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目的探讨合并脑白质异常聋儿行人工耳蜗植入手术的可行性及术后听觉、言语康复和认知发展情况。方法以2012年11月至2015年4月于南京鼓楼医院耳鼻咽喉头颈外科行人工耳蜗植入术的聋儿425例(425耳)中合并脑白质异常的6例患儿为实验组,选取同时期手术的6例脑白质正常聋儿为对照组。比较实验组手术前后言语能力,以及两组患儿术后听力、言语康复效果和认知发展水平。结果 (1)实验组和对照组手术前后的有意义听觉整合量表(MAIS)、听觉行为分级标准(CAP)和言语可懂度分级标准(SIR)差异有统计学意义(实验组:术后6个月,Z_(CAP)=-3.127,P_(CAP)=0.002;Z_(SIR)=-3.146,P_(SIR)=0.002;Z_(MAIS)=-2.898,PM AIS=0.004;术后12个月,Z_(CAP)=-3.317,P_(CAP)=0.001,Z_(SIR)=-3.108,P_(SIR)=0.002,Z_(MAIS)=-2.656,P_(MAIS)=0.008。对照组:术后6个月,Z_(CAP)=-3.108,P_(CAP)=0.002;Z_(SIR)=-3.127,P_(SIR)=0.002;Z_(MAIS)=-2.918,P_(MAIS)=0.004;术后12个月,Z_(CAP)=-3.146,P_(CAP)=0.002,Z_(SIR)=-3.207,P_(SIR)=0.001,Z_(MAIS)=-2.913,PMAIS=0.004);(2)手术前后,实验组平均听阈与对照组相比,差异无统计学意义(F=0.797,P=0.393);(3)实验组MAIS、CAP和SIR与对照组相比,术前差异均无统计学意义(Z_(CAP)=0.000,P_(CAP)=1.000;Z_(SIR)=0.000,P_(SIR)=1.000;Z_(MAIS)=-0.756,P_(MAIS)=0.450);开机后6个月差异均无统计学意义(Z_(CAP)=-1.673,P_(CAP)=0.094;Z_(SIR)=-1.369,P_(SIR)=0.171;Z_(MAIS)=-0.978,P_(MAIS)=0.32);开机后12个月,差异均有统计学意义(Z_(CAP)=-2.667,P_(CAP)=0.008;Z_(SIR)=-2.272,P_(SIR)=0.023;Z_(MAIS)=-2.656,P_(MAIS)=0.008);(4)开机后12个月,实验组的韦氏幼儿智力量表(C-WYCSI)评分与对照组比较,总分差异有统计学意义(P<0.05)。结论合并脑白质异常聋儿接受人工耳蜗手术后言语能力较术前显著提高,且其术后平均听阈与脑白质正常聋儿相比差异无统计学意义。因此在进行严格术前筛选后,合并脑白质异常的聋儿可以通过人工耳蜗植入手术获益,手术是可行的。但由于合并脑白质异常聋儿术后12个月的言语康复效果及认知发展水平与脑白质正常聋儿差异有统计学意义,因此远期随访结果仍待进一步研究,且术前需与家长充分沟通。
Objective To investigate the feasibility of postoperative cochlear implant surgery in deaf children with dementia and postoperative hearing, verbal rehabilitation and cognitive development. Methods A total of 425 deaf children (425 ears) with cochlear implants were enrolled in this study from November 2012 to April 2015 in the Department of Otolaryngology-Head and Neck Surgery, Nanjing Drum Tower Hospital. Six children with abnormal white matter were selected as the experimental group. 6 cases of normal white matter deaf children as control group. The speech ability of the experimental group before and after surgery was compared, and the hearing, verbal rehabilitation and cognitive development of the two groups were compared. Results (1) There were significant differences in the MAIS, CAP and SIR between the experimental group and the control group before and after surgery (experimental group: postoperative 6 months, Z CAP = - 3.127, P CAP = 0.002; Z SIR = - 3.146 P_ (SIR) = 0.002; Z MAIS = -2.898 and PM AIS = Month, Z CAP = -3.317, P CAP = 0.001, Z SIR = -3.108, P SIR = 0.002, Z MAIS = -2.656, P MAIS = 0.008. : Z_ (CAP) = - 3.108 and P_ (CAP) = 0.002 at 6 months after surgery; Z_SIR = -3.127 and P_SIR = 0.002; Z MAIS = -2.918 and P MAIS = 0.004; Z CAP = - 3.146, P CAP = 0.002, Z SIR = -3.207, P SIR = 0.001, Z MAIS = -2.913, PMAIS = ; (2) Before and after operation, the average hearing threshold in experimental group was not significantly different from that in control group (F = 0.797, P = 0.393); (3) Compared with control group, MAIS, CAP and SIR in experimental group The difference was not statistically significant (Z CAP = 0.000, P CAP = 1.000; Z SIR = 0.000, P SIR = 1.000; Z MAIS = - 0.756 P MAIS = 0.450) (CAP) = - 1.673, P_ (CAP) = 0.094; Z_ (SIR) = -1.369, P_ (SIR) = 0.171; Z_ (MAIS) = -0.978 , P_ (MAIS) = 0.3 2). At 12 months after starting up, the differences were statistically significant (Z CAP = -2.667, P CAP = 0.008, Z SIR = -2.272, P SIR 0.023, = -2.656, P_ (MAIS) = 0.008); (4) Twelve months after starting up, the score of C-WYCSI in the experimental group was significantly lower than that in the control group <0.05). Conclusions The speech competence of deaf children with cochlear abnormalities after cochlear implantation is significantly higher than that before operation, and the average hearing threshold after operation is not significantly different from that of deaf children with normal white matter. Therefore, after rigorous preoperative screening, deaf children with abnormal white matter may benefit from cochlear implant surgery. Surgery is feasible. However, the results of long-term follow-up still remain to be further studied because of the difference in speech rehabilitation and cognitive development between normal deaf children and normal deaf children at 12 months after deafness, Full communication.