人工耳蜗相关的中文言语测听材料十年发展巡礼

语言是社会交际的工具,也是人类思维的载体。使用有声语言--言语进行交际是人类区别于其他动物的最重要的标志。接收并识别言语信号是人类听觉最重要的功能,临床上如果只能选择一种测试来评估听觉功能,那一定只能是言语测听[1]。可以说,受试者的言语识别能力是评判其听功能的金标准[2]。中文言语测听的工作始于上世纪五十年代,但由于我国人口、民族、方言众多,听力学的学科体系尚未完善,标准化的中文言语测听材料寥若晨星,言语测听的工作开展得尚不普及[3]。     

汉语言语测听材料的历史与现状

语言(language)是人类最基本的交流方式,言语(speech)指人类按照一定的自然语言模式发出的声音。接收和理解语言是人类听觉最重要的功能,言语测听(speech audiometry)是一种用言语信号作为刺激声来检查受试者言语听阈和言语识别能力的听力学测试方法[1],可用于听障患者的诊断以及评估听力康复效果。20世纪中叶后以美国为代表的英语国家,在言语测听材料的开发上做了大量的工     

我国言语测听材料的历史与现状

言语（Speech）是语言最基本的表现形式,人类听觉最重要的功能是接收和理解言语,言语识别能力是评价一个人听功能的“金标准”。本文回顾了我国在言语测听材料编制领域做出的探索,总结所取得的成就,并分析得到的启示,对我国的言语测听材料,尤其是普通话言语测听材料在方言区人群中的应用以及方言版言语测听材料的开发提出展望。     

言语测听的基本操作规范(上)

语言(language)是人类所特有的用以交流思想、传递信息的工具。日常生活中用口说出来的"言语"(speech),则是语言的最基本形式。人类听觉的最重要的功能是接收和理解言语。因此,能否听懂言语,是判断听功能状态的最主要指标。如果只能选择一种测试来评价听觉功能的话,那就是言语测听。言语测听(speech audiometry)是一种用标准化的言语信号作为声刺激来测试受试者的言语识别能力的测听方法。作为一项直观有效的技术手段,言语测听在诊断听力疾患、选择干预方案和评估康复效果等方面发挥着不可替代的作用。但中文言语测听长期受到"测听材料匮乏"和"测听方法     

推进中文言语测听材料的标准化和临床应用

人类听觉的最重要的功能是接收和理解言语，因此早期听力学的发展是以纯音测听和言语测听为基础的。二战结束后，言语测听在评估听力伤残和选配助听器时占有重要地位，在美国得到迅速发展并走向规范化。用于言语识别阈测试的材料（扬扬格词表）和方法（阶梯式降低言语声级）得以确立，同时用于日常交流障碍评估的阈上英文单音节词识别率测试方法也逐渐普及,20世纪40—60年代因而被称为听力学发展历程中的“言语测听年代”。     

计算机辅助的中文言语测听平台的建立

言语测听和纯音测听一样,是听力学最基本、最重要的测试手段^[1]。它既可在临床诊断中与纯音听力图相互验证,提供患者的言语听敏度信息,又能够评估患者在言语察觉、分辨、识别和理解等方面的能力。     

言语测听在儿童人工耳蜗植入术后的应用

言语测听(speech audiometry)也称为清晰度测验或言语可懂度测量,是用言语信号作为刺激声来评价言语察觉阈和言语识别能力的听力学检查.与其他听功能检查相比,言语测听反映日常生活交流言语信息的获得障碍,在临床实践中更有实际意义和诊断价值[1].     

中文言语测听材料概述

语言(language)是人类特有的用来表达感情、交流思想、传递信息的工具和手段,言语(speech)作为语言最基本的表现形式,是判断听功能状态最主要的指标之一[1].言语测听(speech audiometry)是用言语信号作为声刺激来检查受试者言语听阈和言语识别能力的听力学测试方法[2].     

研发汉语测听材料的重要性

人类的听力康复和干预技术都以改善患者的言语识别能力为主要目的。言语测听fspeech audiometry）作为诊断听力疾患、选择干预方案和评估康复效果的主要工具之一，其重要性不言而喻。随着临床听力学技术，尤其是近年来人工耳蜗植入和助听器验配技术的发展，临床科技人员越来越清楚地认识到这一点。     

普及言语测听提高耳科学诊疗水平

听觉在人类交流的“言语链”中占据重要一环,耳科学和听力学技术均以改善患者的言语识别能力为终极目的。因而，作为一项直观有效的技术手段．言语测听（speech audiometry）在诊断听力疾患、选择干预方案和评估康复效果等方面发挥着不可替代的作用。     

噪声下言语测听材料的发展历程

噪声下言语测听能较好地模拟日常交流的言语环境,且在评估受试者听力言语能力、指导听力障碍人士听力康复等方面发挥着不可替代的作用。随着噪声下言语测听在临床中的应用,临床迫切需要大量相关等价的言语测听材料以促进临床听力学的发展。本文主要阐述了国内外噪声下言语测听的发展现状、临床应用及相关测听材料的编制,为我国噪声下言语测听材料的开发提供帮助。     

The influence of hearing and age on speech recognition scores in noise in audiological patients and in the general population

OBJECTIVE: To describe the influence of pure-tone audiometry and age on the speech recognition score in noise, both in audiological patients and also in a random population sample. DESIGN: In a cross-sectional study, speech recognition scores (SRS) using monosyllabic words presented in a fixed background noise were evaluated on 1895 audiological patients of both genders with normal hearing or sensorineural hearing losses. The background noise was speech weighted and presented with a signal to noise ratio of +4 dB. In 291 participants, SRS in quiet was estimated as well. A female random population sample also was tested (N = 513). RESULTS: The major predictor for the SRS-noise was high-frequency hearing thresholds. If hearing was normal, age had no effect on speech recognition. Young persons with hearing loss had higher SRS-noise than older persons with the same degree of hearing loss. The difference between young and old persons became larger the greater the hearing loss. Predictive SRS-noise with consideration taken to hearing function and age are presented. SRS-noise correlated stronger with pure-tone audiometry and age than SRS-quiet. Controls performed better (by 10 to 20%) than their same-aged peers with similar hearing loss. CONCLUSION: It is recommended that speech recognition tests be performed in background noise. SRS-noise is a valuable tool for audiologists and audiological physicians to identify patients in need of pedagogic rehabilitation programs or further diagnostic investigations.     

Comparative speech audiometry studies with compact disk]

We compared the results of speech audiometry, performed with recorded tape and CD, respectively, in 21 subjects with bone conduction hearing loss, and in 27 subjects with sensorineural hearing loss. In all cases, speech audiometry was performed by using the German Freiburg speech test material, recorded in 1969 on the basis of the German DIN standard 45626. In subjects with an air-bone gap, the hearing loss for speech is 2.3 dB smaller if tested by use of CD, and the speech recognition is 10.5 points better, respectively. Smaller differences could be found in sensorineural HL: For CD, the hearing loss is 1.2 dB smaller, and the speech recognition score is raised by only 1 point. These differences are statistically not significant, and the calculation of hearing impairment and individual hearing handicap from the tables commonly used in Germany in medicolegal expert opinions must not be corrected, if records on CD are used basing on the recordings from 1969 according to DIN 45626. The handling of compact discs has many advantages in relation to the handling of tapes.     

Variable-speech-rate audiometry for hearing aid evaluation

A new hearing aid evaluation method using variable-speech-rate audiometry (VSRA) was developed. VSRA was newly created based on the Japanese speech audiometry authorized by the Japan Audiological Society. The ordinary speech audiometry can not reveal a temporal factor in word discrimination ability of the hearing impaired. Since, with VSRA, we can compare several performance-intensity curves obtained from different speech-rate speech audiometries, the impact on the auditory system of each patient by the fast or slow speech rate could be easily determined. Taking the temporal factor of the auditory systems into consideration by using VSRA, hearing aid evaluation was performed for a master hearing aid with three types of signal processing and fitting for 36 hearing impaired subjects. Then hearing aid evaluation was performed using VSRA for a newly developed portable multi-function digital hearing aid with two types of signal processing and analog hearing aids which had been used by hearing-impaired patients. As a result, VSRA was useful for hearing aid evaluation, in particular, for cases when ordinary normal speech rate audiometry does not provide a significant difference in word discrimination scores. In addition, using VSRA revealed that amplitude compression is more effective for improvement of word discrimination than linear amplification.     

Speech discrimination tests with hearing aids in tele-coil listening mode. A comparative study in school children

The object of this study was to compare the discrimination scores obtained in conventional speech audiometry with the scores recorded when the same speech test lists were presented through individually fitted, ear-level hearing aids. Comparative tests were performed in 50 hearing-impaired students aged 8 to 20 years, all well trained everyday hearing aid users. The test material consisted of Swedish standardized 50 words PB lists, recorded on tape. To keep the test conditions under control in the hearing aid presentation, the recorded speech was transmitted from a neck-loop telecoil to the student's hearing aid (T-mode listening). The result shows that the great majority of children recorded considerably higher discrimination scores when the tests were performed with their individual hearing aids than with the test lists presented through the audiometer and the TDH-49 earphone. The conclusion is that, in children who are using carefully fitted hearing aids and are well adapted to those, the results of traditional speech audiometry tests involve a risk of underrating such children's practical hearing ability. The finding stresses that it is important to maintain one and the same amplification characteristic to which the child has accommodated, and to avoid switching between systems with different characteristics.     

The Finnish speech in noise test for assessing sensorineural hearing loss

A computerized adaptive Finnish speech in noise test was developed recently. As part of the test's evaluation process 172 patients with sensorineural hearing loss including 20 normally hearing subjects were measured using pure-tone audiometry, speech recognition threshold in noise (SRTN) test and conventional speech audiometry without background noise. As anticipated, sensorineural hearing loss yielded an elevation of SRTN although individual differences were considerable. The SRTN test was accurate as the absolute difference between individual repeated SRTNs was, on average, 1.5 dB (SD 1.5 dB) when the range of possible test values is from approximately -12 to +20 dB. On average, the learning effect was 0.5 dB.     

Earmoulds: some benefits from horn fitting.

The narrow bore of conventional hearing aid earmoulds restricts the transmission of higher auditory frequencies. For subjects with moderate to severe high-frequency hearing loss this is likely to have an adverse effect on the perception and recognition of phonemes with high-frequency components. Twenty-two subjects with predominantly high-frequency hearing loss underwent a series of tests to compare the performance of earmoulds having conventional 1.9 mm through-tubing with earmoulds fitted with a smooth horn with a final internal diameter of 4 mm. The test battery comprised free-field Békésy audiometry, in-the-ear pressure measurement, speech audiometry using AB word lists and semantic differential rating of the relative sound quality of the two systems. Subjectively the horn fitting was rated as clearer, more natural, undistorted and acoustically comfortable. Objectively, by both Békésy audiometry and in-the-ear pressure measurement, the horn gave more gain in the higher auditory frequencies. With the horn there was improved recognition of phonemes, especially fricatives and affricatives.     

Vocal audiometry: the "phonatome" recognition test. Principle, technique, initial results]

Whereas tonal audiometry makes it possible to analyze the elementary deficits of hearing, vocal audiometry enables an overall synthetic assessment of these deficits. The vocal material usually used is composed of lists of sentences, words, logatomes or even phonemes. The authors suggest resorting to lists of phonetically balanced phonatomes or diphonemes. Among the advantages this technique offers, are the rapidity of the test, the excellent representativity of the most informative acoustic components of speech and the elimination of the extralinguistic factors of speech recognition.     

Variables affecting pure tone and speech audiometry in experimentally simulated hearing loss

Previous studies have found that subjects simulating hearing losses can provide information which is useful to audiological clinicians when patients produce exaggerated hearing levels with no apparent organic aetiology. Two groups of normally-hearing subjects were used, designated unsophisticated or sophisticated in audiometric testing. Each subject was instructed to feign any amount of hearing loss in both ears prior to carrying out pure tone and speech audiometry using monosyllabic speech material. A number of variables was studied to identify factors influencing success or failure in simulating hearing loss and to investigate strategies used by the subjects. Analysis of the audiometric results revealed no typical degree of hearing loss for tones or speech. The majority of the subjects simulated sensori-neural pure tone losses with flat audiometric configuration. Approach mode, ascending or descending, had no significant effect on simulated tonal threshold. Four strategies for simulating a loss were identified. A fair degree of test/retest reliability in hearing loss for speech and tones was observed. Large discrepancies in hearing loss for speech and tones were recorded with the hearing loss for tones typically in excess of that for speech. Responses during speech audiometry showed a high occurrence of 'no response' errors. No significant differences were recorded between the sophisticated and unsophisticated groups, except in the pattern of response during speech audiometry, when the sophisticated subjects gave significantly fewer correct responses and 'no response' errors.     

对称性聋患者单耳助听后双耳言语识别率差别探讨

目的通过检测对称性聋患者单耳助听后双耳言语识别率的差别来进一步研究听觉剥夺效应。方法选取右耳助听4～5年的双耳对称性感音神经性聋患者15名,在标准隔声室中,测试其双耳的纯音气导和骨导听闻,然后再采用汉语普通话单音节词表分别进行左右裸耳言语识别率测试,并将所得数据进行对比研究。结果15名受试者右耳配戴助听器前及配戴4～5年后两耳间平均听阈无显著性差异（P〉0．05）;受试者右耳助听前及助听4～5年后左、右耳平均听阀前后无显著性差异（P〉0．05）;右耳助听4～5年后,受试者左、右耳裸耳言语识别率存在显著性差异（t=2．76,P=0．02〈0．05）。结论对称性感音神经性聋患者单耳助听后裸耳平均听阈无显著改变,但非助听耳言语识别能力显著下降。