Nikolopoulos T P, O'Donoghue G M, Archbold S
Department of Otolaryngology, University Hospital, Queen's Medical Centre National Health System Trust, Nottingham, United Kingdom.
Laryngoscope. 1999 Apr;109(4):595-9. doi: 10.1097/00005537-199904000-00014.
To assess the influence of age at implantation on speech perception and speech intelligibility following pediatric cochlear implantation.
A prospective study was undertaken on a consecutive group of 126 congenital and prelingually deaf children up to 4 years after implantation. The study group was confined to prelingually deaf children less than 7 years of age at the time of implantation. All had implantation with the same multichannel cochlear implant system. No child was lost to follow-up, and there were no exclusions from the study.
The Iowa Matrix Closed Set Sentence test, connected discourse tracking, categories of auditory performance, and speech intelligibility rating were used to assess the speech perception (closed and open set) and speech intelligibility of the children with implants. Regression analysis and Spearman rank correlation coefficients were used to assess the correlation between the outcome measures with age at implantation. The setting was a tertiary referral pediatric cochlear implant center in the United Kingdom.
Age at implantation positively correlated with preimplantation assessment performance and with most of the outcome measures up to 24 months following implantation. However, at the 3-and 4-year intervals following implantation, age at implantation was found to be a strong negative predictor of all the outcomes studied (correlation coefficients ranging from -0.44 to -0.58, all statistically significant [P<.05]).
The results of the present study provide strong evidence that prelingually deaf children should receive implants as early as possible to facilitate the later development of speech perception skills and speech intelligibility and thus maximize the health gain from the intervention. However, because of the wide variation in individual outcomes, age alone should not be used as a criterion to decide implant candidacy.
评估小儿人工耳蜗植入时的年龄对言语感知和言语清晰度的影响。
对一组连续的126名先天性及语前聋儿童进行前瞻性研究，随访时间长达植入后4年。研究组仅限于植入时年龄小于7岁的语前聋儿童。所有儿童均使用同一多通道人工耳蜗植入系统。无儿童失访，研究无排除标准。
采用爱荷华矩阵封闭集语句测试、连贯话语追踪、听觉表现类别和言语清晰度评分来评估植入儿童的言语感知（封闭集和开放集）及言语清晰度。使用回归分析和斯皮尔曼等级相关系数评估结果指标与植入时年龄之间的相关性。研究地点为英国一家三级转诊小儿人工耳蜗植入中心。
植入时年龄与植入前评估表现以及植入后24个月内的大多数结果指标呈正相关。然而，在植入后3年和4年时，发现植入时年龄是所有研究结果的强负预测因子（相关系数范围为-0.44至-0.58，均具有统计学意义[P<0.05]）。
本研究结果提供了有力证据，表明语前聋儿童应尽早接受植入，以促进后期言语感知技能和言语清晰度的发展，从而使干预带来的健康收益最大化。然而，由于个体结果差异很大，不应仅以年龄作为决定植入候选资格的标准。
