语后聋人工耳蜗植入患者音乐音调感知能力的评价

目的探讨语后聋成人人工耳蜗使用者感知音乐音调的能力。方法使用慕尼黑音乐经验问卷(Munich music questionnaire,MUMU)评估12例听力正常受试者(听力正常组,男5例,女7例)与12例人工耳蜗使用者(人工耳蜗组,男5例,女7例)的年龄与音乐经验的匹配程度。使用Fitzgerald等开发的人工耳蜗音乐评估软件(MuSIC)中的音调辨差阈值测试、旋律辨别与和弦辨别测试评估人工耳蜗使用者的音乐音调感知能力。结果听力正常组与人工耳蜗组的年龄与音乐经验相匹配。人工耳蜗组F3调的音调辨差阈值平均为16.2个1/4音,C4调的音调辨差阈值平均为6.2个1/4音,均显著高于听力正常组(P<0.05)。人工耳蜗组的旋律辨别测试平均正确率为69.8%,和弦辨别测试的平均正确率为72.4%,与听力正常组比较差异无统计学意义(P>0.05)。人工耳蜗组耳蜗植入前助听器使用时间与其植入后聆听音乐的经验均与其音调辨差阈值显著相关(P<0.05)。结论语后聋成人人工耳蜗使用者的音调辨差阈值显著高于听力正常人,但个体差异较大,其音乐音调感知能力与人工耳蜗植入前助听器佩戴时间以及植入后聆听音乐的经验相关。     

语后聋患者多通道人工耳蜗植入后听觉效果分析

目的:探讨使用心理物理测试及听觉行为分级、言语可懂度分级对语后聋多通道人工耳蜗植入患者听觉言语康复效果进行评估的意义,比较语前聋和语后聋患者术后康复效果.方法:1997-03-2007-06共植入人工耳蜗353例,选择语后聋植入者31例,语前聋植入者59例参加研究.对语后聋和语前聋受试者的纯音听阈、听觉行为分级标准(CAP)和言语可懂度分级标准(SIR)进行评估分析,并比较相同植入电极的语后聋和语前聋患者开机0.5年后的电听觉阈值、最大舒适强度和动态范围有无差异,用统计学方法加以分析.结果:所有受试者声场测试语言频率平均听阈(啭音)为25～45 dB(nHL).植入同种电极(澳大利亚直电极、澳大利亚弯电极、奥地利Medel C40+)的语前聋和语后聋患者之间听觉阈值最大舒适强度和动态范围差异无统计学意义(P>0.05).语后聋患者的CAP和SIR得分高于语前聋患者.结论:CAP和SIR是一种对人工耳蜗植入者日常生活中听说能力的方便有效的评估方法.植入相同电极的语前聋和语后聋患者之间的纯音听阈、电听觉阈值、最大舒适强度、动态范围无明显差异,但语后聋患者听觉水平和言语可懂度效果好与语前聋患者.     

语前聋患者人工耳蜗植入术后听觉能力评估

目的通过对129例极重度语前聋患者人工耳蜗植入术后声母、韵母、单音节及双音节词识别能力的评估,研究人工耳蜗植入术后患者的听觉康复效果及相关影响因素。方法选用《听力障碍儿童听觉、语言能力评估标准及方法》作为测试材料,分别测试患者的声母、韵母、单音节词、双音节词识别率,用各分项评估结果的均值代表总体听觉能力,进而研究康复时间、植入年龄、术前配戴助听器经验及性别对听觉能力的影响。结果随着康复时间的延长,听觉能力各分项得分逐渐提高（P〈0．05）。术前、术后6个月及术后1年低龄组与大龄组间总体听觉能力差异有统计学意义（P〈0．05）,术后3个月两组间差异无统计学意义（P〉0．05）。人工耳蜗植入术前、术后3个月、6个月及1年,男、女组之间总体听觉能力差异无统计学意义（P〉0．05）,配戴助听器组与未配戴助听器组间总体听觉能力差异无统计学意义（P〉0．05）。结论人工耳蜗植入能提高语前聋患者的听觉能力。植入时间越长,听觉康复效果越好。植入时年龄越小,术后听觉能力进步越快。大龄语前聋患者植入人工耳蜗后听觉能力仍能获得一定的改善。术前短时间配戴助听器对于极重度语前聋患者术后听觉能力康复无明显帮助。     

成人语前聋和语后聋人工耳蜗植入效果分析

目的分析成人人工耳蜗植入术后听觉及言语康复效果情况,探讨成人行人工耳蜗植入适应症的选择。方法对中国医科大学附属第一医院耳鼻咽喉科收治的18岁以上行人工耳蜗植入术患者52例进行测试,分为语前聋无干预组(9例)、语前聋佩戴助听器组(27例)、语后聋(16例)三组。采用声场助听听阈测试、电刺激听觉反应阈值(Threshold,THR)、最大舒适阈值(Maximum comfort level,MCL)评价其声音感知能力;采用普通话言语测听材料MSTMs中双音节词表评价其言语分辨能力。分别在开机6个月及24个月进行评估。结果开机6个月后三组声场助听阈值、THR、MCL均值无统计学差异。双音节识别率在开机6个月时语前聋无干预组8.78%、语前聋助听器组16.44%、语后聋组53.13%;在开机24个月时各组双音节识别率均上升,语前聋无干预组达18.22%、语前聋助听器组达52.89%、语后聋组达84.31%,语前聋助听器组提高明显。结论成人语前聋患者术后可获得与语后聋相近的听觉感知水平,长期使用人工耳蜗可加强言语识别能力,对术前有听觉言语基础的成人语前聋患者应积极行人工耳蜗植入术。     

语后聋成人人工耳蜗植入后言语感知能力的测评

目的通过对植入人工耳蜗的语后聋成人听力言语感知能力的测评,探讨人工耳蜗对语后聋成人言语康复的作用.方法受试者为14名语后聋成人患者,男性9例,女性5例;耳蜗植入年龄22岁～67岁,平均46岁;耳聋时间6年-42年,平均16年.在人工耳蜗植入6个月、12个月及24个月时,进行开放性单词和短句言语感知测试.分别在三种模式下进行:只听模式(开放人工耳蜗)、听觉加视觉模式(开放人工耳蜗加唇读)及视觉模式(关闭人工耳蜗只用唇读).结果在听觉模式及听觉加视觉模式下,患者对单词和句子的正确感知随人工耳蜗使用时间而不断改善.术后6个月,听觉模式下的开放性单词和短句的正确感知率分别是38%和54%;听觉加视觉模式下的开放性单词和短句的正确感知率分别是70%和76%.术后24个月,听觉模式下的开放性单词和短句的正确感知率分别是65%和72%;听觉加视觉模式下的开放性单词和短句的正确感知率分别是84%和88%.结论人工耳蜗植入能显著改善语后聋成人的言语感知能力,并随着人工耳蜗使用时间的增加,言语感知能力逐渐得到提高.     

语后聋长期全聋耳的人工耳蜗植入

目的 探讨语后聋长期全聋耳的人工耳蜗植入术后效果.方法 双侧听力下降时间不同步、双侧耳聋程度不一致的语后聋患者4例,对重度聋时间较长(均>10年)、耳聋程度较重侧进行植入人工耳蜗,分别在开机后6个月、12个月,使用心理物理学测试(T/C值),术后声场内最佳助听条件下言语频率平均听阈(pure-tonethreshold average,PTA).安静及噪声环境巾的言语识别率(HINT句表),单音节词识别率(HOPE词表),汉语声调识别(MESP),听觉行为分级标准(CAP),成人生活质量调奁问卷等评价指标,评价其术后听觉言语康复效果.结果 4例受试者在开机半年至一年内均达到了较为理想的康复效果,PTA接近或达到正常水平;安静环境中的言语识别率平均达到90%以上,噪声环境中平均达到70%;植入者可以很好地识别汉语声调;人工耳蜗为植入者带来了较高的社会效益.患者对人工耳蜗的植入效果均表示满意.结论 4例受试者都选择重度聋时间较长侧作为人工耳蜗植入侧,开机后均在较短时间内获得了良好的听觉言语康复效果,充分发挥了人工耳蜗的功能和优势的同时.听力相对较好侧耳还町继续佩戴助听器,保留了患者双耳聆听和日后接收其它治疗的机会,最大限度地为患者创造了最佳聆听条件.     

语后聋多通道人工耳蜗使用者的普通话言语识别

普通话是我国的规范语言，其语音学特点有别于西方语系，特别是声调。人工耳蜗植入作为治疗重度感音性聋的最重要手段，目前多为基于西方语系设计的国外产品，能否充分地体现汉语、特别是汉语普通话的语音学特点，一直备受关注。我国多通道人工耳蜗使用者、特别是更具代表性的语后聋使用者的普通话言语识别状况，目前仅报道5例。     

语后聋Nucleus人工耳蜗使用者的声调识别

目的 评估语后聋Nucleus人工耳蜗使用者的普通话声调识别水平，探讨其影响因素。方法应用(MACC)材科及北京协和医院耳蜗中心自编（声调测试）材科，评估14例语后聋Nucleus人工耳蜗使用者的普通话声调识别能力，其中使用Nucleus24型Sprint产品ACE方案者11例，Nucleus22型MSP产品MPEAK方案者3例。结果所有植入者的普通话声调识别率均高于机会水平，其中2例Nucleus24型Sprint产品使用者可达到100％。结论Nucleus人工耳蜗语后聋使用者可以获得较好的普通话声调识别．Nucleus24型Sprint产品可为部分植入者提供充分的声调信息。     

语前聋患者人工耳蜗植入后声调识别能力研究

目的分析语前聋患者人工耳蜗植入后声调识别的特点,为编制适用于汉语的人工耳蜗言语编码策略提供参考资料。方法23名语前聋患者,人工耳蜗植入时年龄2～18岁,均使用人工耳蜗1年以上。按人工耳蜗植入时年龄分为6岁以下和6岁以上两组,分别测试患者对一声与二声、一声与三声、一声与四声、二声与三声、二声与四声、三声与四声6种声调组合的识别能力。结果6岁以上组患者一声与二声分辨测试得分最低,与其余5种组合测试得分之间的差异有统计学意义（P〈0.05）;三声与四声分辨的测试得分最高,除二声与四声组合外,与其余4种组合测试得分之间的差异有统计学意义（P〈0.05）。6岁以下组患者一声与二声分辨的测试得分最低,三声与四声分辨的测试得分最高。6种不同声调组合测试得分之间的差异无统计学意义（P〉0.05）。6岁以下组患者6种不同声调组合测试的得分均高于6岁以上组。结论语前聋患者最易区分三声与四声之间的差别,而一声与二声之间的差异最难分辨。语前聋患者植入人工耳蜗越早,使用人工耳蜗时间越长,其声调识别能力越好。     

语后聋人工耳蜗植入的参数变化规律及意义

目的回顾语后聋病人在人工耳蜗植入术后一年内的程序图参数设置,研究其中主要参数T值和C值的变化规律,更好地为语后聋病人制定复诊计划。方法收集我科近年来接受植入手术的语后聋病人共16例(17耳),康复时间均达一年以上,选取他们程序图中高频区1号电极、中频区11号电极以及低频区22号电极为研究对象,选择分别代表着开机、首次程序调整、程序完善和长期随访的术后第1个月、第2个月、术后半年左右以及术后1年四个典型时间段,记录四次复诊时各电极T值、C值,使用单因方差分析检验,对每次复诊时T值的变化以及C值的变化情况进行统计学分析。结果各电极的T值自术后第1月复诊时既保持相对稳定值,四次复诊的T值在相互间两两比较中均无明显统计学差异(p>0.05),而在每次复诊时同一电极C值的比较中,首次复诊分别与后三次复诊的C值在两两比较中均具有显著统计学差异(p<0.05),后三次复诊之间的C值比较则无统计学意义(p>0.05),且术后第1个月时的C值明显低于后三次。结论术后第1个月和第2个月时的复诊在整个康复周期中意义重大,第1个月复诊目的主要在于获得准确的T值,使病人重新感受到声音,而第2个月复诊即可测得准确地C值,从而制定出病人主观感觉适合且相当稳定程序图,为后续的听觉言语康复打下基础,程序图的调试应按照循序渐进的原则,根据每个时期病人的特点制定每次复诊计划。     

Musical FAVORS: Reintroducing music to adult cochlear implant users

Abstract

Music represents a considerable challenge for many adult users of cochlear implants (CIs). Around half of adult CI users report that they do not find music enjoyable, and, in some cases, despite enhanced speech perception skills, this leads to considerable frustration and disappointment for the CI user. This paper presents suggestions to improve the musical experiences of deafened adults with CIs. Interviews with a number of adult CI users revealed that there were a number of factors which could lead to enhanced music experiences. The acronym FAVORS (familiar music, auditory–visual access, open-mindedness, and simple arrangements) summarizes the factors that have been identified, which can help CI users in their early music listening experiences. Each of these factors is discussed in detail, along with suggestions for how they can be used in therapy sessions. The use of a group approach (music focus groups) is also discussed and an overview of the approach and exercises used is presented. The importance of live music experiences is also discussed.     

Multivariate predictors of music perception and appraisal by adult cochlear implant users

The research examined whether performance by adult cochlear implant recipients on a variety of recognition and appraisal tests derived from real-world music could be predicted from technological, demographic, and life experience variables, as well as speech recognition scores. A representative sample of 209 adults implanted between 1985 and 2006 participated. Using multiple linear regression models and generalized linear mixed models, sets of optimal predictor variables were selected that effectively predicted performance on a test battery that assessed different aspects of music listening. These analyses established the importance of distinguishing between the accuracy of music perception and the appraisal of musical stimuli when using music listening as an index of implant success. Importantly, neither device type nor processing strategy predicted music perception or music appraisal. Speech recognition performance was not a strong predictor of music perception, and primarily predicted music perception when the test stimuli included lyrics. Additionally, limitations in the utility of speech perception in predicting musical perception and appraisal underscore the utility of music perception as an alternative outcome measure for evaluating implant outcomes. Music listening background, residual hearing (i.e., hearing aid use), cognitive factors, and some demographic factors predicted several indices of perceptual accuracy or appraisal of music.     

Contribution of hearing aids to music perception by cochlear implant users

Abstract

Objectives

Modern cochlear implant (CI) encoding strategies represent the temporal envelope of sounds well but provide limited spectral information. This deficit in spectral information has been implicated as a contributing factor to difficulty with speech perception in noisy conditions, discriminating between talkers and melody recognition. One way to supplement spectral information for CI users is by fitting a hearing aid (HA) to the non-implanted ear.

Methods

In this study 14 postlingually deaf adults (half with a unilateral CI and the other half with a CI and an HA (CI + HA)) were tested on measures of music perception and familiar melody recognition.

Results

CI + HA listeners performed significantly better than CI-only listeners on all pitch-based music perception tasks. The CI + HA group did not perform significantly better than the CI-only group in the two tasks that relied on duration cues. Recognition of familiar melodies was significantly enhanced for the group wearing an HA in addition to their CI. This advantage in melody recognition was increased when melodic sequences were presented with the addition of harmony.

Conclusion

These results show that, for CI recipients with aidable hearing in the non-implanted ear, using a HA in addition to their implant improves perception of musical pitch and recognition of real-world melodies.     

Emotional and analytic music perception in cochlear implant users after optimizing the speech processor

The present study examined transmitters that regulate commissural inhibition. Extracellular spikes of a single vestibular neuron were recorded in decerebrated cats. Multibarreled electrodes were filled with transmitter candidates (GABA and glycine), their specific antagonists (bicuculline, strychnine) and 2 M NaCl for extracellular recording. After isolation of a type I neuron, chemicals were iontophoretically applied to examine their effects on the activity of the neuron. The results were as follows. Commissural inhibition caused by electrical stimulation of the contralateral labyrinth was not abolished by the application of strychnine (a glycine antagonist), but was abolished by bicuculline (a GABA antagonist). Commissural inhibition was not abolished by phaclofen. Some bicuculline-sensitive neurons, with a short-latency commissural inhibition (presumably disynaptic inhibition), showed spacial summation when the conditioning stimulation (contralateral vestibular nerve stimulation) was applied with the test stimulation (vestibular nucleus stimulation). It was concluded that commissural inhibition was activated by the GABA_A receptor, but not by the GABA_B receptor, that the inhibitory type I neurons located in the contralateral vestibular nucleus were GABAergic, and that inhibitory type II neurons were also GABAergic neurons.     

Non-auditory stimulation in adult cochlear implant users

This is a retrospective case review of all 163 adults to have received multichannel cochlear implants on the Manchester University/Manchester Royal Infirmary programme between 1988 and 1998. The aims were to investigate the incidence of unwanted non-auditory effects of electrical stimulation (NAS) of the cochlea, and to try to identify any factors that seemed to be related to these effects. The effectiveness of programming strategies in eliminating unwanted effects was also studied. Most of the devices were Nucleus CI 22M or CI 24M. The remainder were Med-el Combi 40 or Combi 40+. NAS occurred in 23.9% of implantees. There were 20 cases of facial nerve stimulation (12.3%), 18 cases of pain in the ear or throat (11.0%) and one case of vestibulospinal spinal stimulation (0.6%). Two aetiologies were significantly associated with NAS. Otosclerosis tended to be associated with facial nerve stimulation and skull base fracture was associated with pain. Pain was associated with electrodes stimulated in the base turn of the cochlea and facial nerve stimulation tended to occur with more distally situated electrodes, close to labyrinthine segment of the nerve. There was no association with one particular make of device. The T and C levels for the rogue electrodes were in the normal range. It is concluded that the unwanted effects result from shorting of current through areas of low electrical resistance in the temporal bone. A number of different strategies were employed to prevent the effect, including alteration of current levels, removal of electrodes from the map and changing the stimulation mode, and this was successfully achieved in all cases. There was no difference between the performance of patients who had had NAS and those who had not, as assessed on open-set BKB sentence scores.     

Current research on music perception in cochlear implant users

The authors present a comprehensive review of the state of music perception with cochlear implant (CI) users. They discuss methods of assessment and results of studies of the aspects of music perception, melody, timbre, rhythm, and so forth in individuals with cochlear implants. They discuss neural mechanisms of music perception and the anticipation of broader acceptance of standardized tests for music perception in CI users.     

Non-auditory stimulation in adult cochlear implant users

Abstract

This is a retrospective case review of all 163 adults to have received multichannel cochlear implants on the Manchester University/Manchester Royal Infirmary programme between 1988 and 1998. The aims were to investigate the incidence of unwanted non-auditory effects of electrical stimulation (NAS) of the cochlea, and to try to identify any factors that seemed to be related to these effects. The effectiveness of programming strategies in eliminating unwanted effects was also studied. Most of the devices were Nucleus CI 22M or CI 24M. The remainder were Med-el Combi 40 or Combi 40+. NAS occurred in 23.9% of implantees. There were 20 cases of facial nerve stimulation (12.3%), 18 cases of pain in the ear or throat (11.0%) and one case of vestibulospinal spinal stimulation (0.6%). Two aetiologies were significantly associated with NAS. Otosclerosis tended to be associated with facial nerve stimulation and skull base fracture was associated with pain. Pain was associated with electrodes stimulated in the base turn of the cochlea and facial nerve stimulation tended to occur with more distally situated electrodes, close to labyrinthine segment of the nerve. There was no association with one particular make of device. The T and C levels for the rogue electrodes were in the normal range. It is concluded that the unwanted effects result from shorting of current through areas of low electrical resistance in the temporal bone. A number of different strategies were employed to prevent the effect, including alteration of current levels, removal of electrodes from the map and changing the stimulation mode, and this was successfully achieved in all cases. There was no difference between the performance of patients who had had NAS and those who had not, as assessed on open-set BKB sentence scores.     

Cross-modal perception of rhythm in music and dance by cochlear implant users

Abstract

Two studies examined adult cochlear implant (CI) users' ability to match auditory rhythms occurring in music to visual rhythms occurring in dance (Cha Cha, Slow Swing, Tango and Jive). In Experiment 1, adults CI users (n = 10) and hearing controls matched a music excerpt to choreographed dance sequences presented as silent videos. In Experiment 2, participants matched a silent video of a dance sequence to music excerpts. CI users were successful in detecting timing congruencies across music and dance at well above-chance levels suggesting that they were able to process distinctive auditory and visual rhythm patterns that characterized each style. However, they were better able to detect cross-modal timing congruencies when the reference was an auditory rhythm than when the reference was a visual rhythm. Learning strategies that encourage cross-modal learning of musical rhythms may have applications in developing novel rehabilitative strategies to enhance music perception and appreciation outcomes of child implant users.     

Neural response telemetry in cochlear implant users

Programming of multichannel cochlear implants requires subjective responses to a series of sophisticated psychophysical percepts. It is often difficult for cochlear implant patients (especially young prelinguistically deaf children) to provide adequate responses for device fitting. However, the neural response telemetry (NRT) system renders possible the measurement of the compound action potential threshold. We performed NRT examinations in 27 cochlear implant users with Nucleus 24-channel cochlear implants. Measurements were obtained from five electrodes (3, 5, 10, 15, and 20) in each patient. Our goal was to look for correlation between behavioral subjective thresholds and compound action potentials. The action potentials could be elicited in 23 patients in all measured electrodes. The NRT threshold values were highly correlated with electrical threshold levels obtained through subjective responses. Our results suggest that the electrically elicited neural responses may yield very important information for device fitting in patients with cochlear implants.