基于事件相关电位评估语前聋儿童人工耳蜗植入者的早期语音加工能力  

Early auditory processing of speech in prelingually-deafened children with cochlear implants based on event-related potentials

作　　者：许欣然 孙家强 管锐瑞 郭小涛 孙敬武 Xu Xinran;Sun Jiaqiang;Guan Ruirui;Guo Xiaotao;Sun Jingwu(Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230001,China;Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学生命科学与医学部,合肥230001 [2]中国科学技术大学附属第一医院(安徽省立医院)耳鼻咽喉头颈外科,合肥230001

出　　处：《中华耳鼻咽喉头颈外科杂志》2024年第7期705-713,共9页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金项目(82201278,82271180);安徽省自然科学基金项目(2208085MH231,2008085QH429)。

摘　　要：目的利用听觉事件相关电位评估语前聋儿童人工耳蜗(cochlear implant,CI)植入者对元音、辅音和声调的早期听觉加工能力。方法2021年2月到2024年2月期间招募19例语前聋CI儿童(男12例、女7例,年龄3~8岁,平均6.0岁)和19例听力正常(normal hearing,NH)儿童(男12例、女7例,年龄4~9岁,平均6.8岁)。使用单音节/ta1/作为标准刺激,/tu1/,/te1/,/da1/,/ra1/,/ta4/和/ta2/作为偏差刺激,构建多偏差oddball范式。记录并分析两组儿童由元音、辅音和声调变化诱发的事件相关电位。应用SPSS 24.0软件对数据进行统计学分析。结果NH儿童对元音、辅音和声调变化均表现出显著的失匹配负波(mismatch negativity,MMN)(P<0.05),而CI儿童对元音和辅音变化仅表现出正向失匹配反应(positive mismatch response,pMMR)(P<0.05)和P3a反应(P<0.05),且未对声调变化表现出任何事件相关电位(P>0.05)。与NH儿童相比,CI儿童的pMMR和P3a潜伏期更长(P<0.01),两组间幅值差异无统计学意义(P>0.05)。时频分析显示,CI儿童的θ频段神经振荡同步性较NH儿童低(P<0.05)。相关性分析显示,CI儿童的CI使用时间与听觉能力分级量表(Categories of Auditory Performance,CAP)(P=0.004)、言语可懂度分级量表(Speech Intelligibility Rate,SIR)(P=0.044)和有意义听觉整合量表(Meaningful Auditory Integration Scale,MAIS)(P=0.001)得分呈正相关。结论语前聋CI儿童对元音和辅音具备一定的早期听觉加工能力,但与同龄NH儿童相比,语前聋CI儿童对语音尤其是声调的加工能力仍不成熟。事件相关电位可作为反映CI儿童听觉言语功能成熟度的客观电生理指标。坚持长期佩戴CI有助于语前聋儿童听觉言语能力的提高。Objective To investigate the early auditory discrimination of vowels,consonants and lexical tones in prelingually-deafened children with cochlear implants(CI)using auditory event-related potentials.Methods Nineteen prelingually-deafened CI children and 19 normal hearing(NH)children were recruited in this study.A multi-deviant oddball paradigm was constructed using the monosyllable/ta1/as the standard stimulus and monosyllables/tu1/,/te1/,/da1/,/ra1/,/ta4/and/ta2/as the deviant stimuli.The event-related potentials evoked by vowel,consonant and lexical tone contrasts were recorded and analyzed in the two groups.Results NH children showed robust mismatch negativities(MMNs)to vowel,consonant and lexical tone contrasts(P<0.05),whereas CI children only showed positive mismatch responses(pMMRs)and P3a responses to the vowel(P<0.05)and consonant contrasts(P<0.05)and no significant event-related potential to the lexical tone contrasts(P>0.05).The longer pMMR and P3a peak latencies(P<0.01)but similar amplitudes(P>0.05)were found in CI children than in NH children.CI children showed weaker phase synchronization ofθoscillations than NH children(P<0.05).The duration of CI use was positively correlated with the scores of Categories of Auditory Performance(CAP)(P=0.004),Speech Intelligibility Rate(SIR)(P=0.044)and Meaningful Auditory Integration Scale(MAIS)(P=0.001)in CI children.Conclusions Prelingually-deafened CI children can process vowels and consonants at an early stage.However,their ability of processing speech,especially lexical tones,is still more immature compared with their NH peers.The event-related potentials could be objective electrophysiological indicators reflecting the maturity of CI children′s auditory speech functions.Long-term CI use is beneficial for prelingually-deafened children to improve auditory and speech performance.

关 键 词：耳蜗植入术 诱发电位 听觉 事件相关电位 失匹配反应 语音 

分 类 号：R764.9[医药卫生—耳鼻咽喉科]