Auditory and Language Development after Cochlear Implantation in Children with Inner Ear Malformation
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摘要:
目的 通过对内耳结构异常患儿进行人工耳蜗植入手术，评估该类患儿术后听觉言语发育情况，对比分析此类患儿与内耳结构正常患儿在听觉言语发育上的差异。 方法 回顾性分析52例行单侧人工耳蜗植入手术患儿，根据内耳结构有无异常分为结构异常组与结构正常组，每组各26例。对比分析2组在术前、术后1月、3月、6月、12月时听觉言语发育情况，其中听觉功能使用CAP与ITMAIS量表评估，言语功能使用SIR与MUSS量表评估。 结果 全部患儿在行人工耳蜗植入术后1、3、6、12月，听觉言语发育相关评分（CAP、ITMAIS、SIR、MUSS）较术前均有明显差异，且呈现逐步升高的趋势。结构正常组与结构异常组的听觉功能分别在术前、术后1、3、6、12月对比，差异有统计学意义（P < 0.001）。结构正常组与结构异常组在术前的言语功能SIR评分中对比，无明显差异，P = 0.303。但2组言语功能分别在术后1、3、6、12月对比，差异有统计学意义（P < 0.05）。 结论 内耳结构异常患儿行人工耳蜗植入手术，在术后1 a内的听觉言语能力较术前有明显提高，但内耳结构异常患儿在术后听觉言语发育上与内耳结构正常患儿有一定差异。 Abstract:Objective To systematically evaluate the development of auditory and language in children with inner ear malformation after cochlear implantation, in addition, to compare and analyze the differences of auditory and language development between these children and children with normal inner ear structure. Methods The 52 children with unilateral cochlear implantation were retrospectively selected and analyzed, they were divided into abnormal inner ear structure group and normal inner ear structure group according to whether the inner ear structure was abnormal or not, with 26 cases in each group. The auditory and language development of the two groups were compared and analyzed before operation, the 1st month, 3rd month, 6th month and 12th month after operation. The auditory function was assessed with CAP and ITMAIS scales, while the language function was assessed with SIR and MUSS scales. Results At the 1st month, 3rd month, 6th month and 12th month after cochlear implantation, the scores of auditory and language development （CAP, ITMAIS, SIR and MUSS） were significantly different from those before cochlear implantation, which has showed a gradually increasing trend. The auditory function of normal inner ear structure group and abnormal inner ear structure group were compared before operation, the 1st month, 3rd month, 6th month and 12th month after operation, there was statistical significant difference （P < 0.001）. There was no significant difference between the normal inner ear structure group and the abnormal inner ear structure group in the preoperative language function SIR score （P = 0.303）, however, there were significant differences in language function between the two groups at the 1st month, 3rd month, 6th month and 12th month after operation （P < 0.05）. Conclusion Within one year after cochlear implantation, the auditory and language ability of children with inner ear malformation has been significantly improved, however, there are some differences between the children with abnormal inner ear structure and those with normal inner ear structure. -
图 1 2组在不同时期听觉功能CAP变化趋势
Figure 1. The change trend of auditory function CAP in different periods of both groups
图 2 2组在不同时期听觉功能ITMAIS变化趋势
Figure 2. The change trend of auditory function ITMAIS in different periods of both groups
图 3 2组在不同时期言语功能SIR变化趋势
Figure 3. The change trend of speech function SIR in different periods of both groups
图 4 2组在不同时期言语功能MUSS变化趋势
Figure 4. The change trend of speech function MUSS in different periods of both groups
图 5 颞骨CT：冠位显示双侧耳蜗不完全分隔（红色箭头所示）
Figure 5. CT of the temporal bone: Coronary view shows that the cochlea is incompletely separated on both sides （the red arrows show）
图 6 耳蜗不完全分隔患儿右耳植入人工耳蜗（红色箭头显示植入的人工耳蜗电极）
Figure 6. The child with incomplete cochlea separation is implanted with cochlear implant in the right ear （the red arrow shows the implanted cochlear implant electrode）
表 1 患儿基本情况（n）
Table 1. The information of patients （n）
年龄（岁） 结构异常组 结构正常组 耳蜗前庭及半规管共同腔 耳蜗不完全分隔 耳蜗发育不全 大前庭导水管 0～ 1 2 6 1～ 1 1 7 1 10 2～ 5 7 3～ 1 3 3 4～ 1 5～ 6～ 1 2 0 合计 1 1 10 14 26 
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表 2 同一时间不同组间和同组不同时间听觉言语功能比较[M（P25，P75）]
Table 2. Comparison of auditory and speech functions among different groups during the same period or in the same group at different times [M（P25，P75）]
听觉言语功能 结构正常组（n = 26） 结构异常组（n = 26） U P CAP 术前 0.00（0.00，1.00） 0.00（0.00，0.00） 182.000 < 0.001* 术后1月 1.00（1.00，2.00） 0.00（0.00，0.00） 77.500 < 0.001* 术后3月 3.00（2.00，4.00） 1.00（0.00，2.00） 44.000 < 0.001* 术后6月 4.00（3.00，4.00） 2.00（1.00，3.00） 114.500 < 0.001* 术后12月 6.00（4.00，7.00） 3.00（3.00，5.00） 99.000 < 0.001* H 102.879 98.399 P < 0.001* < 0.001* ITMAIS 术前 1.50（1.00，2.00） 0.00（0.00，1.00） 65.000 < 0.001* 术后1月 4.00（2.75，5.00） 1.00（1.00，2.00） 58.500 < 0.001* 术后3月 12.00（10.00，13.25） 7.00（5.75，8.00） 0.000 < 0.001* 术后6月 18.50（15.75，22.25） 9.00（9.00，11.00） 0.000 < 0.001* 术后12月 28.50（24.75，31.25） 14.50（11.00，17.00） 0.000 < 0.001* H 119.569 119.282 P < 0.001* < 0.001* SIR 术前 1.00（1.00，1.00） 1.00（1.00，1.00） 312.000 0.303 术后1月 1.00（1.00，1.25） 1.00（1.00，1.00） 273.000 0.044* 术后3月 2.00（2.00，2.00） 1.00（1.00，1.00） 73.000 < 0.001* 术后6月 3.00（2.00，3.00） 1.00（1.00，1.00） 16.000 < 0.001* 术后12月 4.00（3.00，4.00） 2.00（1.00，2.00） 13.500 < 0.001* H 101.841 56.114 P < 0.001* < 0.001* MUSS 术前 5.00（5.00，5.00） 2.50（2.00，3.00） 0.000 < 0.001* 术后1月 5.00（5.00，6.00） 4.00（3.00，4.25） 59.500 < 0.001* 术后3月 11.00（9.75，11.25） 6.50（5.00，8.00） 12.000 < 0.001* 术后6月 15.00（13.00，16.25） 10.00（8.00，11.00） 0.000 < 0.001* 术后12月 20.50（18.00，21.00） 13.00（11.00，14.25） 0.000 < 0.001* H 121.564 115.497 P < 0.001* < 0.001* *P < 0.05。
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