Wake M, Poulakis Z, Hughes E K, Carey-Sargeant C, Rickards F W
Centre for Community Child Health, Murdoch Childrens Research Institute, Melbourne, Australia.
Arch Dis Child. 2005 Mar;90(3):238-44. doi: 10.1136/adc.2003.039354.
Better language outcomes are reported for preschool children with hearing impairment (HI) diagnosed very early, irrespective of severity. However, population studies of older children are required to substantiate longer term benefits of early detection.
To study impact of age of diagnosis and severity of HI in a population cohort of 7-8 year old children.
Eighty eight 7-8 year old children born in Victoria, who were (a) fitted with hearing aids for congenital HI by 4.5 years and (b) did not have intellectual or major physical disability were studied. Main outcome measures were Clinical Evaluation of Language Fundamentals (CELF) and Peabody Picture Vocabulary Test (PPVT). Predictors were pure tone average (0.5, 1, 2 kHz) in better ear at diagnosis and age at diagnosis. Marginal (adjusted) means were estimated with general linear models.
Response rate was 67% (n = 89; 53 boys). Mean age at diagnosis was 21.6 months (SD 14.4); 21% had mild, 34% moderate, 21% severe, and 24% profound HI; mean non-verbal IQ was 104.6 (SD 16.7). Mean total CELF score was 76.7 (SD 21.4) and mean PPVT score 78.1 (SD 18.1). Age of diagnosis, adjusted for severity and IQ, did not contribute to language scores. In contrast, adjusted mean CELF and PPVT language scores fell sequentially with increasing severity of HI.
More severe HI, but not later diagnosis, was strongly related to poorer language outcomes at 7-8 years. Further systematic study is needed to understand why children with hearing impairment have good or poor outcomes.
据报道，无论听力损失严重程度如何，极早期被诊断为听力障碍（HI）的学龄前儿童语言能力结果更好。然而，需要对大龄儿童进行群体研究，以证实早期检测的长期益处。
研究7-8岁儿童群体队列中诊断年龄和听力损失严重程度的影响。
对88名出生在维多利亚州的7-8岁儿童进行研究，这些儿童（a）在4.5岁前因先天性听力损失佩戴了助听器，且（b）没有智力或严重身体残疾。主要结局指标为语言基本能力临床评估（CELF）和皮博迪图片词汇测试（PPVT）。预测因素为诊断时较好耳的纯音平均听阈（0.5、1、2千赫）和诊断年龄。采用一般线性模型估计边际（调整后）均值。
回复率为67%（n = 89；53名男孩）。诊断时的平均年龄为21.6个月（标准差14.4）；21%为轻度听力损失，34%为中度，21%为重度，24%为极重度听力损失；平均非言语智商为104.6（标准差16.7）。CELF总分平均为76.7（标准差21.4），PPVT分数平均为78.1（标准差18.1）。经听力损失严重程度和智商调整后的诊断年龄对语言分数无影响。相比之下，CELF和PPVT语言分数的调整后均值随听力损失严重程度增加而依次下降。
在7-8岁时，更严重的听力损失与较差的语言能力结果密切相关，而非诊断时间较晚。需要进一步进行系统研究，以了解听力障碍儿童语言能力结果好坏的原因。
