| Objective: Study the effectiveness of unilateral,bimodal,and bilateral cochlear implant for children with severe to profound sensorineural hearing loss.Explore the effect of inner ear malformation children.Methods: 261 patients who received the cochlear implantation in our hospital from January 2015 to July 2018 were selected(78 UCI,67 BIM,and 116 BCI).24 months after surgery,we tested the aided sound-field thresholds at 0.5kHz,1kHz,2kHz,and 4kHz.Besides,we conducted questionnaires including meaningful auditory integration scale(MAIS)and infant-toddler meaningful auditory integration scale(ITMAIS),meaningful use of speech scale(MUSS),categories of auditory performance(CAP),and speech intelligibility rating(SIR).Then,they were sub-divided into inner ear malformation group and control group,respectively.All the data were analyzed by SPSS 22.0 software.Results:1.The aided sound-field thresholds of three groups(UCI,BIM,BCI)at four frequencies were better in the BCI group than in the UCI and BIM groups,with a statistically significant difference(P<0.001).There was no statistical difference between the BIM and UCI groups.In the BIM group,the aided sound-field thresholds at 0.5kHz were better in both ears and HA ear(P<0.001).However,CI ear outperformed HA ear at 1kHz,2kHz,and 4kHz(P<0.001).Although double ears at 1kHz,2kHz,and4 kHz performed better than CI ear,the difference was not statistically significant.For the BCI group,the double ears had better listening effect than the left or right ear at four frequencies(P<0.001).No significant difference was found between the left and right ear.2.Among the three groups(UCI,BIM,BCI),the BIM group outperformed the UCI group on both the MUSS scores(P=0.014),and the SIR scores(P=0.035).Both the mean values of the MAIS/IT-MAIS scores and the CAP scores can be ranked as BIM > BCI > UCI,and no significant difference was found in all results.3.The three groups(UCI,BIM,BCI)were sub-divided into two subgroups,i.e.,the inner ear malformation group and the control group.In both the UCI and the BIM groups,there were no statistical differences in MAIS/IT-MAIS,MUSS,CAP and SIR scores between the inner ear malformed and control groups.In the BCI group,only CAP scores showed statistically significant difference(P=0.026).In addition,for the UCI group,no statistical differences were observed in aided sound-field thresholds at frequencies of 0.5kHz,1kHz,2kHz,and 4kHz.When similar sub-grouping comparison was carried out in aided sound-field thresholds of CI ear,HA ear and double ears,there were no statistically significant differences except for the CI ear in the BIM group at0.5kHz(P=0.007).When comparing aided sound-field thresholds of left ear,right ear,and double ears between these two groups,there were no statistically significant differences at 0.5kHz,1kHz,2kHz,and 4kHz.Conclusion:1.The BCI group has better aided sound-field thresholds than the UCI and BIM groups,indicating that children with BCI have the best performance of auditory awareness in quiet environment.When UCI cannot provide enough low-frequency signals for patients,it is effective to wear HA on the contralateral ear for compensation.At this point,the children’s binaural low-frequency hearing can largely benefit from the HA ear.However,when low-frequency signals can be sufficiently provided,UCI and BIM have similar hearing effects.The BCI group has better aided sound-field thresholds than the UCI group.In the BCI group,the double ears’ listening effect is better than the left or right ear alone at four frequencies.This indicates that binaural listening mode close to human auditory physiology is superior to monaural listening mode.2.For the questionnaires,BIM group has higher MUSS and SIR scores than the UCI group,but there were no significant differences in the MAIS/IT-MAIS and CAP scores among the three groups.It means that,children with BIM have better control of their voices and better verbal skills in everyday life than children with UCI,and that people are more likely to understand what they are expressing.The auditory and verbal advantages of children with BCI in daily life have not been fully demonstrated,but we have high expectations for the potential benefits of BCI in the future.3.Under certain conditions,children with enlarged vestibular aqueduct,incomplete partition(IP-Ⅱ),semicircular canal abnormalities,cochlear hypoplasia(CH-Ⅲ),common cavity deformity,internal auditory canal abnormalities can have good hearing and speech ability through cochlear implantation,and inner ear malformation is not the decisive factor in whether a child undergoes CI surgery. |
