Iwasaki Satoshi, Nishio Shinya, Moteki Hideaki, Takumi Yutaka, Fukushima Kunihiro, Kasai Norio, Usami Shin-Ichi
Department of Hearing Implant Sciences, Shinshu University School of Medicine, Japan.
Int J Pediatr Otorhinolaryngol. 2012 Mar;76(3):433-8. doi: 10.1016/j.ijporl.2011.12.027. Epub 2012 Jan 26.
This study aimed to investigate a wide variety of factors that influence auditory, speech, and language development following pediatric cochlear implantation (CI).
Prospective collection of language tested data in profound hearing-impaired children.
Pediatric CI can potentially be effective to development of practical communication skills and early implantation is more effective.
We proposed a set of language tests (assessment package of the language development for Japanese hearing-impaired children; ALADJIN) consisting of communication skills testing (test for question-answer interaction development; TQAID), comprehensive (Peabody Picture Vocabulary Test-Revised; PVT-R and Standardized Comprehension Test for Abstract Words; SCTAW) and productive vocabulary (Word Fluency Test; WFT), and comprehensive and productive syntax (Syntactic processing Test for Aphasia; STA). Of 638 hearing-impaired children recruited for this study, 282 (44.2%) with >70 dB hearing impairment had undergone CI. After excluding children with low birth weight (<1800 g), those with >11 points on the Pervasive Developmental Disorder ASJ Rating Scale for the test of autistic tendency, and those <2 SD on Raven's Colored Progressive Matrices for the test of non-verbal intelligence, 190 children were subjected to this set of language tests.
Sixty children (31.6%) were unilateral CI-only users, 128 (67.4%) were CI-hearing aid (HA) users, and 2 (1.1%) were bilateral CI users. Hearing loss level of CI users was significantly (p<0.01) worse than that of HA-only users. However, the threshold level, maximum speech discrimination score, and speech intelligibility rating in CI users were significantly (p<0.01) better than those in HA-only users. The scores for PVT-R (p<0.01), SCTAW, and WFT in CI users were better than those in HA-only users. STA and TQAID scores in CI-HA users were significantly (p<0.05) better than those in unilateral CI-only users. The high correlation (r=0.52) has been found between the age of CI and maximum speech discrimination score. The scores of speech and language tests in the implanted children before 24 months of age have been better than those in the implanted children after 24 months of age.
We could indicate that CI was effective for language development in Japanese hearing-impaired children and early CI was more effective for productive vocabulary and syntax.
本研究旨在调查影响小儿人工耳蜗植入（CI）后听觉、言语和语言发育的多种因素。
前瞻性收集重度听力障碍儿童的语言测试数据。
小儿人工耳蜗植入对实际沟通技能的发展可能有效，早期植入更有效。
我们提出了一套语言测试（日本听力障碍儿童语言发育评估包；ALADJIN），包括沟通技能测试（问答互动发育测试；TQAID）、综合（皮博迪图片词汇测试修订版；PVT-R和抽象词标准化理解测试；SCTAW）和生成性词汇（词汇流畅性测试；WFT），以及综合和生成性句法（失语症句法处理测试；STA）。在本研究招募的638名听力障碍儿童中，282名（44.2%）听力损失>70dB的儿童接受了人工耳蜗植入。在排除低出生体重（<1800g）儿童、广泛性发育障碍ASJ自闭症倾向测试评分>11分的儿童以及瑞文彩色渐进矩阵非言语智力测试<2标准差的儿童后，190名儿童接受了这套语言测试。
60名儿童（31.6%）仅使用单侧人工耳蜗，128名（67.4%）使用人工耳蜗-助听器（HA），2名（1.1%）使用双侧人工耳蜗。人工耳蜗使用者的听力损失程度显著（p<0.01）比仅使用助听器的使用者更严重。然而，人工耳蜗使用者的阈值水平、最大言语辨别得分和言语可懂度评分显著（p<0.01）优于仅使用助听器的使用者。人工耳蜗使用者的PVT-R（p<0.01）、SCTAW和WFT得分优于仅使用助听器的使用者。人工耳蜗-助听器使用者的STA和TQAID得分显著（p<0.05）高于仅使用单侧人工耳蜗的使用者。人工耳蜗植入年龄与最大言语辨别得分之间存在高度相关性（r=0.52）。24个月龄前植入儿童的言语和语言测试得分优于24个月龄后植入儿童。
我们可以表明，人工耳蜗植入对日本听力障碍儿童的语言发育有效，早期人工耳蜗植入对生成性词汇和句法更有效。
