人工耳蜗植入术295例语言康复临床分析

目的 研究耳蜗植入术后听觉言语康复效果及其影响因素。 方法 采用听觉行为分级(CAP)、言语可懂度分级(SIR)及视频和录音言语清晰度分析法分别对295例人工耳蜗植入术后患者进行听觉言语康复效果评估。 结果 2例蜗神经细小合并内耳畸形患者开机听阈为45 dB,其余听阈为25~40 dB。单因素分析结果显示:术前助听器的佩戴、植入年龄、植入后时间、术前残余听力、内耳畸形程度、脑白质病变对CAP及SIR差异有统计学意义;手术方法、中耳炎、Waardenburg综合征对CAP、SIR差异无统计学意义。多因素Logistic回归分析结果显示:植入后时间、脑白质病变与CAP、SIR显著相关。 结论 大部分患者可从人工耳蜗植入术中获得满意效果,其听觉言语康复程度受多种因素的影响。

Clinical analysis of language rehabilitation in 295 cases of cochlear implantation

Objective To identify factors contributing to effective rehabilitation after cochlear implantation. Methods We evaluated the outcome of rehabilitation in 295 patients who underwent cochlear implantation by analysis of auditory performance(CAP), speech intelligibility rating(SIR), and articulation on audiovisual speech recordings. Results The hearing threshold was 25-40 dB in all patients except for 2, who had a combination of microcochlear and inner ear malformations and a hearing threshold of 45 dB. In univariate analysis, wearing a hearing aid, age at the time of cochlear implantation, time since implantation, degree of inner ear malformation, amount of residual hearing, and presence of leukodystrophy were correlated with CAP and SIR, whereas the surgical implantation method used and presence of otitis media or Waardenburg syndrome were not. In multivariate analysis using a stepwise logistic regression model, the most significant contributors to CAP and SIR were time since implantation and presence of leukodystrophy. Conclusion The outcomes of cochlear implantation are generally satisfactory and the degree of auditory rehabilitation is influenced by many factors.