【作者】 杨影；

【导师】 孙喜斌；

【作者基本信息】 华东师范大学 ， 言语与听觉科学， 2014， 博士

【摘要】 目的：本研究通过观察0-3岁听障儿童早期干预过程的听觉言语康复效果,分析年龄和配戴辅听装置时间对听觉言语康复效果的影响,探究0～3岁听障儿童听觉言语康复的基本规律,为听障儿童使用辅听装置的主客观成效评估提供依据。方法：依据生理年龄,将45例0-2岁听障儿童分为7～12个月组(16例)、13～18个月组(16例)和19～24个月组(13例)。依据配戴辅听装置类型和言语能力得分,将38例2-3岁听障儿童分为A组(助听器,MUSS得分>22分,9例)、B组(助听器,MUSS得分≤22分,9例)、C组(人工耳蜗,MUSS得分>22分,9例)和D组(人工耳蜗,MUSS得分≤22分,11例)。采用婴幼儿有意义听觉整合量表(IT-MAIS)、有意义使用言语量表(MUSS)、听觉行为分级标准(CAP)、言语可懂度分级标准(SIR)等主观评估方法,对45例0～2岁听障儿童和38例2～3岁听障儿童进行听觉言语能力主观评估,分析年龄和配戴辅听装置时间对0-2岁听障儿童听觉言语能力的影响。进一步结合事件相关电位(ERP)的客观听力学评估方法,对9例3岁正常儿童和38例2-3岁听障儿童进行客观评估,分析配戴辅听装置类型和言语能力得分对听障儿童失匹配负波(MMN)引出率、潜伏期和波幅的影响,进一步探讨MMN潜伏期、波幅与听觉言语能力得分的相关性。结果：一、0～2岁听障儿童听觉能力和言语能力的发展1、在听障儿童的听觉能力和言语能力测试中,7-12个月组、13～18个月组和19～24个月组的IT-MAIS、CAP、MUSS、SIR得分在听障儿童配戴辅听装置后一年内(0个月、3个月、6个月、9个月、12个月)发展迅速,随着听觉年龄的增长,听觉言语能力逐渐增强。2、通过配戴辅听装置各个时间(0个月、3个月、6个月、9个月、12个月)听觉言语康复效果可以看出,无论配戴辅听装置时的生理年龄大小,听觉能力和言语能力的发展趋势均为快速增长的线性趋势特征(p<0.05), IT-MAIS、MUSS得分以配戴辅听装置后的0～6个月上升趋势表现的更为明显,CAP、SIR得分以配戴辅听装置后的7～12个月上升趋势表现的更为明显。3、依据年龄分组后,在听障儿童配戴辅听装置0-12个月期间,7-12个月组在各个康复时间段的CAP、MUSS、SIR得分均高于13～18个月组和19～24个月,差异显著(p<0.05),13～18个月组的IT-MAIS、CAP、MUSS、SIR得分均高于19～24个月听障儿童组,差异不显著(p>0.05)二、事件相关电位研究1、声调刺激声和纯音刺激声下的MMN引出率在声调对MMN测试中,正常儿童MMN引出率为88.89%,听障儿童A～D组MMN引出率分别为87.5%、77.8%、89%和63.6%；在纯音对MMN测试中,正常儿童和为88.89%,听障儿童A-D组MMN引出率分别为87.5%、77.8%、89%和80%。2、声调刺激声和纯音刺激声下的MMN潜伏期在声调对MMN测试中,正常儿童组的MMN潜伏期为197.22±34.72ms,听障儿童A-D组的MMN潜伏期分别为192.43±38.22ms、190.33±25.24ms、210.43±36.64ms和221.28±25.03ms,听障儿童A-B组的MMN潜伏期和正常儿童组的MMN潜伏期相当,听障儿童C组、D组的MMN潜伏期比正常儿童组和听障儿童A组、B组的MMN潜伏期约延长约12-24ms,正常儿童组和听障儿童A-D组之间的MMN潜伏期差异不显著(p>0.05)；在纯音对MMN测试中,正常儿童组的MMN潜伏期为156.55±43.00ms,听障儿童A-D组的MMN潜伏期分别为177.28±45.75ms、189.73±25.67ms、176.85±30.96ms和170.42±36.84ms,听障儿童A-D组的MMN潜伏期比正常儿童组的MMN潜伏期延长约10-23ms,听障儿童B组的MMN潜伏期比听障儿童A组、C组、D组的MMN潜伏期约延长约12-20ms,正常儿童组和听障儿童A-D组之间的MMN潜伏期差异不显著(p>0.05)。3、声调刺激声和纯音刺激声下的MMN波幅在声调对MMN测试中,正常儿童的MMN波幅约为-2.41±2.91μV,听障儿童A-D组的MMN波幅分别约为0.36±1.97μV、0.87±1.29μV、-0.29±2.87μV和1.06±±2.84μV,正常儿童组与听障儿童A组、C组之间差异不显著(p>0.05),正常儿童组与听障儿童B、D组之间差异显著(p<0.05)。在纯音对MMN测试中,正常儿童的MMN波幅约为-1.89±1.65μV,听障儿童A-D组的MMN波幅分别约为-0.44±2.37μV、0.50±1.31μV、-0.34±2.73μV和0.83±1.19μV。正常儿童组与听障儿童A组、C组之间差异不显著(p>0.05),正常儿童组与听障儿童B组、D组之间差异显著(p<0.05)。4、·MMN潜伏期、波幅与听障儿童听觉言语能力的相关性在声调刺激声和纯音刺激声下的MMN测试中,MMN潜伏期与MUSS、SIR、IT-MAIS、CAP听觉言语能力得分之间均不相关(p>0.05)。听障儿童A组声调对MMN波幅与MUSS得分呈显著负相关(r=-0.773,p<0.05),听障儿童A组纯音对MMN波幅和IT-MAIS得分呈显著负相关(r=-0.757,p<0.05),听障儿童C组声调对MMN波幅与CAP得分呈显著负相关(r=-0.797,p<0.05),听障儿童D组纯音对MMN波幅和IT-MAIS得分呈显著负相关(r=-0.823,p<0.05)。结论：1、0-2岁听障儿童早期干预时间越早,配戴辅听装置时间越长,听觉言语的康复效果越好。IT-MAIS、MUSS得分以配戴辅听装置后的0～6个月上升趋势表现的更为明显,CAP、SIR得分以配戴辅听装置后的7～12个月上升趋势表现的更为明显。2、在失匹配负波(MMN)测试中,言语能力强听障儿童可以对言语信号和纯音信号进行很好的感知和分辨,大脑听觉皮层的前注意加工过程与正常儿童发展水平相当,听觉言语能力差听障儿童对言语信号和纯音信号的感知和前注意加工过程还未发育成熟。3、2-3岁听障儿童MMN波幅和听觉言语能力呈部分显著负相关,MMN波幅在预估听障儿童听觉言语能力方面有一定意义。可主客观测试相结合,相互印证。更多还原

【Abstract】 Purpose:This study observed the ability of hearing and speech in hearing impaired children between the ages of0and3in early intervention, analyze the effects of chronological age and wearing auxiliary device of time, explore the basic rules for listening and speech rehabilitation, assess the effectiveness of assisted listening devices and provide basis for subjective and objective evaluation.Methods:Based on the physiological age,45hearing loss children aged0-2years that were divided into7-12months group,13-18months group and19-24months group. According to auxiliary device type and speech ability score,38children aged2-3years with hearing impairment were divided into group A (hearing aids, MUSS score>22points,9chlidren), group B (hearing aids, MUSS score≤22points,9chlidren), group C (cochlear implant, MUSS score>22points,9chlidren) and group D (cochlear implant, MUSS score≤22points,11chlidren). Infant and toddler meaningful auditory integration Scale (IT-MAIS), meaningful use speech scale (MUSS), categories of auditory performance(CAP), speech intelligibility rating scale (SIR) were used to evaluate hearing and speech ability in hearing impaired children, analyzed the impact of age and the time of wearing auxiliary device, combined with event-related potentials (ERP) to compare the occurrence of mismatch negativity (MMN), MMN latency, MMN amplitude with9normal hearing children3years old, to discuss the latency and amplitude of MMN correlated with hearing and speech ability.Results:1.The development of hearing and speech ability between the ages of0and3in children with hearing impairment(1)With the growth of the age, hearing and speech ability gradually enhanced, IT-MAIS, CAP, MUSS, SIR score has developed rapidly within one year after wearing auxiliary device (Omonth,3months,6months,9months,12months) in deaf children. (2)Regardless of the chronological age and when wearing auxiliary device, the development trend of hearing and speech ability were the rapid growth of linear trend features in each period of auditory rehabilitation (p<0.05). IT-MAIS and MUSS score rised more obviously after wearing auxiliary device of0to6months, while CAP and SIR score grew more obviously7to12months.(3)According to the chronological age group of deaf children, IT-MAIS, CAP, MUSS and SIR score between the ages of7-12months were higher than the ages of13-18months and the ages of19-24months(p<0.05), while the ages range from13-18months of deaf children were much higher than19-24months(p>0.05).2. Research on event related potential in children with hearing loss between the ages of2and3years(1)MMN elicitationLexical tone MMN was elicited88.89%in normal hearing children, the currence of lexical tone MMN were87.5%、77.8%、89%and63.6%in deaf children group A-D.Pure tone MMN derivation rate was88.89%in normal hearing children, the currence of pure tone MMN were elicited87.5%、77.8%、89%and80%in deaf children group A-D.(2) MMN latencyLexical tone MMN latency was about197.22±34.72ms in normal hearing children, the latency of lexical tone MMN were about192.43±38.22ms,190.33±25.24ms,210.43±36.64ms and221.28±25.03ms in deaf children group A-D, the latency of group A-B were similar to normal hearing children, group C-D are much longer than normal hearing children and group A-B, the lexical tone MMN latency were no obvious difference between normal hearing children and deaf children (p>0.05).Pure tone MMN latency was about156.55±43.00ms in normal hearing children, the latency of lexical tone MMN were about177.28±45.75ms,189.73±25.67ms,176.85±30.96ms and170.42±36.84ms in deaf children group A-D, the latency of group A, group C and group D were similar to normal hearing children, group B are much longer than normal hearing children, the pure tone MMN latency were no obvious difference between normal hearing children and deaf children (p>0.05).(3) MMN amplitudeLexical tone MMN amplitude was about-2.41±2.91μV in normal hearing children, the amplitude of lexical tone MMN were about-0.36±1.97μV,0.87±1.29μV,-0.29±2.87μV and1.06±2.84μV in deaf children groups A-D, the amplitude of MMN in group A and group C were similar to normal hearing children (p>0.05), the amplitude of MMN were significantly reduced in group B and group D much compared with normal hearing children (p<0.05).Pure tone MMN amplitude was about-1.89±1.65μV in normal hearing children, the amplitude of lexical tone MMN were about-0.44±2.37μV,0.50±1.31μV,-0.34±2.73μV and0.83±1.19μV in deaf children groups A-D, the amplitude of MMN in group A and group C were similar to normal hearing children (p>0.05), the amplitude of MMN were obvious reduced in group B and group D compared with normal hearing children (p<0.05).3. Correlation of MMN Latency and amplitude with hearing and speech abilityLexical tone MMN latency and pure tone MMN latency were no significantly correlated with hearing and speech ability in hearing impaired children (p>0.05). lexical tone MMN amplitude was significantly negative correlated with MUSS score in group A(r=-0.773,p<0.05), IT-MAIS score was significantly negative correlated with pure tone MMN amplitude in group A (r=-0.757, p<0.05), Lexical tone MMN amplitude was significantly negative correlated with CAP score in group C(r=-0.797,p<0.05), IT-MAIS score was significantly negative correlated with pure tone MMN amplitude in group D (r=-0.823,p<0.05).Conclusion:1. The earlier time erter early intervention, the longer wear auxiliary listening device, the better effect of hearing and speech rehabilitation in0-2years deaf children. IT-MAIS and MUSS score rise more obviously after wearing auxiliary device of0to6months, while CAP and SIR score grow more obviously7to12months. 2. Good performers of hearing impaired children can be well perception and discrimination speech signal and pure tone signal, the ability of signal perception and preattention process in bad performers of hearing impaired children is much lower than normal hearing children and auditory cortex may be immature.3.The amplitude of MMN was negatively corelated with hearing and speech ability in hearing impaired children. It suggests that MMN amplitude testing may offer a means of predicting hearing and speech ability. Suggest a combined objective and subjective method to measure and evaluate, confirm mutually.更多还原