器或植入人工耳蜗的平均月龄为20±13个月。3岁以下32人(64%,32/50),3岁以上18人(36%,18/50)。33名患儿出生时接受过听力筛查(66%,33/50),17名未接受过听力筛查(34%,17/50)。随听力年龄的增长,各组儿童的听觉能力均不断提高,使用人工耳蜗患儿的听觉能力进步速度比佩带助听器的患儿快,3岁以下选配助听器或植入人工耳蜗的患儿听觉能力的发展速度比3岁以上快;各组患儿听觉能力的发展速度均比正常儿童慢。结论耳聋患儿使用助听装置时间越长,其听觉能力发育的越好。重度以上耳聋儿童宜早期进行人工耳蜗植入。     

108例重及极重度聋幼儿助听效果观察

目的　为双耳重、极重度感音神经性聋患儿选配助听器 ,并进行定期调试 ,观察助听效果。方法　用功能增益法评估助听器效果。结果　佩戴助听器 1～ 3年后的助听器效果较初戴时好 ,两者之间有显著性差异 (P<0 .0 1) ,高频差异更大。结论　聋儿佩戴经验配后的助听器 ,听敏度特别是高频部分的听敏度有提高     

Early prelingual auditory development and speech perception at 1-year follow-up in Mandarin-speaking children after cochlear implantation

Objective

The primary purpose of the current study was to evaluate early prelingual auditory development (EPLAD) and early speech perception longitudinally over the first year after cochlear implantation in Mandarin-speaking pediatric cochlear implant (CI) recipients. Outcome measures were designed to allow comparisons of outcomes with those of English-speaking pediatric CI recipients reported in previous research.

Method

A hierarchical outcome assessment battery designed to measure EPLAD and early speech perception was used to evaluate 39 pediatric CI recipients implanted between the ages of 1 and 6 years at baseline and 3, 6, and 12 months after implantation. The battery consists of the Mandarin Infant-Toddler Meaningful Auditory Integration Scale (ITMAIS), the Mandarin Early Speech Perception (MESP) test, and the Mandarin Pediatric Speech Intelligibility (MPSI) test. The effects of age at implantation, duration of pre-implant hearing aid use, and Mandarin dialect exposure on performance were evaluated. EPLAD results were compared with the normal developmental trajectory and with results for English-speaking pediatric CI recipients. MESP and MPSI measures of early speech perception were compared with results for English-speaking recipients obtained with comparable measures.

Results

EPLAD, as measured with the ITMAIS/MAIS, was comparable in Mandarin- and English-speaking pediatric CI recipients. Both groups exceeded the normal developmental trajectory when hearing age in CI recipients and chronological age in normal were equated. Evidence of significant EPLAD during pre-implant hearing aid use was observed; although at a more gradual rate than after implantation. Early development of speech perception, as measures with the MESP and MPSI tests, was also comparable for Mandarin- and English-speaking CI recipients throughout the first 12 months after implantation. Both Mandarin dialect exposure and the duration of pre-implant hearing aid use significantly affected measures of early speech perception during this time period.

Conclusions

EPLAD and early speech perception exhibited similar patterns of improvement during the first 12 months after early cochlear implantation. The duration of pre-implant hearing aid use had a significant positive effect on both categories of outcome measures. Consistent post-implant EPLAD trajectories and early speech perception results provide objective evidence that can guide best practices in early intervention protocols.     

Assessment of basal sound identification skills and communication abilities in profoundly deaf children fitted with hearing aids or a cochlear implant

Basal auditory functions and early verbal communication skills were examined in young, profoundly deaf children with hearing aids or a cochlear implant. The hearing aid users (n = 23) were subdivided on the basis of their (unaided) hearing thresholds into: group A (pure tone average (PTA) at 0.5, 1 and 2 kHz: 90–100 dB HL); group B (PTA: 100–110 dB HL); and group C (PTA > 110 dB HL). All the children with a cochlear implant (n = 20) had a profound sensorineural hearing loss with a PTA that exceeded 120 dB HL. Functional hearing was evaluated by means of basal sound identification. The child’s communication abilities with hearing aids or a cochlear implant were assessed using structured observations on the Scales of Early Communication Skills for Hearing Impaired Children. The basal auditory functions on a sound identification level improved over time in the cochlear implant users and groups A and B. Hardly any improvement was seen in group C. The performance of all the groups (either hearing aid or cochlear implant) on the Scales of Early Communication Skills for Hearing Impaired Children at 6 months after fitting the device and at later evaluations, was close to the average level for their age.     

Der Wortschatzumfang bei jungen sensorineural schwerhörigen Kindern

The primary aim of the study was to measure the receptive and expressive vocabulary with respect to clinical parameters and selected socio-demographic variables and to assess whether the size of vocabulary could be predicted by certain variables in a consecutive series of children identified as having bilateral sensorineural hearing loss ("G?ttinger H?r-Sprachregister"). METHOD: All children aged between 2;6 to 6;3 years diagnosed in the Department of Phoniatrics/Pedaudiology of the University G?ttingen as having a permanent bilateral sensorineural hearing impairment ("G?ttinger H?r-Sprachregister") in a defined period (july 1995-september 2000) were examined with standardized receptive and expressive vocabulary tests as well as a nonverbal intelligence test (on average 5.5 months after diagnosis and 2.9 months after fitting with hearing aids). SAMPLE: 37 children (20 boys, 17 girls). Mean age at diagnosis: 48.5 (SD 15.9; min. 18, max. 75) months, mean age at hearing aid fitting: 51 months (SD 15.2). Multiple handicapped children, children with additional conductive hearing impairment and those with postnatal losses were excluded. The sample as a whole demonstrated lexical deficits of varying severity that were greater in the expressive than in the receptive vocabulary, depending on the clinical parameter. Children with congenital hearing impairment, with severe-to-profound hearing impairment (> 70 dB) and bilingual children demonstrated on average the smallest receptive and expressive vocabulary. An early fitting with hearing aids did not correspond with a better lexical development when a severe-to-profound hearing impairment existed. Severity of a hearing impairment and nonverbal intelligence significantly predicted the average size of the receptive vocabulary. A moderate hearing impairment, high non-verbal intelligence, and gender (female) emerged as the strongest significant predictors of the expressive vocabulary. The vocabulary test result of a bilateral sensorineurally hearing-impaired child may be an indicator for early cognitive training.     

Early Diagnosis of Infant Hearing Impairment after Introduction of Newborn Hearing Screening (UNHS)

In 2009, the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) enacted to introduce the newborn hearing screening (NHS). The records of 11?155 children were analyzed with the aim to obtain data of the age at the time of determined diagnosis of childhood hearing impairment before and after introduction of the NHS.The records of all children presented at our department between January 1, 2000, and December 31, 2009, based on suspected hearing impairment were evaluated. Additionally the data of 3?325 newborns were analyzed who had been screened between 2003 and 2010. The recorded data included the age at the time of determined diagnosis, the type and grade of hearing impairment of the different age groups, the start and type of rehabilitation, the incidence of consecutive control examinations.For the evaluation interval a total of 1?410 children with permanent hearing impairment could be identified. The mean age at the time of diagnosis was 64 months in 2000 and was reduced to 8.6 months in 2005. Between 2006 and 2009 the babies' mean age was 3.3 months at the time of diagnosis and after introduction of NHS in 2009, the mean age at the time of determined diagnosis was again reduced to 2.4 months. The part of diagnosed sensorineural hearing loss is higher than other hearing disturbances.The introduction of NHS verified to improve the early detection of childhood hearing impairment. The early diagnosis allows an early rehabilitation and makes a positive development of the children possible. However, children with permanent hearing impairment require continuous long-term care of competent specialists.     

Hearing aid fitting in children treated at the Phoniatric Outpatient Clinic in Zabrze in years 1986-1990

The purpose of this study was to evaluate the hearing aid fitting of 179 regularly controlled, hearing-disabled children from the Silesian area, first time admitted to Phoniatric Outpatient Clinic in Zabrze in years 1986-1990. The mean age of provision of a hearing aid was high. Children were supplied with hearing aids at mean age of 4,9 years (losses > 60 dB) and of 9,3 years (losses < or = 60 dB). There was a delay from 8,4 up to 12,5 months (losses < or = 60 dB) between the age of fitting and the issue of the hearing aid. It was also stated that the total amount of children wearing their aids binaurally decreased significantly from 118 to 74 during 5 years' period. As for the utilisation of hearing aids, prevalence of full-time users (57.9%) was demonstrated in confrontation to non-users (5.6%).