Reeder Ruth M, Firszt Jill B, Cadieux Jamie H, Strube Michael J
Washington University School of Medicine, St. Louis, MO.
St. Louis Children's Hospital, MO.
J Speech Lang Hear Res. 2017 Jan 1;60(1):276-287. doi: 10.1044/2016_JSLHR-H-16-0175.
Whether, and if so when, a second-ear cochlear implant should be provided to older, unilaterally implanted children is an ongoing clinical question. This study evaluated rate of speech recognition progress for the second implanted ear and with bilateral cochlear implants in older sequentially implanted children and evaluated localization abilities.
A prospective longitudinal study included 24 bilaterally implanted children (mean ear surgeries at 5.11 and 14.25 years). Test intervals were every 3-6 months through 24 months postbilateral. Test conditions were each ear and bilaterally for speech recognition and localization.
Overall, the rate of progress for the second implanted ear was gradual. Improvements in quiet continued through the second year of bilateral use. Improvements in noise were more modest and leveled off during the second year. On all measures, results from the second ear were poorer than the first. Bilateral scores were better than either ear alone for all measures except sentences in quiet and localization.
Older sequentially implanted children with several years between surgeries may obtain speech understanding in the second implanted ear; however, performance may be limited and rate of progress gradual. Continued contralateral ear hearing aid use and reduced time between surgeries may enhance outcomes.
对于年龄较大、已单侧植入人工耳蜗的儿童，是否以及何时应进行双耳人工耳蜗植入仍是一个悬而未决的临床问题。本研究评估了年龄较大的序贯植入儿童第二次植入耳以及双耳植入人工耳蜗后的言语识别进展率，并评估了其定位能力。
一项前瞻性纵向研究纳入了24名双耳植入儿童（平均首次耳部手术年龄为5.11岁，第二次为14.25岁）。在双耳植入后的24个月内，每隔3 - 6个月进行一次测试。测试条件包括单耳和双耳的言语识别及定位。
总体而言，第二次植入耳的进展速度较为缓慢。在双耳使用的第二年，安静环境下的言语识别能力持续提高。噪声环境下的改善较为有限，且在第二年趋于平稳。在所有测试指标上，第二次植入耳的结果均不如首次植入耳。除了安静环境下的句子理解和定位外，双耳得分在所有指标上均优于单耳。
手术间隔数年的年龄较大的序贯植入儿童，其第二次植入耳可能获得言语理解能力；然而，表现可能有限，进展速度也较为缓慢。持续使用对侧耳助听器以及缩短手术间隔时间可能会改善结果。
