序贯双侧人工耳蜗植入儿童中的皮层P1潜伏期、声场测听与言语测听：一项比较性初步研究

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中文摘要

背景/目的： 对人工耳蜗（CI）植入儿童听觉康复的客观评估具有挑战性，因为行为测试需要幼儿并不总能提供的配合。皮层听觉诱发电位（CAEP）的P1成分是中枢听觉成熟的标志物，但很少有研究在序贯双侧CI儿童中将其与行为学测量直接比较。方法：8名患有语前极重度感音神经性听力损失并接受序贯双侧CI治疗的儿童（中位年龄8.4岁）接受了CAEP（言语刺激/m/、/g/、/t/，55和65 dB声压级（SPL））、声场测听和言语测听。一项预先设定的生理合理性标准排除了1名儿童的所有检测反应以及另一名儿童的另外1项反应；因此相关性分析基于7名儿童，并采用Spearman秩相关及精确置换p值进行评估。结果：P1潜伏期与声场阈值呈频率特异性关联，在高频/t/刺激4 kHz处最强（rho = 0.836，精确p = 0.056），该关联在留一法分析中保持在+0.70至+0.92之间。较长的P1潜伏期倾向于伴随较差的言语接收（65 dB SPL时的平均潜伏期，rho = 0.679，精确p = 0.110），但该关联不稳定，且未发现与植入物使用时长存在一致关系。两个系数在55 dB SPL时达到名义显著性，但在65 dB SPL时未能持续，其他关联均无显著性。结论：在这项初步研究中，P1潜伏期与频率匹配的助听听阈相关，而其与言语接收的关系具有方向性但未得到证实。CAEP可能在该人群中补充行为测试，但需要采用感觉级匹配刺激的更大规模纵向研究。

英文摘要

Background/Objectives: Objective assessment of auditory rehabilitation in children with cochlear implants (CIs) is challenging, as behavioral tests require cooperation that young children cannot always provide. The P1 component of the cortical auditory evoked potential (CAEP) is a marker of central auditory maturation, but few studies have compared it directly with behavioral measures in children with sequential bilateral CIs. Methods: Eight children (median age 8.4 years) with prelingual profound sensorineural hearing loss treated with sequential bilateral CI underwent CAEP (speech tokens/m/,/g/,/t/at 55 and 65 dB sound pressure level (SPL)), sound field audiometry and speech audiometry. An a priori physiological plausibility criterion excluded all detected responses in one child and one further response in a second child; correlations were therefore based on seven children and were assessed by Spearman rank correlation with exact permutation p-values. Results: P1 latency showed a frequency-specific association with sound field thresholds, strongest for the high-frequency/t/stimulus at 4 kHz (rho = 0.836, exact p = 0.056), which remained between +0.70 and +0.92 in leave-one-out analysis. Longer P1 latency tended to accompany poorer speech reception (mean latency at 65 dB SPL, rho = 0.679, exact p = 0.110), but this association was unstable, and no consistent relationship with duration of implant use was found Two coefficients reached nominal significance at 55 dB SPL but did not persist at 65 dB SPL, no other association was significant. Conclusions: In this pilot study P1 latency was associated with to frequency-matched aided thresholds, whereas its relationship with speech reception was directional but unconfirmed. CAEP may complement behavioral testing in this population, but larger longitudinal studies using sensation-level-matched stimulation are required.