不同月龄婴幼儿人工耳蜗植入术后听觉能力发育规律及特点

目的：总结不同月龄婴幼儿人工耳蜗植入术后听觉能力的发育规律及特点,为婴幼儿患儿人工耳蜗植入年龄的选择及制定合理的术后听力言语康复训练计划提供依据。方法：共有139例极重度语前聋婴幼儿患儿参加本次研究。按手术时年龄将患儿分为A组（≤12个月）、B组（13～18个月）、C组（19～24个月）、D组（25～30个月）、E组（31～36个月）。使用婴幼儿有意义听觉整合量表（IT-MAIS）并由经过培训的听力学专业人员对患儿术后听觉能力进行评估。评估采用面对面询问的方式,由患儿家长或监护人回答。评估人员将家长或监护人对每一问题的回答进行详细记录并根据患儿听觉行为出现的频率对其进行评分。分别在术前和术后开机后1、3、6、12个月时对各组患儿进行评估。结果：经两组独立样本T检验,不同性别患儿在术前和术后不同时期听觉能力的差异均无统计学意义（均P〉0．05）。经单因素方差分析,在术前和开机后1、3、6、12个月各年龄组患儿听觉能力的差异均无统计学意义（均P〉0．05）。各年龄组患儿听觉能力得分随开机时间的增加而增加,其差异有统计学意义（P〈0．05）。结论：不同性别婴幼儿患儿术后听觉能力的发育遵循相同的规律。婴幼儿患儿手术时年龄对术后听觉能力的发育影响不大。大部分患儿的听觉能力在术后6个月之内提高较快,其后进入较缓慢的发展期。     

植入年龄对婴幼儿人工耳蜗患者早期听力发育的影响

目的:评估使用人工耳蜗的婴幼儿患者的早期听觉能力,总结其发育规律,探讨植入年龄对患儿人工耳蜗植入术后1年内听觉能力发育的影响,为其有效康复提供临床资料。方法:将272例因极重度语前聋行人工耳蜗植入的婴幼儿根据植入年龄分为3组:A组,植入年龄<18个月(107例);B组,植入年龄18～24个月(74例);C组,植入年龄>24～36个月(91例)。使用听觉行为分级(CAP)问卷对患儿的听觉能力分别在术前及术后开机1、3、6、9、12个月进行评估。结果:患儿CAP得分在术前及术后开机1、3、6、9、12个月之间均差异有统计学意义(均P<0.05)。A、B、C 3组患儿的CAP得分在术后开机1、3个月间差异有统计学意义(P<0.05),而术前和术后开机6、9、12个月之间均差异无统计学意义(均P>0.05)。结论:极重度语前聋患儿人工耳蜗植入后的听觉能力在术后1年内有显著提高,植入年龄对患儿术后早期听觉能力的发育无显著影响,CAP问卷适合在中国临床工作中使用。     

Effect of age at cochlear implantation on auditory and speech development of children with auditory neuropathy spectrum disorder

Objective

To evaluate the auditory and speech abilities in children with auditory neuropathy spectrum disorder (ANSD) after cochlear implantation (CI) and determine the role of age at implantation.

Methods

Ten children participated in this retrospective case series study. All children had evidence of ANSD. All subjects had no cochlear nerve deficiency on magnetic resonance imaging and had used the cochlear implants for a period of 12–84 months. We divided our children into two groups: children who underwent implantation before 24 months of age and children who underwent implantation after 24 months of age. Their auditory and speech abilities were evaluated using the following: behavioral audiometry, the Categories of Auditory Performance (CAP), the Meaningful Auditory Integration Scale (MAIS), the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS), the Standard-Chinese version of the Monosyllabic Lexical Neighborhood Test (LNT), the Multisyllabic Lexical Neighborhood Test (MLNT), the Speech Intelligibility Rating (SIR) and the Meaningful Use of Speech Scale (MUSS).

Results

All children showed progress in their auditory and language abilities. The 4-frequency average hearing level (HL) (500 Hz, 1000 Hz, 2000 Hz and 4000 Hz) of aided hearing thresholds ranged from 17.5 to 57.5 dB HL. All children developed time-related auditory perception and speech skills. Scores of children with ANSD who received cochlear implants before 24 months tended to be better than those of children who received cochlear implants after 24 months. Seven children completed the Mandarin Lexical Neighborhood Test. Approximately half of the children showed improved open-set speech recognition.

Conclusion

Cochlear implantation is helpful for children with ANSD and may be a good optional treatment for many ANSD children. In addition, children with ANSD fitted with cochlear implants before 24 months tended to acquire auditory and speech skills better than children fitted with cochlear implants after 24 months.     

婴幼儿人工耳蜗植入术后听觉能力的发育

目的:观察行人工耳蜗植入术的婴幼儿听觉能力的发展规律,试图为患儿制定合理的术后听力言语康复训练计划提供依据。方法:共有86例患儿参加本次调查,手术年龄为1～3岁,均为语前聋患儿。评估使用婴幼儿有意义听觉整合量表(ITMAIS),由经过培训的听力学专业人员进行评估。评估人员逐一询问量表中的10个问题,主要调查患儿的发声情况、对声音的觉察能力和对声音的理解能力等三方面的内容,由家长对患儿在日常生活中听力方面的自发性反应做出详细的描述。分别在术前和术后开机后1、3、6、12个月时对患儿的上述情况进行评估。评估人员根据患儿听觉行为出现的频率进行评分。结果:经单因素方差分析,问题1的得分在术前与开机后1、3、6、12个月之间差异均有统计学意义(均P<0.01);问题2的得分在术前与开机后6、12个月之间差异均有统计学意义(均P<0.01);问题3的得分在术前与开机后3、6、12个月之间差异均有统计学意义(均P<0.01);问题4的得分在术前与开机后3、6、12个月之间差异均有统计学意义(均P<0.01);问题5的得分在术前与开机后1、3、6、12个月之间差异均有统计学意义(分别为P<0.05,P<0.01和P<0.01,P<0.01);问题6的得分在术前与开机后3、6、12个月之间差异均有统计学意义(分别为P<0.05,P<0.01,P<0.01);问题7的得分在术前与开机后3、6、12个月之间差异均有统计学意义(均P<0.01);问题8的得分在术前与开机后6、12个月之间差异均有统计学意义(均P<0.01);问题9的得分在术前与开机后3、6、12个月之间差异均有统计学意义(分别为P<0.05,P<0.01,P<0.01);问题10的得分在术前与开机后12个月之间的差异有统计学意义(P<0.05)。结论:患儿术前对日常生活中的声音不能作出准确的反应,而术后的发声情况、对声音的觉察能力和对声音的理解能力均有显著改善。患儿术后对声音理解能力的发育较发声行为和对声音的觉察能力的发育慢。     

Evaluation of auditory development in infants and toddlers who received cochlear implants under the age of 24 months with the LittlEARS Auditory Questionnaire

Background and Aims

Newborn hearing screening and early intervention for congenital hearing loss have created a need for tools assessing the hearing development of very young children. A multidisciplinary evaluation of children's development is now becoming standard in clinical practice, though not many reliable diagnostic instruments exist. For this reason, the LittlEARS^® Auditory Questionnaire (LEAQ) was created to assess the auditory skills of a growing population of infants and toddlers who receive hearing instruments. The LEAQ relies on parent report, which has been shown to be a reliable way of assessing child development. Results with this tool in a group of children who received very early cochlear implantation are presented.

Methods

The LEAQ is the first module of the LittlEARS^® comprehensive test battery for children under the age of two who have normal hearing (NH), cochlear implants (CIs) or hearing aids (HAs). The LEAQ is a parent questionnaire comprised of 35 “yes/no” questions which can be completed by parents in less than 10 min. Sixty-three children who received unilateral CIs at a young age were assessed longitudinally and their performance was compared to that of a NH group.

Results

All CI children reached the maximum possible score on the LEAQ on average by 22 months of hearing age, i.e. 38 months of chronological age. In comparison, the NH group reached the maximum score by 24 months of age demonstrating that auditory skills of CI children often develop quicker than those of NH children. In the two comparison groups of children aged (a) younger and older than 12 months, and (b) between 6-9 and 21-24 months at first fitting, the early implanted children reached the highest scores faster than the later implanted children. Furthermore, three children with additional needs were tested. They showed slower growth over time but also received benefits from early implantation.

Conclusions

The LEAQ is a quick and effective tool for assessing auditory skills of very young children with or without hearing loss. In our study, the auditory skills of children with CI progressed very quickly after implantation and were comparable with those of NH peers.     

植入年龄对婴幼儿人工耳蜗植入患者早期言语可懂度的影响

目的本研究评估使用人工耳蜗的婴幼儿患者早期言语可懂度发育并探讨植入年龄对言语可懂度的影响,为患儿的听力言语康复提供指导。方法共有272例极重度语前聋人工耳蜗植入婴幼儿参加本次研究。手术年龄9～36个月,平均（21±7）个月。根据植入年龄将患儿分为3个组：A组小于18个月,B组为19～24个月,C组为25～36个月。使用言语可懂度分级（speech intelligibility rating,SIR）问卷在术前及术后开机后1、3、6、9个月和1年时对患儿进行评估。结果患儿SIR平均得分在术前、术后开机后1、3、6、9个月和1年之间的差异有显著性。3个组患儿SIR平均得分在术后开机后3个月、6个月之间的差异有显著性,在术前、术后开机后1个月、9个月、1年之间的差异无显著性。结论极重度语前聋人工耳蜗植入婴幼儿患者的言语可懂度在术后1年内有显著提高。植入年龄对婴幼儿人工耳蜗患者术后早期言语可懂度发育没有显著影响。     

The effect of age at cochlear implant initial stimulation on expressive language growth in infants and toddlers.

This study examined the growth of expressive language skills in children who received cochlear implants (CIs) in infancy. Repeated language measures were gathered from 29 children who received CIs between 10 and 40 months of age. Both cross-sectional and growth curve analyses were used to assess the relationship between expressive language outcomes and CI experience. A beneficial effect of earlier implantation on expressive language growth was found. Growth curve analysis showed that growth was more rapid in children implanted as infants than those implanted as toddlers. Age at initial stimulation accounted for 14.6% of the variance of the individual differences in expressive language growth rates.     

Language development in deaf infants following cochlear implantation

OBJECTIVE: To evaluate the benefits of cochlear implantation in infancy and compare them to those obtained in children implanted at a slightly older age. MATERIAL AND METHODS: Using standard language measurement tools, including the Grammatical Analysis of Elicited Language--Presentence Level (GAEL-P) and the Reynell Developmental Language Scales, progress was documented in a child who received a cochlear implant in infancy and compared to that achieved in children implanted at older ages. A new measurement tool, the Visual Habituation Procedure, was used to document early skills and the results were compared to those obtained in normal-hearing infants. RESULTS: By the age of 2 years the subject implanted in infancy achieved scores on the GAEL-P which were nearly equivalent to those achieved at the age of 5 1/2 years by children implanted at later ages. Age-equivalent scores on the Reynell Developmental Language Scales were achieved by the subject implanted in infancy and the ability to discriminate speech patterns was demonstrated using the Visual Habituation Procedure. CONCLUSION: This report demonstrates enhanced language development in an infant who received a cochlear implant at the age of 6 months.     

The development of auditory skills in infants with isolated Large Vestibular Aqueduct Syndrome after cochlear implantation

Objective

The purpose of this study was to investigate the auditory performance of infants with isolated Large Vestibular Aqueduct Syndrome (LVAS) after cochlear implantation, compare their performance with those of infants with a normal inner ear, and establish a database of auditory development.

Method

435 infants with congenital severe to profound hearing loss participated in this study. 62 infants in group A were diagnosed with isolated LVAS. 373 infants in group B had a normal inner ear. Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) was used to evaluate the development of auditory skills.

Results

The mean scores for auditory ability showed no significant difference between groups A and B. The mean scores for the three different auditory skills increased significantly over time. The differences were statistically significant in mean scores among the three different auditory skills for group B.

Conclusion

Auditory skills of infants with isolated LVAS developed rapidly after cochlear implantation, in a similar manner to those of infants with a normal inner ear. Cochlear implantation is an effective interventional approach and an established therapeutic option for infants with isolated LVAS.     

The development of auditory perception in children following cochlear implantation

The time course for the development of auditory perception in prelingually deaf children following cochlear implantation may extend over many years, thus making long-term studies necessary to evaluate any such outcome. However, few such studies exist in the literature. We prospectively followed-up a consecutive group of 133 prelingually deaf children up to 6 years following implantation. All children were prelingually deaf with age at onset of deafness < 3 years and age at implantation < 8 years. The aetiology of deafness was meningitis for 45 children (34%), congenital deafness for 77 children (58%) and other causes for 11 children (8%). All were implanted with a Nucleus-22 multi-channel cochlear implant and followed the same rehabilitation programme. No child was lost to follow-up and there were no exclusions from the study. Prelingually deaf children showed significant improvement in the auditory perception with implant experience. 82% of children who reached the 6-year interval could understand conversation without lip-reading. The respective percentage in the 4-year interval was 70%. The long-term results of cochlear implantation reveal that the majority of prelingually deaf children, when implanted before the age of 8 years, will develop significant auditory perception.     

Age at implantation and auditory memory in cochlear implanted children

Abstract

Early cochlear implantation, before the age of 3 years, provides the best outcome regarding listening, speech, cognition an memory due to maximal central nervous system plasticity. Intensive postoperative training improves not only auditory performance and language, but affects auditory memory as well. The aim of this study was to discover if the age at implantation affects auditory memory function in cochlear implanted children. A total of 50 cochlear implanted children aged 4 to 8 years were enrolled in this study: early implanted (1-3y) n = 27 and late implanted (4-6y) n = 23. Two types of memory tests were used: Immediate Verbal Memory Test and Forward and Backward Digit Span Test. Early implanted children performed better on both verbal and numeric tasks of auditory memory. The difference was statistically significant, especially on the complex tasks. Early cochlear implantation, before the age of 3 years, significantly improve auditory memory and contribute to better cognitive and education outcomes.     

Central auditory maturation and babbling development in infants with cochlear implants

OBJECTIVE: To examine the relationship between the maturation of central auditory pathways and the development of canonical (speechlike) babbling in infants with cochlear implants. DESIGN: Comparison of the latencies of the P1 cortical auditory evoked potential and vocalizations produced by subjects before they were fitted with a cochlear implant and at several time points within the first year after implantation. SUBJECTS: Two congenitally deaf children who were implanted with a multichannel cochlear implant at ages 13 and 14 months. INTERVENTIONS: P1 response latencies were recorded in response to a /ba/ stimulus before implantation and at several time points following implantation. Vocalizations produced by the subjects while interacting with their caregiver were audiorecorded twice before implantation and at monthly sessions following implantation. RESULTS: Subjects showed a rapid decrease in P1 latencies resulting in normal P1 latencies within about 3 months after implantation. Before implantation, the vocalizations were primarily of a precanonical nature. After 3 months' experience with the implants, the proportion of canonical vocalizations increased dramatically relative to the number of precanonical utterances. CONCLUSIONS: Results of this study suggest that the development of P1 response latencies and the development of early communicative behaviors may follow a similar developmental trajectory in children implanted early. Although preliminary, these findings indicate that the development of early communicative behaviors following implantation may be positively influenced by the rate of plastic changes in central auditory pathways.     

Effect of age at cochlear implantation on open-set word recognition in Mandarin speaking deaf children

OBJECTIVE: The purpose of this study was to determine whether age at cochlear implantation influences open-set speech perception in children after long-term use of the implant device. METHOD: Twenty-eight congenitally deafened children, receiving implants of Nucleus CI24M devices, were divided into two groups: (1) CI < 3: those who received implants before 3 years of age and (2) CI > 3: those who received implants after 3 years of age. We compared open-set speech perception in CI < 3 and CI > 3 after 4-5 years of device use. Speech perception tests were conducted using the Mandarin Lexical Neighborhood Test (M-LNT). Unpaired t-test was applied for statistical analysis, and p < 0.05 was considered significant. RESULTS: In CI < 3, the average of percent correct was 80.0 +/- 8.8 and 70.5 +/- 9.2% on, respectively, the easy and hard versions of the M-LNT. By contrast, in CI > 3, the average percent correct was 62.5 +/- 19.9 and 59.1 +/- 15.2%, respectively. Regardless of the M-LNT version used, CI < 3 performed significantly better than CI > 3 (easy, p = 0.005 versus hard, p = 0.022). CONCLUSION: The present investigation demonstrated that age at implantation influences open-set speech perception of cochlear implanted children 4-5 years after device connection. Implantation before 3 years of age promotes the development of open-set speech perception abilities in congenitally deafened children.     

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.     

Impact of auditory cortical asymmetry in cochlear implantation

Abstract

Objective

Is there a cochlear implant ear advantage for speech perception?

Patients

A total number of 68 cochlear implant recipients were evaluated retrospectively. They were 20 adults implanted in right ear, 20 matched adults implanted in left ear while 14 children implanted in right ear and 14 matched children implanted in left ear.

Methods

Behavioral responses & age based speech perception tests were evaluated at 6 months and 1 year post implantation.

Results

Adult showed no statistical difference in all tests at 6 months evaluation while 1 year evaluation showed significant better performance for right implanted group in monosyllabic discrimination test. Children showed statistical significant performance in monosyllabic identification and minimal pairs testes at 6 months evaluation; and in monosyllabic identification only at 1 year evaluation.

Conclusion

The present data support that right ear implantation would fasten the development of auditory skills especially in young children, an issue to be considered in unilateral implantation.     

The effect of age at cochlear implantation outcomes in Saudi children

Objectives

To determine for the effect of age (late versus early age) on the cochlear implant outcomes; in terms of language development, auditory skills, speech perception, and production outcomes).

Methods

67 children were included in the study out of 93 implanted cases in the study period. Children were classified into 2 groups according to age at time of implantation. Group 1 contained 43 children who were implanted before the age of 5 years. Group 2 contained 24 children who were implanted after the age of 5 years. All children were evaluated pre-operatively and at 3, 6, 12, 24 months device experience using the language screening test, Standardized Arabic Language test, Listening Progress Profile (LiP Test), the Monosyllabic-Trochee-polysyllabic Test (MTP), and the meaningful Auditory Integration Scale (MAIS) Test. Charts with incomplete data were excluded.

Results

Only 67 children had complete data out of 93 patients. The mean age (in months) for Group 1 was (43.37 ± 8.63) and for Group 2 was (70.38 ± 9.97) at time of implantation. Significantly higher mean values were detected for Group 2 in comparison to Group 1 in the pre-operative period. No significant difference was detected after 2 years evaluation using the test battery for language development and auditory skills.

Conclusions

Children who were implanted under the 5 years of age had a better outcome in the form of better auditory skills, speech perception, and language production. Limited resources and the absence of a national hearing screening program in Saudi Arabia result in the late presentation of children for evaluation and intervention of hearing problem; this late intervention reduces the benefits the late – implanted children derive from cochlear implantation.     

Vocabulary acquisition rate after pediatric cochlear implantation and the impact of age at implantation

OBJECTIVE: studies of early vocabulary development after pediatric cochlear implantation show growth rates that approach normality. Do these growth rates continue to rise over time and, therefore, allow a 'catch up' with ideal scores for age, or do they decline after an initial peak. Could age at implantation be a decisive factor in that process? DESIGN: retrospective study (mean follow-up 4 years). Patients: pre-lingually deaf children implanted between 1988 and1999, who serially performed Peabody Picture Vocabulary Test-Revised (PPVT), (37 patients) and Expressive One-word Picture Vocabulary Test-Revised (EOWPVT), (35 patients). OUTCOME MEASURES: the mean rates of age equivalent scores were determined for the whole follow-up period and analyzed further for two post-implant periods (the two halves of follow-up duration of individual patients). After sub-grouping by age at implantation (younger or older than 5 years old), the same analysis was executed for each subgroup. RESULTS: the mean EOWPVT rate of the earlier period was higher than that of the later period (1.33 vs. 0.67, P<0.01) and the mean PPVT rate of the earlier period was higher than that of the later period (0.72 vs. 0.5). The latter difference was not statistically significant (P>0.05). Within subgroups by age at implantation, the PPVT mean rates were stable for younger implanted patients (0.56 for both periods) and dropped for the older implanted sub-group (0.87-0.43, P>0.05). The EOWPVT mean rates declined significantly for the older patients group (1.72-0.55, P<0.01) but insignificantly for the younger patients (0.99-0.77, P>0.05). CONCLUSIONS: vocabulary acquisition rates decline in the post-implantation period. This is more pronounced with older implanted children and the EOWPVT rates. This information on the time course development of vocabulary after implantation would be valuable in counseling and planning habilitation in addition to candidate selection.     

12月龄以下婴儿人工耳蜗植入的可行性分析与手术技巧

目的 分析12月龄以下婴儿人工耳蜗植入的可行性和相关手术技巧.方法 14例12月龄以下婴儿及63例13～24月龄幼儿在上海交通大学附属新华医院耳鼻咽喉头颈外科植入单侧人工耳蜗.记录分析内容分为两部分,手术相关部分包括手术时间、术中出血量、住院时间、手术并发症,听力学部分包括声场啭音听阈、听力表现指数、言语发育商、咿呀学语发生及爆发月龄.结果 婴儿组与幼儿组的住院时间((-x)±s,下同)分别为(5.1±0.5)d和(5.8±1.1)d,差异有统计学意义(t=-3.17,P<0.05);术后并发症发生率分别为7.1%(1/14)和11.1%(7/63),差异无统计学意义(x2=0.19,P<0.05);手术时间、术中出血量差异无统计学意义(t值分别为1.55和-0.86,P值均<0.05).随访时间12～24个月,随访期间,两组患儿声场啭音听阈、言语发育商均有提高,但差异无统计学意义(t值分别为4.6和3.8,P值均<0.05).80%(8/10)婴儿在术后24个月听力表现指数达到6～7分,且咿呀学语发生在(14.1 ±0.9)月龄,明显优于幼儿组的(22.6±3.0)月龄.结论 12月龄以下婴儿人工耳蜗植入具有可行性,可缩短患儿听力剥夺时间,但其手术技巧和经验要求较高,建议有经验的耳科医师有选择地谨慎开展这一领域的研究.     

Reading abilities after cochlear implantation: the effect of age at implantation on outcomes at 5 and 7 years after implantation

OBJECTIVES: The reading skills of deaf children have typically been delayed and this delay has been found to increase with age. This study explored the reading ability of a large group of children who had received cochlear implants 7 years earlier and investigated the relationship between reading ability and age at implantation. METHODS: The reading ages of 105 children, with age at implantation less than 7 years and onset of deafness below the age of three, were assessed 5 and 7 years after implantation using the Edinburgh reading test. Net reading age was calculated by using the difference between chronological age and reading age. Non-verbal intelligence was measured for a subset of 71 children, using Raven's coloured progressive matrices. Further investigation of this subset looked at the association of nonverbal intelligence, age at implantation and reading ability. RESULTS: There was a strong negative correlation at both 5 and 7 years after implant between net reading score and age at implantation. In the subset of 71 children who had an IQ score within normal range, those implanted at or before 42 months had age-appropriate reading both 5 and 7 years post-implant. This was not the case for children implanted after 42 months. Reading progress at the two post-implant assessment intervals were found to be highly related. CONCLUSIONS: Age at implantation was a significant factor in the development of reading skills in this group. In children implanted below the age of 42 months, reading progress was in line with chronological age, which has not been the case previously with profoundly deaf children. With earlier implantation more common in present groups, and improved technology, there is every reason to be optimistic about the influence of cochlear implantation on the development of reading skills in deaf children.     

听神经病及蜗神经发育不良儿童人工耳蜗植入的有效性

目的 通过问卷量表评估,探讨听神经病及蜗神经发育不良儿童的人工耳蜗植入效果.方法 实验组为2004年1月至2010年10月期间接受人工耳蜗植入的符合听神经病或蜗神经发育不良诊断标准、且术前至少佩戴3个月助听器并接受语言训练的患儿,共21例,其中听神经病9例,蜗神经发育不良12例.植入对照组为20例同期植入人工耳蜗的感音神经性聋患儿.所有人工耳蜗植入患儿均开机使用6个月以上.正常听力对照组为42例听力正常的儿童,按年龄分为正常听力A组(年龄在24个月以下)18例、正常听力B组(年龄24～ 48个月)16例和正常听力C组(年龄在48个月以上)8例.采用听觉行为分级(Categories of Auditory Performance,CAP)和言语可懂度分级(Speech Intelligibility Rating,SIR)两个量表进行评分,使用SPSS16.0软件对实验组得分与植入对照组和正常听力对照组进行比较.结果 听神经病组、蜗神经发育不良组、感音神经性聋组以及三组正常听力儿童的CAP得分(x±s,下同)分别为(4.44±1.50)分、(4.83±1.69)分、(4.55±1.66)分、(5.22±1.11)分、(6.75±0.45)分和(7.00±0.00)分,SIR得分分别为(2.66±1.11)分、(2.33±1.15)分,(2.40±0.75)分,(2.56±1.04)分、(4.12±0.81)分和(5.00±0.00)分.CAP和SIR得分在六组受试者间差异均具有统计学意义(x2=35.481,P＜0.001;x2 =40.549,P＜0.001);组内两两比较,听神经病组/蜗神经发育不良组与感音神经性聋组及正常听力A组得分比较,差异无统计学意义(P值均＞0.05),而与正常听力B组及C组相比,差异具有统计学意义(P值均＜0.01).结论 听神经病和蜗神经发育不良儿童接受人工耳蜗植入后,同感音神经性聋患儿一样,能够获得听觉及言语能力的进步,但落后于听力正常的同龄儿童.人工耳蜗提高此类患儿听觉及言语能力的远期效果还有待进一步随访和评估.