Sharma Sunil D, Cushing Sharon L, Papsin Blake C, Gordon Karen A
Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology: Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.
Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada; Department of Otolaryngology: Head & Neck Surgery, University of Toronto, Toronto, ON, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
Int J Pediatr Otorhinolaryngol. 2020 Jun;133:109984. doi: 10.1016/j.ijporl.2020.109984. Epub 2020 Mar 9.
Cochlear implantation is a safe and reliable treatment for children with severe to profound hearing loss. The primary benefit of these medical devices in children is the acquisition of hearing, which promotes development of spoken language. The present paper reviews published literature demonstrating predictive effects of a number of factors on acquisition of hearing development and speech recognition. Of the many variables that contribute to an individual child's development after implantation, age at implantation, the presence of medical comorbidities, social determinants of health, and the provision of bilateral versus unilateral hearing are those that can vary widely and have consistently shown clear impacts. Specifically, age of implantation is crucial to reduce effects of deafness on the developing auditory system and capture the remarkable plasticity of early development. Language development after cochlear implantation requires therapy emphasizing hearing and oral communication, education, and other support which can be influenced by known social determinants of health; specifically, outcomes in children decline with reductions in socioeconomic status and levels of parental education. Medical co-morbidities also slow rates of progress after cochlear implantation. On the other hand, benefits of implantation increase in children who are provided with access to hearing from both ears. In sum, cochlear implants promote development of hearing in children and the best outcomes are achieved by providing early access to sound in both ears. These benefits can be limited by known social determinants of health which restrict access to needed support and medical comorbidities which add further complexity in care and outcome.
人工耳蜗植入是治疗重度至极重度听力损失儿童的一种安全可靠的方法。这些医疗设备对儿童的主要益处是获得听力，这有助于促进口语语言的发展。本文综述了已发表的文献，这些文献表明了一些因素对听力发展和言语识别获得的预测作用。在植入后影响个体儿童发展的众多变量中，植入时的年龄、是否存在合并症、健康的社会决定因素以及双耳与单耳听力的提供情况，是那些差异可能很大且一直显示出明显影响的因素。具体而言，植入年龄对于减少耳聋对发育中的听觉系统的影响以及捕捉早期发育的显著可塑性至关重要。人工耳蜗植入后的语言发展需要强调听力和口语交流、教育及其他支持的治疗，而这些可能会受到已知的健康社会决定因素的影响；具体来说，儿童的治疗效果会随着社会经济地位和父母教育水平的降低而下降。合并症也会减缓人工耳蜗植入后的进展速度。另一方面，双耳都能获得听力的儿童植入后的益处会增加。总之，人工耳蜗植入可促进儿童听力发展，通过早期双耳获得声音可实现最佳效果。这些益处可能会受到已知的健康社会决定因素的限制，这些因素限制了获得所需支持的机会，合并症则会使护理和治疗结果更加复杂。
