Yang Yang, Haihong Liu, Jun Zheng, Min Chen, Ying Li, Jinsheng Hao, Wei Liu, Jie Zhang, Xin Ni
Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Street, Xicheng District, Beijing, China.
Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Eur Arch Otorhinolaryngol. 2017 Jul;274(7):2757-2763. doi: 10.1007/s00405-017-4601-0. Epub 2017 May 17.
The purpose is to determine the value of preoperative evaluation on developmental levels using Gesell score in predicting the postoperative outcome in pediatric cochlear implantation (CI) recipients. 78 children who underwent CI were included in our study. Age at the time of CI ranged from 6 to 67 months. The Gesell score including adaptability, fine motor, gross motor, language, and social skill was used for evaluating the patients' developmental levels before the CI, and a developmental quotient (DQ) was calculated by the following formula: (developmental age/actual age) × 100. The auditory perception and speech production abilities were evaluated using the categories of auditory performance (CAP) and speech intelligibility rating (SIR) before CI and at 1 year after CI. The associations between the preoperative Gesell score/DQ and the improvement of postoperative CAP/SIR outcomes were analyzed. Preoperative developmental evaluation of CI candidates suggested that the developmental delay was common in children with profound hearing loss. The mean of language DQ (46.72 ± 17.59) was significantly decreased than the mean of others' ability DQ in the enrolled children. The older the pediatric CI candidates were, the lower the DQ were. Age/adaptability DQ and improvement of postoperative CAP/SIR 1 year after CI were related. Age was negative correlation with the CI outcome and adaptability DQ was positive correlation with the CI outcome. The mean of CAP 1 year after CI was 4.16, and the mean of SIR 1 year after CI was 2.03. The first logistics regression equation was Y1 = exp (-18.123 + 0.199 × adaptability DQ - 0.163 × age), and Y1 was the possibility which CAP was lower than 5 1 year after CI. The sensitivity of first regression equation was 84.2% and specificity was 70.8%. The second logistics regression equation was Y2 = exp (-23.347 + 0.268 × adaptability DQ - 0.164 × age), and Y2 was the possibility which SIR was lower than 3 1 year after CI. The sensitivity of second regression equation was 85.7% and specificity was 72.7%. Preoperative Gesell score may be value in predicting the postoperative outcome in pediatric CI recipients. The older children are more serious developmental delay occur, so the CI operation should be finished as early as possible. Adaptability DQ combined with age has predictive effect on the postoperative outcome of cochlear implantation in children.
目的是确定使用格塞尔发育量表对发育水平进行术前评估，在预测小儿人工耳蜗植入（CI）受者术后结果方面的价值。我们的研究纳入了78例接受CI的儿童。CI时的年龄范围为6至67个月。使用包括适应性、精细运动、大运动、语言和社交技能的格塞尔发育量表来评估患者在CI术前的发育水平，并通过以下公式计算发育商（DQ）：（发育年龄/实际年龄）×100。在CI术前和CI术后1年，使用听觉表现类别（CAP）和言语可懂度评分（SIR）来评估听觉感知和言语产生能力。分析术前格塞尔发育量表评分/DQ与术后CAP/SIR结果改善之间的关联。对CI候选者进行的术前发育评估表明，重度听力损失儿童中发育迟缓很常见。在纳入的儿童中，语言DQ的平均值（46.72±17.59）明显低于其他能力DQ的平均值。小儿CI候选者年龄越大，DQ越低。年龄/适应性DQ与CI术后1年的CAP/SIR改善相关。年龄与CI结果呈负相关，适应性DQ与CI结果呈正相关。CI术后1年CAP的平均值为4.16，CI术后1年SIR的平均值为2.03。第一个逻辑回归方程为Y1 = exp（-18.123 + 0.199×适应性DQ - 0.163×年龄），Y1是CI术后1年CAP低于5的可能性。第一个回归方程的敏感性为84.2%，特异性为70.8%。第二个逻辑回归方程为Y2 = exp（-23.347 + 0.268×适应性DQ - 0.164×年龄），Y2是CI术后1年SIR低于3的可能性。第二个回归方程的敏感性为85.7%，特异性为72.7%。术前格塞尔发育量表评分可能对预测小儿CI受者的术后结果有价值。年龄较大的儿童发生发育迟缓更严重，因此CI手术应尽早完成。适应性DQ结合年龄对儿童人工耳蜗植入术后结果有预测作用。
