Problems related to the detection of infantile hearing loss and rehabilitation in yamaguchi prefecture

1998年4月から2012年12月までに山口大学医学部附属病院耳鼻咽喉科を聴力精査,または療育目的に受診し,難聴の経過観察を行うことができた50例(男児30例,女児20例)を対象に,難聴の疑いから療育に至る経緯を調査した.新生児聴覚スクリーニングを受けた14例の療育開始月齢は,高度･重度難聴児7.3±6.1ヵ月,軽度･中等度難聴児10.5±6.6ヵ月であった.一方,新生児聴覚スクリーニングを受けていない26例の療育開始月齢は,高度･重度難聴児が21.3±9.7ヵ月,軽度･中等度難聴児が57.4±20.2ヵ月と遅れていた.また,難聴ハイリスク児として聴覚検査を受けた症例は早期に難聴と診断されたが,検査を受けていないハイリスク児では発見の遅れが認められた.次に,50例のうち,2011年4月から2012年12月までの間に,7歳から15歳であり,聴取能と言語発達の評価が可能であった19例に対し,聴力検査,補聴器または人工内耳の装用閾値検査,語音聴取検査,PVT-R絵画語い発達検査,WISC-Ⅳ知能検査を実施した.WISC-Ⅳの言語理解指標の合成得点は知覚推理指標の合成得点と相関が認められた.また,PVT-R絵画語い発達検査の評価点はWISC-Ⅳ知能検査の言語理解指標の合成得点との相関が強く,知覚推理指標の合成得点,装用閾値,語音聴取能の順で相関が認められた.今回の検討では,WISC-Ⅳ知能検査の言語理解指標とPVT-R絵画語い発達検査の評価点は,いずれも療育開始月齢との関連が認められなかった.すなわち,療育開始が早期であっても言語発達に必要な療育体制が十分に整っていないという現状が考えられる.今後は,山口県の難聴児の早期発見体制に加え,早期療育体制の整備が必要と考えられる.

To examine the progress from suspected hearing loss to rehabilitation, we conducted a survey involving 50 patients at the Department of Otolaryngology, Yamaguchi University Hospital, who underwent a hearing test or consultation for rehabilitation and whose progress concerning hearing loss we were able to observe. With regard to the 14 patients who had received hearing screening for infants, their rehabilitation had started at less than 1 year old regardless of the degree of hearing loss. Concerning the 26 patients who had not received hearing screening, those with severe of excessively severe hearing loss had started their rehabilitation at an average age of 21 months old, while patients with slight or moderate hearing loss had stated their rehabilitation at an average age of 4 years and 9 months old. Next, we assessed the speech recognition and language development of the 19 patients we were able to observe over a long period. With regard to the 19 patients who were assessed using the Wechsler Intelligence Scale for Children-Fourth Edition(WISC-Ⅳ),we observed a correlation between their composite score for the Verbal Comprehension Index(VCI)and that for the Perceptual Reasoning Index(VCI).

小児難聴

早期発見

療育

言語発達