Division of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Ear Hear. 2010 Apr;31(2):166-85. doi: 10.1097/AUD.0b013e3181c8e7b6.
The purpose of this study was to determine the influence of selected predictive factors, primarily age at fitting of amplification and degree of hearing loss, on auditory-based outcomes in young children with bilateral sensorineural hearing loss.
Forty-four infants and toddlers, first identified with mild to profound bilateral hearing loss, who were being fitted with amplification were enrolled in the study and followed longitudinally. Subjects were otherwise typically developing with no evidence of cognitive, motor, or visual impairment. A variety of subject factors were measured or documented and used as predictor variables, including age at fitting of amplification, degree of hearing loss in the better hearing ear, cochlear implant status, intensity of oral education, parent-child interaction, and the number of languages spoken in the home. These factors were used in a linear multiple regression analysis to assess their contribution to auditory-based communication outcomes. Five outcome measures, evaluated at regular intervals in children starting at age 3, included measures of speech perception (Pediatric Speech Intelligibility and Online Imitative Test of Speech Pattern Contrast Perception), speech production (Arizona-3), and spoken language (Reynell Expressive and Receptive Language).
The age at fitting of amplification ranged from 1 to 72 mo, and the degree of hearing loss ranged from mild to profound. Age at fitting of amplification showed the largest influence and was a significant factor in all outcome models. The degree of hearing loss was an important factor in the modeling of speech production and spoken language outcomes. Cochlear implant use was the other factor that contributed significantly to speech perception, speech production, and language outcomes. Other factors contributed sparsely to the models.
Prospective longitudinal studies of children are important to establish relationships between subject factors and outcomes. This study clearly demonstrated the importance of early amplification on communication outcomes. This demonstration required a participant pool that included children who have been fit at very early ages and who represent all degrees of hearing loss. Limitations of longitudinal studies include selection biases. Families who enroll tend to have high levels of education and rate highly on cooperation and compliance measures. Although valuable information can be extracted from prospective studies, not all factors can be evaluated because of enrollment constraints.
本研究旨在确定选择预测因素（主要为听力补偿年龄和听力损失程度）对双侧感音神经性听力损失幼儿的基于听觉的结果的影响。
44 名婴儿和学步儿童最初被确定为患有轻度至重度双侧听力损失，他们正在接受助听设备的适配，并进行了纵向随访。这些受试者在其他方面均发育正常，无认知、运动或视觉障碍的证据。测量或记录了各种受试者因素，并将其作为预测变量，包括助听设备适配的年龄、较好耳的听力损失程度、人工耳蜗植入状态、口语教育强度、亲子互动以及家庭中使用的语言数量。这些因素被用于线性多元回归分析，以评估它们对基于听觉的交流结果的贡献。在 3 岁开始的儿童中定期评估了 5 种结果测量，包括言语感知（小儿言语清晰度和在线模仿言语模式对比感知测试）、言语产生（亚利桑那州-3）和口语语言（雷内尔表达和接受语言）。
助听设备适配的年龄范围为 1 至 72 个月，听力损失程度从轻度到重度不等。适配年龄对所有结果模型的影响最大，是一个重要的因素。听力损失程度是言语产生和口语语言结果建模的重要因素。人工耳蜗的使用是对言语感知、言语产生和语言结果有显著贡献的另一个因素。其他因素对模型的贡献较小。
对儿童进行前瞻性纵向研究对于确定受试者因素与结果之间的关系非常重要。本研究清楚地表明早期听力补偿对交流结果的重要性。这一演示需要一个参与者群体，包括在非常早的年龄就适配助听设备的儿童，以及代表所有听力损失程度的儿童。纵向研究的局限性包括选择偏倚。参加的家庭通常具有较高的教育水平，并且在合作和遵守措施方面评分较高。虽然前瞻性研究可以提取有价值的信息，但由于 enrolment 限制，并非所有因素都可以进行评估。
