【摘要】：目的:1評(píng)估6歲以下雙側(cè)傳導(dǎo)性耳聾患兒佩戴Sophono牌新型軟帶骨導(dǎo)助聽(tīng)器后的聽(tīng)覺(jué)及言語(yǔ)改善效果;2分析6歲及其以上雙側(cè)傳導(dǎo)性耳聾患者佩戴Sophono牌新型軟帶骨導(dǎo)助聽(tīng)器后的聽(tīng)力及言語(yǔ)改善情況;3了解6歲及其以上單側(cè)極重度感音神經(jīng)性耳聾患者佩戴Sophono牌新型軟帶骨導(dǎo)助聽(tīng)器后的聽(tīng)力改善情況。方法:收集2015年7月至2016年4月就診于白求恩國(guó)際和平醫(yī)院耳鼻咽喉頭頸外科的耳聾患者,經(jīng)篩選,符合入選標(biāo)準(zhǔn)27例,分為三組,對(duì)三組耳聾患者佩戴新型軟帶式骨導(dǎo)助聽(tīng)器后的聽(tīng)力言語(yǔ)改善情況做初步分析,并評(píng)估佩戴該型骨導(dǎo)助聽(tīng)器軟帶的臨床應(yīng)用效果。1入選標(biāo)準(zhǔn):1)傳導(dǎo)性或混合性耳聾患者:患者年齡≥1歲,純音測(cè)聽(tīng)(pure-tone audiometry)或骨導(dǎo)聽(tīng)性腦干反應(yīng)(auditory brainstem response,ABR)測(cè)試中的骨導(dǎo)閾值≤30 dB,氣骨導(dǎo)差30 d B;2)單側(cè)感音神經(jīng)性耳聾(single side deafness,SSD):患者年齡≥6歲,患耳純音測(cè)聽(tīng)提示感音神經(jīng)性耳聾,氣導(dǎo)PTA≥90 d B HL,健耳骨導(dǎo)PTA≤20 dB HL,患病時(shí)間最少在1年以上,除單耳極重度聽(tīng)力損失外,無(wú)眩暈、耳鳴等其他癥狀。2試驗(yàn)分組:1)6歲以下雙側(cè)傳導(dǎo)性耳聾患兒組11例(年齡1~5歲,平均年齡2.64±1.03歲);2)6歲及其以上雙側(cè)傳導(dǎo)性耳聾患者組12例(年齡9~24歲,平均年齡13.58±5.44歲);3)6歲以上單側(cè)極重度感音神經(jīng)性耳聾患者組4例(14~67歲,平均年齡39.75±21.79歲)。3聽(tīng)力學(xué)評(píng)估:1)6歲以下雙側(cè)傳導(dǎo)性耳聾患兒組首先進(jìn)行骨導(dǎo)ABR測(cè)試其裸耳骨導(dǎo)反應(yīng)閾,其次通過(guò)聲場(chǎng)下純音測(cè)聽(tīng)測(cè)試其助聽(tīng)前、佩戴當(dāng)日、佩戴2周及佩戴3個(gè)月后的純音平均聽(tīng)閾(pure-tone average,PTA)測(cè)試,最后進(jìn)行助聽(tīng)前及佩戴2周、佩戴3個(gè)月后聽(tīng)覺(jué)行為分級(jí)標(biāo)準(zhǔn)(categories of auditory performance,CAP)量表評(píng)估;2)6歲及其以上患者組在聲場(chǎng)下進(jìn)行助聽(tīng)前、佩戴當(dāng)日、佩戴2周及佩戴3個(gè)月后的pta測(cè)試,并利用天使語(yǔ)訓(xùn)中文開(kāi)放式言語(yǔ)評(píng)估系統(tǒng)進(jìn)行言語(yǔ)識(shí)別閾(speechrecognitionthreshold,srt)測(cè)試。同時(shí),記錄所有患者佩戴后的不良反應(yīng)及不良事件。結(jié)果:16歲傳導(dǎo)性耳聾組,骨導(dǎo)abr反應(yīng)閾均值為14.09±5.84dbnhl,佩戴sophono軟帶骨導(dǎo)助聽(tīng)器前聲場(chǎng)下裸耳純音測(cè)聽(tīng)pta均值為75.68±13.64dbhl,佩戴當(dāng)日、佩戴2周及佩戴3個(gè)月后助聽(tīng)聽(tīng)閾分別下降至36.59±9.88、35.00±5.92、33.40±4.22dbhl。佩戴當(dāng)日、2周及3個(gè)月后患者聽(tīng)力分別增益了39.09±10.64、40.68±12.85、42.27±12.99db。佩戴前聲場(chǎng)測(cè)聽(tīng)pta均值與佩戴當(dāng)日、佩戴2周及佩戴3個(gè)月后pta均值之間比較有統(tǒng)計(jì)學(xué)意義(p0.05),佩戴當(dāng)日、佩戴2周及佩戴3個(gè)月后pta之間無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)。佩戴sophono軟帶骨導(dǎo)助聽(tīng)器3個(gè)月后在0.25khz、0.5khz、1khz、2khz、4khz聽(tīng)閾分別降低了31.82±12.90、35.00±13.78、48.19±14.19、41.81±12.10、44.09±17.86db。助聽(tīng)前cap量表評(píng)分均值2.64±0.50分,佩戴2周及佩戴3個(gè)月后cap量表評(píng)分分別上升至5.36±0.50、5.36±0.50分。佩戴3個(gè)月平均提高了2.57分;2≥6歲傳導(dǎo)性耳聾組,骨導(dǎo)聽(tīng)閾平均閾值均值7.00±6.67dbhl,助聽(tīng)前聲場(chǎng)測(cè)聽(tīng)pta均值60.52±9.13dbhl,佩戴當(dāng)日、佩戴2周及佩戴3個(gè)月后聲場(chǎng)助聽(tīng)pta均值下降至26.35±5.55、29.38±4.69、31.35±9.83dbhl。助聽(tīng)當(dāng)日、佩戴后2周、佩戴后3個(gè)月較助聽(tīng)前分別增益34.17±10.12、31.15±11.07、30.21±14.45db。助聽(tīng)前聲場(chǎng)測(cè)聽(tīng)pta均值與佩戴當(dāng)日、佩戴2周及佩戴3個(gè)月之間比較有統(tǒng)計(jì)學(xué)意義(p0.05),佩戴當(dāng)日、佩戴2周及佩戴3個(gè)月助聽(tīng)后pta之間無(wú)統(tǒng)計(jì)學(xué)差異(p0.05)。助聽(tīng)3個(gè)月后0.25khz、0.5khz、1khz、2khz、4khz聽(tīng)閾分別降低了16.25±15.24、30.42±14.05、40.00±15.37、25.42±16.58、20.84±15.64db。助聽(tīng)前三個(gè)方向(0°、90°、270°)srt分別為67.30±4.46、68.66±5.08、69.16±4.53dbhl,佩戴當(dāng)日三個(gè)方向srt分別為39.40±4.97、37.40±5.27、41.76±8.19dbhl,佩戴2周后三個(gè)方向srt分別為37.51±5.06、37.24±7.09、40.42±7.46dbhl及srt佩戴3個(gè)月后三個(gè)方向srt分別為38.32±4.92、38.72±6.34、42.65±5.68dbhl;3單側(cè)極重度感音神經(jīng)性耳聾組患耳裸耳氣骨導(dǎo)閾值大多數(shù)不能引出,無(wú)法計(jì)算其PTA,對(duì)側(cè)耳骨導(dǎo)聽(tīng)閾均值為9.37±6.80 d B HL,助聽(tīng)前掩蔽后聲場(chǎng)測(cè)聽(tīng)PTA均值為55.00±12.08 dB HL,佩戴當(dāng)日、佩戴2周及佩戴3個(gè)月后聲場(chǎng)助聽(tīng)聽(tīng)閾下降至25.63±4.62、28.13±7.74、30.63±6.81 dB HL。佩戴當(dāng)日、佩戴2周及3個(gè)月后較助聽(tīng)前分別增益29.38±14.31、26.88±11.61、24.38±11.84 dB。助聽(tīng)前0°、90°、270°方向言語(yǔ)識(shí)別閾分別為54.15±2.96、55.47±3.32、54.60±3.04 dB HL,佩戴當(dāng)日三個(gè)方向SRT分別為38.02±2.11、31.08±2.65、38.54±2.81 dB HL,佩戴2周后三個(gè)方向言語(yǔ)識(shí)別閾分別為34.76±3.56、31.14±2.41、36.68±5.70 dB HL及佩戴3個(gè)月后三個(gè)方向言語(yǔ)識(shí)別閾分別為34.95±2.41、30.75±2.33、39.35±2.77dB HL;4各組患者均無(wú)助聽(tīng)器相關(guān)不良反應(yīng)及不良事件。結(jié)論:1佩戴Sophono新型軟帶骨導(dǎo)助聽(tīng)器明顯改善了6歲以下雙側(cè)傳導(dǎo)性耳聾患兒聽(tīng)力及言語(yǔ)能力,早期佩戴可能會(huì)改善此類患兒的言語(yǔ)發(fā)育狀況。2佩戴Sophono新型軟帶骨導(dǎo)助聽(tīng)器能有效的提升6歲及以上雙側(cè)傳導(dǎo)性耳聾患者的聽(tīng)力及言語(yǔ)識(shí)別閾,可作為此類患者改善聽(tīng)力狀況一種新的選擇。3佩戴Sophono新型軟帶骨導(dǎo)助聽(tīng)器對(duì)于單側(cè)極重度感音神經(jīng)性耳聾患者有很好助聽(tīng)效果,能改善患者在安靜情況下的聽(tīng)閾及方位感。
[Abstract]:Objective: 1. To evaluate the hearing and speech improvement of children with bilateral conductive deafness under 6 years old wearing Sophono brand new soft-band bone-guided hearing aid; 2. To analyze the hearing and speech improvement of children with bilateral conductive deafness over 6 years old wearing Sophono brand new soft-band bone-guided hearing aid; 3. Methods: From July 2015 to April 2016, 27 deaf patients in the Department of Otolaryngology, Head and Neck Surgery of Bethune International Peace Hospital were selected, and they were divided into three groups. The improvement of hearing and speech after hearing aids was analyzed and the clinical effect of wearing the bone-guided hearing aids was evaluated. 1 Selection criteria: 1) Bone in conductive or mixed deafness: age (> 1), pure-tone audiometry (pure-tone audiometry) or auditory brainstem response (ABR) test. Conduction threshold < 30 dB, air-bone conduction difference 30 dB; 2) unilateral sensorineural deafness (SSD): the patient's age (> 6 years), pure tone audiometry suggesting sensorineural deafness, air conduction PTA (> 90 dB HL), healthy ear bone conduction PTA (> 20 dB HL), the duration of the disease is at least 1 year, except for severe hearing loss in one ear, no dizziness, tinnitus and other. Symptoms: 1) 11 children under 6 years old with bilateral conductive deafness (aged 1-5 years, with an average age of 2.64 + 1.03 years); 2) 12 children aged 6 years or above with bilateral conductive deafness (aged 9-24 years, with an average age of 13.58 + 5.44 years); 3) 4 children over 6 years old with unilateral very severe sensorineural deafness (aged 14-67, with an average age of 39.75 + 21.7 years) 9-year-old) 3-year-old children with bilateral conductive deafness underwent bone conduction ABR test first, followed by pure-tone average (PTA) test before, on the day of, 2 weeks and 3 months after the hearing aid, and 2 weeks before and after the hearing aid. Three months after wearing, the auditory behavior rating scale (CAP) was assessed; 2) The patients aged 6 years and over were tested with PTA before, on the same day, 2 weeks and 3 months after wearing PTA under the sound field, and the speech recognition thresholds (SPEEC) were assessed with the Chinese Open Speech Assessment System of Angelic Speech Training. Results: In the 16-year-old conductive deafness group, the mean ABR threshold was 14.09 (+5.84) dbnhl, and the mean PTA was 75.68 (+13.64) dBHL in the bare ear before and after wearing the sophono soft-band bone-guided hearing aid. The auditory threshold decreased to 36.59 [9.88], 35.00 [5.92], 33.40 [4.22] dbhl. On the day of wearing, 2 weeks and 3 months after wearing, the patients'hearing gain was 39.09 [10.64], 40.68 [12.85], 42.27 [12.99] DB respectively. There was significant difference between the mean value of PTA measured before wearing and that on the day, 2 weeks and 3 months after wearing (p0.05). There was no significant difference between the two weeks and three months after wearing PTA (p0.05). after 3 months of wearing sophono soft band bone conduction hearing aid, the hearing thresholds of 0.25 khz, 0.5 khz, 1 khz, 2 khz, 4 kHz were decreased by 31.82 [12.90], 35.00 [13.78], 48.19 [14.19], 41.81 [12.10], 44.09 [17.86 db], respectively. the mean pre-hearing aid cap score was 2.64 [0.50], 2 weeks and 3 months after wearing sophono soft band bone conduction hearing aid. The AP scale score increased to 5.36 (+ 0.50) and 5.36 (+ 0.50) respectively. 4.69,31.35 [9.83] dbhl. on the day of hearing aid wearing, 2 weeks after wearing, 3 months after wearing, the gain was 34.17 [10.12], 31.15 [11.07], 30.21 [14.45] DB respectively. there was no significant difference between the mean value of PTA before hearing aid and the day of wearing, 2 weeks after wearing and 3 months after wearing (p0.05). 3 months after hearing aid, 0.25 khz, 0.5 khz, 0.5 khz, 1 khz, 1 khz, 2 khz, 1 khz, 2 khz, 4 kHz auditory threshvalue decreased by 16.25 [15.24, 30.42 [14.05, 40.00 [15.37, 45.00 [15.37, 25.42 [16.58, 25.42 [16.58, 20.84 [15.64] 64db], respectively. The first three directions (0 [, 90 [, 90 [, 270]) SRTs were 67.30 [(0.30 [4.46, 68.66 [6.66 [5.66 [5.08, 68.08, 69.66 40 SRT in three directions after wearing SRT for 2 weeks were 37.51 + 5.06, 37.24 + 7.09, 40.42 + 7.46 dBHL and 38.32 + 4.92, 38.72 + 6.34, 42.65 + 5.68 dBHL respectively, and most of the three directions in the unilateral extremely severe sensorineural deafness group were unable to calculate the pneumoosynamic conduction threshold of the bare ear and could not calculate the PTA. The mean audiometric thresholds were 9.37 (+ 6.80 dB HL), 55.00 (+ 12.08 dB HL) before and after masking. On the day of wearing, 2 weeks and 3 months after wearing, the audiometric thresholds decreased to 25.63 (+ 4.62), 28.13 (+ 7.74), 30.63 (+ 6.81) dB HL. Speech recognition thresholds in 0, 90, and 270 directions before hearing aid were 54.15, 55.47, 55.47, 3.32, 54.60, 3.04 dB HL, 38.02, 2.11, 31.08, 2.65, 38.54, 2.81 dB HL respectively. Speech recognition thresholds in three directions were 34.76, 3.56, 31.14, 2.41, 36.68, 5.70 dB and 3 months after wearing, respectively. Speech recognition thresholds in three directions were 34.95 [2.41], 30.75 [2.33] and 39.35 [2.77] dBHL, respectively; and there were no hearing aid-related adverse reactions and adverse events in all groups. Speech development in children. 2 The wearing of Sophono's new soft-band bone-guided hearing aid can effectively improve the hearing and speech recognition thresholds of patients with bilateral conductive deafness aged 6 years and over, and can be a new choice for improving hearing status in such patients. 3 The wearing of Sophono's new soft-band bone-guided hearing aid can improve the hearing of patients with unilateral extremely severe sensorineural hearing loss. It has a good hearing aid effect and can improve the hearing threshold and sense of orientation of patients in quiet condition.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R764.5

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