【摘要】：隨著我國(guó)經(jīng)濟(jì)的發(fā)展和慈善機(jī)構(gòu)的努力,人工耳蝸對(duì)聾兒已成為一種常見(jiàn)的干預(yù)措施,且其數(shù)量預(yù)計(jì)在未來(lái)幾年將迅速增長(zhǎng)。而這些耳蝸植入患兒的康復(fù)成效也越來(lái)越得到廣泛關(guān)注。本課題主要探索語(yǔ)前聾兒童人工耳蝸植入術(shù)后早期的聽(tīng)覺(jué)發(fā)展、言語(yǔ)識(shí)別和詞匯能力的發(fā)展;并觀察術(shù)前使用助聽(tīng)器對(duì)不同植入年齡兒童術(shù)后康復(fù)成效的影響;同時(shí)探討現(xiàn)行中文評(píng)估聽(tīng)障兒童聽(tīng)覺(jué)、言語(yǔ)及語(yǔ)言能力測(cè)試工具的可行性。本課題共有83例重度-極重度語(yǔ)前聾嬰幼期患兒參與本次研究。使用嬰幼兒／有意義聽(tīng)覺(jué)整合量表問(wèn)卷(MAIS/IT-MAIS),普通話早期言語(yǔ)感知測(cè)試(MESP)、普通話兒童言語(yǔ)能力測(cè)試(MPSI)等閉合式言語(yǔ)識(shí)別測(cè)試，，以及普通話漢語(yǔ)溝通發(fā)展量表(CCDI)、普通話表達(dá)與理解詞匯量測(cè)試(MERVT)等詞匯量測(cè)評(píng)工具,由經(jīng)過(guò)培訓(xùn)的聽(tīng)力學(xué)專(zhuān)業(yè)人員對(duì)患兒術(shù)后的聽(tīng)覺(jué)、言語(yǔ)識(shí)別及語(yǔ)言能力進(jìn)行評(píng)估。分別在術(shù)前和開(kāi)機(jī)后3、6、1年及2年時(shí)對(duì)受試患兒進(jìn)行評(píng)估。問(wèn)卷評(píng)估采用面對(duì)面問(wèn)詢(xún)打分的方式,由患兒家長(zhǎng)或監(jiān)護(hù)人回答問(wèn)卷;閉合項(xiàng)言語(yǔ)識(shí)別及詞匯量測(cè)試為患兒在評(píng)估人員陪同下進(jìn)行測(cè)試。評(píng)估人員記錄測(cè)試結(jié)果并進(jìn)行統(tǒng)計(jì)學(xué)分析。通過(guò)隨訪觀察比較發(fā)現(xiàn),耳蝸植入術(shù)后早期的聽(tīng)覺(jué)發(fā)育、言語(yǔ)識(shí)別及語(yǔ)言能力的發(fā)展隨康復(fù)時(shí)間延長(zhǎng)而逐步提高。各年齡受試兒童的MAIS/IT-MAIS得分隨著康復(fù)時(shí)間的延長(zhǎng),均呈現(xiàn)相似的增長(zhǎng)趨勢(shì);術(shù)前助聽(tīng)器使用經(jīng)驗(yàn)多的兒童,其MAIS/IT-MAIS得分高于未使用助聽(tīng)器或使用經(jīng)驗(yàn)少的兒童。MESP測(cè)試顯示,患兒的言語(yǔ)察覺(jué)能力優(yōu)先于言語(yǔ)識(shí)別能力,但患兒的言語(yǔ)識(shí)別能力也隨著人工耳蝸使用時(shí)長(zhǎng)而有明顯提高,在術(shù)后2年內(nèi)差距逐漸縮小;各亞測(cè)試項(xiàng)的難度呈現(xiàn)較明顯的漸次增大的層級(jí)。MPSI在開(kāi)機(jī)2年時(shí),全部受試兒童才能完成安靜條件下的測(cè)試,且隨著語(yǔ)競(jìng)比的降低,能完成該測(cè)試的兒童的比例顯著下降。術(shù)后早期的詞匯量的發(fā)展隨康復(fù)時(shí)間延長(zhǎng)而逐步提高;耳蝸植入兒童術(shù)后詞匯能力不斷提高,且表現(xiàn)為理解性詞匯先于表達(dá)性詞匯發(fā)展。大齡有助聽(tīng)器使用經(jīng)驗(yàn)的兒童,其聽(tīng)覺(jué)、言語(yǔ)識(shí)別和語(yǔ)言能力均優(yōu)于小齡兒童及大齡缺乏助聽(tīng)器使用經(jīng)驗(yàn)的兒童。研究結(jié)果表明,耳蝸植入術(shù)后2年兒童即發(fā)展出一定的聽(tīng)覺(jué)、言語(yǔ)識(shí)別和語(yǔ)言能力;其聽(tīng)覺(jué)-言語(yǔ)-語(yǔ)言的發(fā)展既有一定的先后次序,又表現(xiàn)出協(xié)同并進(jìn)的趨勢(shì),即首先發(fā)展出一定的聽(tīng)力及言語(yǔ)識(shí)別能力,隨后詞匯的理解和表達(dá)能力才得以快速提高,詞匯理解能力要先于表達(dá)能力的發(fā)展。小齡兒童耳蝸植入術(shù)前可選擇性佩戴助聽(tīng)器,而大齡兒童應(yīng)在術(shù)前佩戴助聽(tīng)器以盡早地接觸聲音。術(shù)后2年大部分耳蝸植入后兒童其聽(tīng)覺(jué)、言語(yǔ)識(shí)別和語(yǔ)言能力已優(yōu)于2歲的健聽(tīng)兒童。中文版IT-MAIS/MAIS、MESP、MPSI、CCDI及MERVT是評(píng)估植入后小兒早期聽(tīng)覺(jué)、言語(yǔ)識(shí)別和語(yǔ)言能力的可用工具。
[Abstract]:With the development of China's economy and the efforts of charity, cochlear implant for deaf children has become a common intervention, and its number is expected to increase rapidly in the next few years. And the rehabilitation effect of these cochlear implant children has been paid more and more attention. The purpose of this study was to explore the early development of hearing, speech recognition and vocabulary in children with prelingual deafness after cochlear implantation, and to observe the effects of hearing aids on postoperative rehabilitation of children of different implantation ages. At the same time, the feasibility of the current Chinese assessment tools for hearing, speech and language abilities of children with hearing impairment was discussed. A total of 83 infants with severe-to-extreme prelingual deafness were involved in this study. Using the Infant / meaningful auditory Integration scale (MAIS/IT-MAIS), (MESP), early speech perception Test (MESP), (MPSI) and other closed speech recognition tests. And the Putonghua Chinese Communication Development scale (CCDI), Putonghua expression and comprehension Vocabulary Test (MERVT), and other vocabulary assessment tools, which were used by trained audiology professionals to assess the hearing of children after operation. Speech recognition and language ability assessment. The children were evaluated before and 3, 6, 1 and 2 years after startup. The questionnaire was evaluated by face-to-face inquiry and answered by the parents or guardians, and the closed item speech recognition and vocabulary size test was carried out with the aid of the evaluator. The evaluators recorded the test results and performed statistical analysis. Through the follow-up observation and comparison, it was found that the development of auditory development, speech recognition and language ability in the early stage after cochlear implantation was gradually improved with the prolongation of rehabilitation time. The MAIS/IT-MAIS scores of children of all ages showed a similar increasing trend with the prolongation of rehabilitation time. The MAIS/IT-MAIS score of children with more experience using hearing aid before operation was higher than that of children without hearing aid or less experience. MESP test showed that the ability of speech detection was superior to speech recognition ability in children who had more experience in using hearing aids before operation than in children with less experience in using hearing aids. However, the speech recognition ability of the children also improved with the duration of cochlear implantation, and the gap gradually narrowed within 2 years after operation. When MPSI was started for 2 years, all the children were able to complete the quietness test, and the proportion of children who could complete the test decreased significantly with the decrease of the ratio of words to contests. 2 years after the MPSI was turned on, all the children were able to complete the test under the quiet condition, and the proportion of the children who could complete the test decreased significantly. The development of vocabulary in early postoperative period was gradually improved with the prolongation of rehabilitation time, and the vocabulary ability of cochlear implant children was improved, which showed that comprehensible vocabulary was prior to the development of expressive vocabulary in children after cochlear implantation. The hearing, speech recognition and language abilities of older children with hearing aid experience are better than those of young children and those who lack hearing aid experience. The results showed that children developed hearing, speech recognition and language abilities 2 years after cochlear implantation. The development of hearing, speech and language not only has a certain sequence, but also shows the trend of cooperation, that is, to develop a certain ability of listening and speech recognition, and then to improve quickly the comprehension and expression of vocabulary. Vocabulary comprehension ability should precede the development of expression ability. Young children may wear hearing aids before cochlear implantation, while older children should wear hearing aids before implantation in order to contact sound as soon as possible. The hearing, speech recognition and language ability of most children after cochlear implantation 2 years after operation were better than those of 2-year-old deaf children. Chinese versions of IT-MAIS/MAIS,MESP,MPSI,CCDI and MERVT are useful tools for evaluating early hearing, speech recognition and language abilities in children after implantation.
【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R764.9

【共引文獻(xiàn)】

相關(guān)期刊論文 前4條

1 張東利;劉勇智;;聽(tīng)障患兒人工耳蝸植入術(shù)后聽(tīng)覺(jué)言語(yǔ)評(píng)估方法[J];臨床耳鼻咽喉頭頸外科雜志;2013年13期

2 劉霞;趙慧莉;宋詩(shī)弦;;兒童人工耳蝸植入術(shù)的護(hù)理研究進(jìn)展[J];護(hù)理學(xué)雜志;2014年10期

3 梁思玉;鄭蕓;李剛;;改良版漢語(yǔ)溝通發(fā)展量表短表在兒童聽(tīng)力康復(fù)中的臨床價(jià)值[J];臨床耳鼻咽喉頭頸外科雜志;2014年01期

4 鄭蕓;李剛;;新生兒聽(tīng)力篩查:0136F經(jīng)驗(yàn)談[J];臨床耳鼻咽喉頭頸外科雜志;2014年22期

本文編號(hào)：2432077