言语编码策略升级对成年人工耳蜗使用者听觉效果影响的研究

目的　探讨言语编码策略升级对有经验人工耳蜗使用者听觉效果的影响趋势，以期为临床制定有效的人工耳蜗言语编码策略升级方案提供参考依据。方法　采用噪声下汉语普通话声调识别测试、普通话噪声下言语识别测试以及自行编制的声音质量自评问卷，对13例有经验成年人工耳蜗使用者言语编码策略升级后的声调识别能力、短句分辨能力以及声音质量和聆听感受进行3个月连续观测。以使用日常言语编码策略（即CIS+策略）的测试结果为参考值，以新言语编码策略（即精细结构编码策略）的测试结果为目标值，分析言语编码策略升级对成年人工耳蜗使用者听觉效果的影响。结果　①声调识别能力：各测试阶段两种编码策略的声调识别测试成绩无显著差异，随着精细结构编码策略使用经验增加，测试成绩呈明显改善趋势[F（3,36）=5.201，P =0.004]；②短句分辨能力：各测试阶段两种编码策略的言语识别测试成绩无显著差异，随精细结构编码策略使用经验增加，测试成绩略有提高[F（3,36）=2.450，P =0.079]；③声音质量自评：更换言语编码策略对本组受试者的声音质量和聆听感受无不利影响（P =0.083）。随着精细结构编码策略使用经验增加，受试者认为声音质量更“饱满、丰富”、聆听感受更“容易、轻松”。结论　言语编程策略升级未对有经验人工耳蜗使用者的言语识别能力造成不良影响且存在潜在的改善作用。在临床工作中可参考患者主观意愿确定是否升级言语编程策略。

Effect of speech recognition outcomes in mandarin-speaking cochlear implant users with updated speech coding strategy

OBJECTIVE To determine speech perception,tone perception and the subjective preferences of mandarin-speaking adults who received the fine structure processing(FSP) coding strategy,at upgrade from the continuous interleaved sampling(CIS+) coding strategy.METHODS Thirteen mandarin-speaking subjects were tested at switch-over from CIS+ to FSP coding strategy approximately 1-,2-,and 3-month after switch-over with the mandarin hearing in noise test(M-HINT),the mandarin tone identification in noise test(M-TINT),and a visual analogue scale assessing sound and speech assessment(SSA).RESULTS Tone perception improved significantly over time with the FSP coding strategy.There were no significant differences in the MHINT over time,nor when compared to the CIS+ coding strategy.Subjects rated the FSP coding strategy with the OPUS 2 as significantly more "full" and "rich" than with the CIS+ coding strategy after 3-months.CONCLUSION Mandarin-speaking adults can use the FSP coding strategy as well as CIS+ coding strategy.Loss in performance was not observed after switch-over.Tone identification improves over time with the FSP coding strategy,which is beneficial to tonal-language users.