语前聋人工耳蜗植入患者听觉和言语康复效果的问卷分级评估

目的使用听觉和言语问卷分级的方法评估人工耳蜗植入患者的听觉言语康复效果，分析康复效果的相关影响因素。探讨人工耳蜗术后听觉言语康复效果的问卷评估方法。方法对97例语前聋人工耳蜗植入患者的家长和康复教师进行调查随访。根据听觉行为分级标准(categories of auditory performance，CAP)和言语可懂度分级标准(speech intelligibility rating，SIR)对患者的听觉感知能力和言语产生能力进行分级评估。CAP共分1—8级，SIR共分1—5级。用组内单因素秩和检验和多因素Logistic回归分析CAP和SIR分级结果与植入电极类型、植入年龄、病因、病程、术前助听器使用情况、植入深度、植入时间、康复模式、家庭经济状况等9个因素的关系。结果单因素分析结果显示：植人体型号(P=0．0439)、植入时间长短(P=0．0001)、康复模式(P=0．0460)、家庭经济状况(P=0．0140)与CAP有关；植入时间长短(P=0．0001)、康复模式(P=0．0271)与SIR有关。植入年龄、病因、病程、植入深度以及术前助听器的佩戴与CAP和SIR均无关。多因素Logistic回归分析结果显示：植入时间长短和家庭经济状况与CAP显著相关：植入时间长短与SIR显著相关。结论植入时间越长，人工耳蜗对患者听觉言语发展的效果越明显。康复模式与手段对人工耳蜗植入后患者的言语和康复能力有着决定性的影响。

Rating evaluation of the effect of pre-lingual cochlear implantees' aural/oral rehabilitation by questionnaires]

OBJECTIVE: To evaluate the effect of cochlear implantees' aural/oral rehabilitation using rating evaluation method by questionnaires, to analyze the relationship between rehabilitation effect and its possible influence factors including type of implant, age at surgery, pathology, etc, and to explore the rating questionnaire method for cochlear implantees' aural/oral rehabilitation effect evaluation. METHODS: Ninety-seven pre-lingual cochlear implantees were involved in this investigation, all of which were severe or profound deafness before implantation. Interviewed the implantees' parents or teachers, asking them to rate the implantees' aural ability objectively from 1 to 8 according to Categories of Auditory Performance (CAP) and speech producing ability from 1 to 5 according to Speech Intelligibility Rating (SIR), then analyzed the relationship between effect of aural/oral rehabilitation represented by CAP/SIR rating results and its possible 9 influence factors including type of implant, age at surgery, pathology, duration of hearing loss, hearing aid wearing, inserting length of electrodes, implanted period, rehabilitation mode and financial conditions. Univariate test and multivatiate stepwise logistic regression model were used for the analysis. RESULTS: In a univariate analysis, it was confirmed that 4 factors i.e. type of implant (P = 0.0439), implanted period (P = 0.0001), rehabilitation mode (P = 0.0460) and financial conditions (0.0140) were correlated to CAP; 2 factors i.e. implanted period (P = 0.0001), rehabilitation mode (P = 0.0271) were correlated to SIR. In a multivariate analysis using stepwise logistic regression model, the more significant influence factor for CAP was implanted period and financial conditions, and for SIR was implanted period. CONCLUSIONS: Cochlear implants will be more effective for aural/oral rehabilitation of implantees with longer implanted period. Rehabilitation mode and method contribute to the effect of rehabilitation.