Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, South Korea.
PLoS One. 2022 Jun 1;17(6):e0267898. doi: 10.1371/journal.pone.0267898. eCollection 2022.
There are still debates about timing and effectiveness of cochlear implants (CI) in pediatric subjects with significant residual hearing who do not belong to traditional indication of CI. In this study, we aimed to investigate the outcomes of CI, specifically on improvement of pronunciation, among hearing-impaired children already with a substantial degree of language skills as evaluated by Categories of Auditory Perception (CAP) scores or sentence score. Our cohort comprised pediatric CI recipients from July 2018 through October 2020. Among them, cases with CAP scores of 5 or 6 preoperatively were defined as "borderline cases". We investigated prevalence and etiologies, and compared speech evaluation data preoperatively and postoperatively at three time points (3, 6 and 9-12 months after implantation). Among 86 pediatric CI recipients, 13 subjects (15.12%) had language development that reached CAP scores of 5 or 6 before implantation. Postoperative speech evaluation data 6 months after implantation revealed significant improvement of pronunciation (Urimal Test of Articulation and Phonation scores: UTAP), Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and word perception scores, but not of CAP and sentence perception scores. Notably, the significant improvement of pronunciation based on UTAP scores outstripped that of other speech parameters and this continued steadily up to one-year postoperatively. The result of the study serves as evidence for what to expect from cochlear implantation in hearing-impaired children who have already achieved a substantial degree of language development in terms of CAP scores or sentence perception scores, preoperatively.
对于那些不属于传统人工耳蜗植入（CI）适应证、但仍有一定残余听力的儿童患者，CI 的时机和效果仍存在争议。本研究旨在探讨人工耳蜗植入对已具有一定语言能力（通过听觉感知分类 [CAP] 评分或句子评分评估）的听力障碍儿童的发音改善效果。我们的研究队列包括 2018 年 7 月至 2020 年 10 月期间接受人工耳蜗植入的儿童患者。其中，术前 CAP 评分为 5 或 6 的患者被定义为“边缘病例”。我们调查了这些患者的患病率和病因，并比较了术前和术后三个时间点（植入后 3、6 和 9-12 个月）的语音评估数据。在 86 名接受人工耳蜗植入的儿童患者中，有 13 名（15.12%）在植入前的语言发展达到了 CAP 评分为 5 或 6。术后 6 个月的语音评估数据显示，发音（言语可懂度测试和发声测试 [UTAP]）、婴幼儿有意义听觉整合量表（IT-MAIS）和单词感知评分均有显著改善，但 CAP 和句子感知评分无显著改善。值得注意的是，基于 UTAP 评分的发音显著改善程度超过了其他语音参数，且这种改善持续稳定至术后 1 年。本研究结果为术前 CAP 评分或句子感知评分已达到一定水平的听力障碍儿童患者的人工耳蜗植入效果提供了参考依据。
