Department of Sense Organs, Sapienza University, Rome, Italy.
Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.
Int J Pediatr Otorhinolaryngol. 2023 Apr;167:111514. doi: 10.1016/j.ijporl.2023.111514. Epub 2023 Mar 15.
Long-term assessments of children with cochlear implants (CI) are important inputs to help guide families and professionals in therapeutic and counselling processes. Based on these premises, the primary aim of the present study was to assess the long-term speech and language outcomes in a sample of prelingually deaf or hard of hearing (DHH) adolescents and young adults with unilateral or bilateral implantation in childhood. The secondary aim was to investigate the correlations of age at implantation with long-term speech and language outcomes.
Retrospective observational study on 54 long-term CI users, 33 unilateral and 21 bilateral (mean age at CI surgery 38.1 ± 24.6 months; mean age at last follow-up assessment 19.1 ± 4.3 years of age and mean follow-up time 16 ± 3.7 years). Means and standards were used to describe speech perception (in quiet, in fixed noise and in adaptive noise using It-Matrix) and morphosyntactic comprehension (TROG-2) outcomes. A univariate analysis was used to evaluate outcome differences between unilateral and bilateral patients. Bivariate analysis was performed to investigate the relationships between age at CI, audiological variables, and language outcomes. Finally, multivariate analysis was performed to quantify the relationship between It-Matrix, sentence recognition in quiet and at SNR+10 and TROG-2.
The participants showed good speech recognition performance in quiet (94% for words and 89% for sentences) whilst their speech-in-noise scores decreased significantly. For the It-Matrix, only 9.2% of the participants showed scores within the normative range. This value was 60% for TROG-2 performance. For both auditory and language skills, group differences for unilateral versus bilateral CI users were not statistically significant (p > 0.05). Bivariate analysis showed that age at CI correlated significantly with overall results at TROG-2 (r = -0.6; p < 0.001) and with It-Matrix (r = 0.5; p < 0.001). TROG-2 was negatively correlated with results for It-Matrix (r = -0.5; p < 0.001). In the multivariate analysis with It-Matrix as a dependent variable, the model explained 63% of the variance, of which 60% was related to sentence recognition and 3% to morphosyntax.
These data contribute to the definition of average long-term outcomes expected in subjects implanted during childhood whilst increasing our knowledge of the effects of variables such as age at CI and morphosyntactic comprehension on speech perception. Although the majority of this prelingually DHH cohort did not achieve scores within a normative range, remarkably better It-Matrix scores were observed when compared to those from postlingually deafened adult CI users.
对植入人工耳蜗的儿童进行长期评估是帮助指导家庭和专业人员进行治疗和咨询过程的重要依据。基于这些前提，本研究的主要目的是评估单侧或双侧植入人工耳蜗的儿童期聋或重听（DHH）青少年和年轻人的长期言语和语言结果。次要目的是调查植入年龄与长期言语和语言结果的相关性。
对 54 名长期人工耳蜗使用者进行回顾性观察研究，其中 33 名单侧植入，21 名双侧植入（人工耳蜗手术平均年龄 38.1±24.6 个月；最后一次随访评估的平均年龄为 19.1±4.3 岁，平均随访时间为 16±3.7 年）。使用均值和标准差来描述言语感知（在安静环境中、固定噪声环境中和自适应噪声环境中使用 It-Matrix）和形态句法理解（TROG-2）结果。使用单变量分析评估单侧和双侧患者的结果差异。进行双变量分析以研究植入年龄、听力学变量和语言结果之间的关系。最后，进行多元分析以量化 It-Matrix、安静时和 SNR+10 时的句子识别以及 TROG-2 之间的关系。
参与者在安静环境中的言语识别表现良好（单词识别率为 94%，句子识别率为 89%），而他们的噪声下言语识别能力显著下降。对于 It-Matrix，只有 9.2%的参与者的得分在正常范围内。TROG-2 得分的这一数值为 60%。对于听觉和语言技能，单侧与双侧人工耳蜗使用者之间的组间差异无统计学意义（p>0.05）。双变量分析显示，植入年龄与 TROG-2 的总体结果（r=-0.6；p<0.001）和 It-Matrix（r=0.5；p<0.001）显著相关。TROG-2 与 It-Matrix 呈负相关（r=-0.5；p<0.001）。在以 It-Matrix 为因变量的多元分析中，模型解释了 63%的方差，其中 60%与句子识别有关，3%与形态句法有关。
这些数据有助于确定在儿童时期植入人工耳蜗的受试者的平均长期结果，并增加我们对植入年龄和形态句法理解等变量对言语感知的影响的认识。尽管本预聋 DHH 队列中的大多数人未达到正常范围内的分数，但与后天聋的成年人工耳蜗使用者相比，It-Matrix 得分显著提高。
