| The Cleft lip and palate patients in addition to exist in the organizational structure abnormalities, most still exist auditory function and speech dysfunction. With the correction of anatomical deformity and the increasing with age, although the routine audiological tests of these patients largely get well, but there are still people with speech disorder, the mechanism is not clear. Studies suggest that in addition to the anatomic abnormalities, central cognitive dysfunction may be one of the reasons, of which the central auditory language is an important part. Whether there are pathological changes in auditory speech center,and whether these changes are related to the speech disorders, In this study, using conventional audiological examination, mismatch negativity in patients with non-syndromic cleft lip and palate to study the peripheral auditory function and central auditory function, to summarize the characteristics of the peripheral and central areas of audiology of these people, and to discuss the relationship between their verbal ability and type of cleft lip and palate, peripheral auditory system, auditory language center, and to further combined with functional magnetic resonance imaging in order to make clear the central lesions,to guide their speech rehabilitation therapy.Part 1.The Clinical Hearing Results of 269 Patients with Cleft PalateObjective:To investigate the characteristics of clinical hearing of patients with cleft palate, and to evaluate the effects of sex; age; and surgery on the hearing results.Methods:269 cases of cleft palate, including 243 cases who had never received cleft-closure operation and 26 cases who had received cleft-closure operation for at least 5 years. To evaluate the effects of sex, we investigated 174 cases(male76, and female 98) who were under 2 years(≤2 y), they were divided into 2 groups; to evaluate the effects of age, the 243 cases with no operation history were divided into group A(≤2 y); group B(>2 y ≤6 y); and group C(>6 y); to evaluate the effects of surgery, we compared group C to 26 cases who had received cleft-closure operation(group D), For DPOAE, at least the pass of ≥3 frequencies at 1818; 2730; 3616; 5434 Hz was defined as normal. For AIM, type A was considered to be normal. Part of these cases were also tested by ABR, and the threshold of wave ⅴ≥ 35 d B n HL was received to be abnormal.Results:174 Patients( ≤2 y, group A)showed no differences in DPOAE, AIM and ABR between sexes(p>0.05);The abnormal rate of DPOAE, AIM, and the threshold of ABR in group A was higher than group C(p<0.05); The abnormal rate of DPOAE, and the threshold of ABR in group A was higher than group B(p<0.05), but AIM showed no significant difference(p>0.05); The abnormal rate of DPOAE in group B was higher than group C(p<0.05); AIM and ABR showed no significant difference(p>0.05);Between group C and group D, only ABR showed significant difference(p<0.05);In group A,B and C together, the pass rate of DPOAE was higher than the normal rate of ABR(p<0.05);Conclusion:Sex has no influence on hearing results of patients with cleft palate. In this kind of patients;there is a tendency that the hearing results become better with the increasing of age. Cleft palate surgery is helpful in the recovery of hearing loss.DPOAE is of easy and relatively rapid manipulation, and steady results, it can be a useful method for the hearing test for patients with cleft palate, especially in infants. But to identify the type and extend of hearing impairment, other hearing tests should also be considered.Part 2. The Auditory Mismatch Negativity(AMMN) Studies in Patients with Cleft Lip and PalateObjective:To study the characteristics of amplitude and latency of auditory mismatch negativity in cleft lip and palate patients and normal volunteers, to discuss the possible neurological mechanisms of speech disorders in these people.Methods:There are 17 cases of cleft lip patients, 10 cases of cleft palate, 20 cases of patients with cleft lip and cleft palate, 16 cases of healthy volunteers performed to check MMN. All subjects underwent pure tone audiometry and ABR examination to determine the hearing threshold and ABR thresholds, MMN check using oddball way, bias stimulus for 2000 Hz, the probability is 20% with a standard stimulus for 1000 Hz, the probability is 80%, observed characteristics of MMN’s latency and amplitude of each group in the performance.Results: The results of latency were: cleft lip group 179.33±25.89ms; cleft palate group 200.37±39.05 ms; cleft lip and palate group 200.11±32.46 ms; normal group 173.00±29.21 ms; it showed the latency of the cleft palate groups were longger than the normal groups and the cleft lip group(P <0.05), no significant differences between the cleft palate group and the cleft lip group,the normal groups and the cleft lip group(p> 0.05).The results of amplitude were: cleft lip group 4.70 ± 2.29μV; cleft palate group 3.62 ± 1.81μV; cleft lip and palate group 5.00 ± 2.40μV; normal group 5.33 ±2.64μV; it showed the amplitude of the normal groups were bigger than the cleft palate groups(P <0.05), no significant differences in the other groups(p> 0.05).Conclusion: The result of MMN’s latency shows a certain degree of disorders in the central auditory function of people with cleft lip and palate, which is nothing to do with cleft lip associated with the extence of cleft lip.The high volatility of MMN’s amplitude is not enough to explain the central auditory aspects. |
PDF Full Text Request