Hess Christi, Zettler-Greeley Cynthia, Godar Shelly P, Ellis-Weismer Susan, Litovsky Ruth Y
1Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin, USA; and 2Nemours BrightStart!, Jacksonville, Florida, USA.
Ear Hear. 2014 Jul-Aug;35(4):387-95. doi: 10.1097/AUD.0000000000000023.
Growing evidence suggests that children who are deaf and use cochlear implants (CIs) can communicate effectively using spoken language. Research has reported that age of implantation and length of experience with the CI play an important role in a predicting a child's linguistic development. In recent years, the increase in the number of children receiving bilateral CIs (BiCIs) has led to interest in new variables that may also influence the development of hearing, speech, and language abilities, such as length of bilateral listening experience and the length of time between the implantation of the two CIs. One goal of the present study was to determine how a cohort of children with BiCIs performed on standardized measures of language and nonverbal cognition. This study examined the relationship between performance on language and nonverbal intelligence quotient (IQ) tests and the ages at implantation of the first CI and second CI. This study also examined whether early bilateral activation is related to better language scores.
Children with BiCIs (n = 39; ages 4 to 9 years) were tested on two standardized measures, the Test of Language Development and the Leiter International Performance Scale-Revised, to evaluate their expressive/receptive language skills and nonverbal IQ/memory. Hierarchical regression analyses were used to evaluate whether BiCI hearing experience predicts language performance.
While large intersubject variability existed, on average, almost all the children with BiCIs scored within or above normal limits on measures of nonverbal cognition. Expressive and receptive language scores were highly variable, less likely to be above the normative mean, and did not correlate with Length of first CI Use, defined as length of auditory experience with one cochlear implant, or Length of second CI Use, defined as length of auditory experience with two cochlear implants.
All children in the present study had BiCIs. Most IQ scores were either at or above that found in the general population of typically hearing children. However, there was greater variability in their performance on a standardized test of expressive and receptive language. This cohort of children, who are mainstreamed in schools at age-appropriate grades, whose mothers' education is high, and whose families' socioecononomic status is high, had, as a group, on average, language scores within the same range as the normative sample of hearing children. Further research identifying the predictors that contribute to the high variability in both expressive and receptive language scores in children with BiCIs will provide useful information that can aid in clinical management and decision making.
越来越多的证据表明，使用人工耳蜗（CI）的失聪儿童能够通过口语进行有效沟通。研究报告称，植入年龄和使用人工耳蜗的时长在预测儿童语言发展方面起着重要作用。近年来，接受双侧人工耳蜗（BiCI）的儿童数量增加，这引发了人们对可能影响听力、言语和语言能力发展的新变量的关注，例如双侧聆听经验的时长以及两次人工耳蜗植入之间的时间间隔。本研究的一个目标是确定一组使用双侧人工耳蜗的儿童在语言和非言语认知标准化测试中的表现。本研究考察了语言和非言语智商（IQ）测试成绩与首次人工耳蜗植入和第二次人工耳蜗植入时的年龄之间的关系。本研究还考察了早期双侧激活是否与更好的语言成绩相关。
对使用双侧人工耳蜗的儿童（n = 39；年龄4至9岁）进行了两项标准化测试，即语言发展测试和修订版莱特国际操作量表，以评估他们的表达/接受性语言技能和非言语智商/记忆力。采用分层回归分析来评估双侧人工耳蜗听力经验是否能预测语言表现。
尽管个体间存在较大差异，但平均而言，几乎所有使用双侧人工耳蜗的儿童在非言语认知测试中的得分都在正常范围内或高于正常范围。表达性和接受性语言得分差异很大，不太可能高于常模均值，且与首次人工耳蜗使用时长（定义为使用一个人工耳蜗的听觉经验时长）或第二次人工耳蜗使用时长（定义为使用两个人工耳蜗的听觉经验时长）均无相关性。
本研究中的所有儿童都使用了双侧人工耳蜗。大多数智商得分与正常听力儿童总体人群中的得分相当或更高。然而，他们在表达性和接受性语言标准化测试中的表现差异更大。这组儿童在适龄年级融入学校，其母亲受教育程度高，家庭社会经济地位高，作为一个群体，他们平均语言得分与听力儿童常模样本处于同一范围。进一步研究确定导致使用双侧人工耳蜗儿童表达性和接受性语言得分高度变异的预测因素，将提供有助于临床管理和决策的有用信息。
