儿童人工耳蜗植入者的言语识别

1　引言在过去的 30年中 ,人工耳蜗 ( cochlearimplant,CI)已从早期的临床试用阶段发展到今天国际上作为重度耳聋的常规治疗方法。美国洛杉矶House耳研所在早期单通道装置的研制和应用方面做了大量的工作 ,他们的 3M/House单道装置于1 984年得到美国食品药品管理局 ( FDA)批准 ,使CI首次作为一种治疗方法正式应用于临床。近 1 0多年来随着微电子学、计算机科学等高新科技的发展 ,多通道 CI在提高使用者的语音识别方面取得了重大突破。1 990年以墨尔本大学 Clark研究中心为代表的多道装置又被 FDA批准应用于临床〔1〕。多通道 CI在重…     

语后聋成年人工耳蜗植入者术后生活质量的跟踪性评价

目的 研究语后聋成年人工耳蜗植入者术后生活质量随时间变化的发展趋势和影响因素.方法 对28例语后聋成年人工耳蜗植入者(男16例,女12例,年龄39.82±16.38岁)分别在人工耳蜗植入术前、开机后1、3、6、12个月时,采用Nij megen人工耳蜗植入量表(NCIQ中文版,包括基本声音感知、高级声音感知、言语能力、...     

低年龄段语前聋儿童人工耳蜗植入后汉语声调识别变化的分析

目的:探讨低年龄段经人工耳蜗植入的语前聋儿童经过开机一段时间后声调识别的变化特点。方法:选择29例已经接受人工耳蜗植入的低年龄语前聋儿童,按植入时年龄分为2组,即A组:3.0~4.5岁,B组:5.0~6.5岁,植入后平均开机时间为1.5~2.0年。采用聋康系统的《聋儿听觉言语康复评估词表》中主要反映声调识别的相应评估内容进行封闭项测试。结果:A组:同音单音节声调识别率为(63.00±16.75)%,双音节声调识别率为(75.60±11.18)%,单音节词识别率为(72.38±11.39)%。B组:同音单音节声调识别率为(49.46±13.91)%,双音节声调识别为(64.71±9.64)%,单音节词识别率为(55.71±8.59)%。所有正确识别率结果均大于机会水平。人工耳蜗植入后不同年龄组患儿有关声调识别的三项测试内容,低年龄组患儿均好于高年龄组,结果均差异有统计学意义。结论:对于语前聋行人工耳蜗植入的低年龄儿童,植入时年龄仍是影响植入后声调识别的重要因素之一,而在更能反映汉语声、韵、调特点的单音节词中差异更为明显,因此植入年龄是术后汉语学习的重要影响因素之一。     

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。     

人工耳蜗植入的言语评估

人工耳蜗作为使深度听障者复聪的主要方法近年来日益得到重视，我国的人工耳蜗从植入数量、科研水平上均与10年前不可同日而语。耳蜗植入的最终目的是使用者能够自如地与他人进行言语交流，其康复成功的第一个标志应该是听懂言语。与国外术前、术后言语评估大量的报告相比．我国的研究相对较少。这不仅影响了国人术后效果与全球各地的比较，而且难以解释现有的多道装置和编码策略对汉     

青少年语前聋患者人工耳蜗植入后生活质量评估

目的 评估青少年语前聋患者人工耳蜗植入术后家庭及个人的生活质量,并比较术前交流方式对其影响.方法 回顾性分析21例语前聋人工耳蜗植入青少年患者的临床资料,按照术前交流方式分为非言语组(10例)和言语组(11例),采用听力植入体使用儿童的家庭生活质量(children using hearing implants quality of life,CuHI Qol)及Nijmegen 人工耳蜗植入量表(Nijmegen cochlear implant questionnaire,NCIQ)对两组患者植入人工耳蜗前后进行评分,比较两组患者得分差异.结果 21例患者人工耳蜗植入术后的CuHI Qol平均得分51.71%±8.9%,较术前(42.14%±6.04%)有明显提高(P<0.001),其中言语组对家庭的影响方面术后得分与非言语组差异无统计学意义(P>0.05),父母的期望及生活质量两方面言语组得分均高于非言语组(P<0.05);术后NCIQ评估言语组平均得分(51.00±0.51%)高于非言语组(31.5%±5.55%),差异有统计学意义(P<0.001);在高级声音感知、言语能力和社会交流方面言语组得分高于非言语组(P<0.05),在基本声音感知、自信心及活动能力方面两组得分差异无统计学意义(P>0.05).结论 语前聋青少年人工耳蜗植入术后生活质量可获得明显改善,术前的交流方式可影响术后的康复效果,术前使用言语交流的患者术后可以获得更好的生活质量.     

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.     

语速和耳语对人工耳蜗植入者言语识别效果的影响

目的研究不同语速和耳语式的言语是否会影响人工耳蜗植入者的言语识别效果。方法在本研究中,分别对一组人工耳蜗植入者和一组听力正常者进行以下4种不同说话方式的言语识别率测试：慢速言语、常速言语、快速言语和耳语。测试时,人工耳蜗植入者聆听由扬声器播放的未经处理的言语声,正常受试者聆听经4通道人工耳蜗处理的言语声,二者使用相同的原始测试材料。结果人工耳蜗植入组与正常对照组对4种不同说话方式的言语识别结果相似,当说话语速增加时言语识别率逐渐下降,耳语的识别率最差,对于人工耳蜗植入者来说快速言语的识别率显著低于慢速言语识别率。结论人工耳蜗植入者言语识别效果会随着所聆听言语的语速增加而降低,并且聆听耳语式的言语对人工耳蜗植入者来说是非常困难的。     

语前聋人工耳蜗植入儿童开放式听觉言语能力评估

目的对人工耳蜗植入（cochlear implant,CI）儿童的开放式听觉言语能力进行评估,以期获得其听觉言语发育特性。方法选取听觉言语能力已达到进行开放式言语测试的27例语前聋人工耳蜗植入儿童（CI组）,按照从易到难的测试方法和顺序,依次进行声场下普通话儿童词汇相邻性双音节易词-双音节难词-单音节易词-单音节难词及儿童版普通话噪声下言语测试（mandarin hearing in noise test for children,MHINT-C）的安静环境-非植入侧噪声-植入侧噪声-前方噪声的测试。将获得的数据与年龄相匹配的听力正常儿童进行比较。结果 27例CI儿童均能进行词汇相邻性测试,其中9例能进行安静环境下句子测试,7例能进行更高难度的噪声环境下的句子测试;双音节难易词表间、单音节难易词表间结果差异均有统计学意义（P〈0.05）,且易词得分均明显高于难词;能进行噪声下言语测试的儿童,噪声在非植入侧、植入侧和前方的言语识别阈（speech response threshold,SRT）分别为4.38&#177;3.43、8.76&#177;4.18、9.15&#177;3.39dB S/N,噪声在非植入侧与噪声在植入侧和前方得分相比差异均有统计学意义（P〈0.05）,噪声在前方与噪声在植入侧结果差异无统计学意义（P〉0.05）。在安静环境下CI儿童的MHINT-C的SRT与听力正常儿童相差31.5dB S/N,噪声在前方、非植入侧和植入侧环境下分别相差13.4、15.2、19.7dB S/N。结论 CI儿童与听力正常儿童一样均对语音表现出一定的敏感性,对易词的识别好于难词;两者听觉言语发育遵循同样的轨迹,但CI儿童相对滞后;聆听技巧的掌握及发挥双耳对噪声的压制作用对CI儿童言语理解尤其是噪声环境下的言语理解有帮助。     

Variables Affecting Speech Perception in Postlingually Deaf Adults Following Cochlear Implantation

Objective--To evaluate the time span over which there is greatest improvement in postlingually deaf adults undergoing cochlear implantation. Additionally, to quantify potential patient and device factors that may predict the postoperative results. Material and methods--A longitudinal study was conducted. Numbers, monosyllables and sentence test results were collected for 66 cochlear implant subjects [Combi 40/40+, n=60; Clarion HF2, n=2; Nucleus 24m/k, n=4] at regular intervals for up to 6 years following cochlear implantation. Results--All patients showed a steady improvement over time on all tests. Progress during the first 12 months was statistically significant, with further improvements being recorded after the 12-month testing period. The duration of deafness and the number of electrodes (8 for the Combi 40, 12 for the Combi 40+) appeared to be weakly correlated with postoperative performance. Re-implantation after device failure had no negative effect on speech reception. Subjects who were "upgraded" from an analogue to a digital cochlear implant improved their test results almost twofold. Conclusion--All the patients in our study gained substantial benefit from their cochlear implants. It is encouraging to note that the factors examined were not deemed to be relevant predictors of performance. Even long-term deaf subjects and re-implantees are able to achieve an excellent level of speech perception.     

Speech Discrimination Scores of Postlingually Deaf Adults Implanted with the Combi 40 Cochlear Implant

The aim of the study was to assess the speech discrimination ability of postlingually deaf adults implanted with the Combi 40 cochlear implant and to compare the results with the postoperative data published for other devices. The postoperative open and closed set speech perception performance of 21 consecutive patients was tested using a standardized test battery comprising a number, monosyllable, sentence, consonant and vowel discrimination test as well as a rhyme test in the sound only condition. Mean values achieved for each test 1, 6 and 12 months after ?switch on? were evaluated. The results demonstrate that all patients have a substantial benefit from their implant and show a continuous improvement in their speech perception abilities with increased device experience. The mean percentages of correct answers after 12 months were 93.4 for numbers, 44.6 for monosyllables, 78.5 for sentences, 67.6 for the rhyme test, 59.8 for vowel, and 67.3 for consonant discrimination. Preoperatively, the mean discrimination score for monosyllables was 0%. The speech discrimination scores of our patients were similar or higher than described for similar patient groups implanted with other devices. The high stimulation rate of the implant system using the continuous interleaved speech processing strategy as well as a deep atraumatic electrode insertion into the apicalmost regions of the scala tympani may be the reason for good performance.     

Speech Perception Performance in Prelingually Deaf Children with Cochlear Implants

The goals of this study were to report on mean values of speech perception performance in prelingually deaf children implanted with a Combi 40/40+ cochlear implant. A total of 31 patients were included in the study. The time span ranged over 3 years, during which time the Evaluation of Auditory Responses to Speech (EARS) test battery was used with the children. The EARS battery contains four measures of closed-set speech perception and three open-set tests. The mean test results exhibited steady improvement on all parts of the EARS test battery, even up to 3 years post-implantation. The preoperative scores for the Listening Progress Profile (LiP) were 4%, rising to 93% at 36 months post-implantation. Results for the open-set testing measures were most encouraging, with some children reaching fairly high levels of speech perception, receiving scores as high as 100% by the 36-month evaluation. The congenitally and prelingually deaf children in our study showed continuous improvement in both closed and open set speech perception following cochlear implantation, although variability in individual performance among the children was noted.     

语后聋成人人工耳蜗植入对于音乐感知的影响的研究

语后聋成人耳聋患者在接受人工耳蜗植入后在音乐感知方面远不如其听力及言语方面的提高令人满意。人工耳蜗植入是目前治疗重度-极重度感音神经性聋的重要手段,其在音乐感知方面的不理想在近年来人工耳蜗的研究中比较深入。本文通过综述近年来国内外相关文献,探讨语后聋成人接受人工耳蜗植入后对音乐感知的现况及分析其可能影响因素,以及可能的方法以助于音乐感知的提高。     

Negative Effect of Deep Cochlear Implant Electrode Insertion on Speech Perception

This case study details the evaluation, explantation, and subsequent reimplantation of a cochlear implant (CI) recipient with an unusually deep electrode array insertion. Although the positive value of sufficiently deep insertion and the effect of insertion variability have been researched, there are few data available that illustrate the detrimental effects on speech recognition when deep insertion corrupts optimal use of the CI. This unique case report challenges the assumption that deeper insertion will result in improved speech understanding and demonstrates the importance of fully evaluating recipients' complaints and recognizing the impact of frequency-to-place mismatch.     

Changes in the Cerebral Blood Flow in Postlingual Cochlear Implant Users

Five postlingually deaf patients (age range 28-58 years) with multichannel cochlear implants were examined with single photon emission tomography (SPECT) (triple-head rotating gamma camera). Changes in the regional cerebral blood flow (rCBF) after intravenous administration of technetium-99m ethyl cysteinate dimer (Tc-99m ECD) were assessed through a stimulation paradigm, consisting of: i) click stimuli (75 dB SPL) in the ear that was to be implanted, 2 weeks before surgery; ii) stimulation with the same click, one month after initial fitting; iii) stimulation with hearing sequential Spanish sentences one month after initial fitting. The results showed a significant increase in the rCBF in the primary left auditory area and in the right auditory cortex, in conditions ii) and iii). The rCBF also showed a significant asymmetrical increase in the frontal lobes when the patient was hearing sequential sentences (condition iii)) with asymmetrical distribution among patients. These results are discussed, principally the correlation between speech discrimination scores and the rCBF distribution in the frontal and temporal lobes.     

伴脑白质病语前聋患儿人工耳蜗植入术后听觉言语康复效果分析

目的 探讨伴脑白质病的语前极重度感音神经性聋患儿人工耳蜗植入的可行性及术后听觉言语康复效果.方法 海南省人民医院耳鼻咽喉科2013年9~11月行人工耳蜗植入的14例伴脑白质病语前聋患儿为研究组(年龄1~6岁,平均3.79±1.93岁),同期无中枢神经系统病变的语前聋患儿16例为对照组(年龄1~6岁,平均4.38±1.93岁),术前均行临床听力学、影像学检查及语言能力、智力水平等评估,经乳突后鼓室面神经隐窝入路一期行人工耳蜗植入术,术后均到海南省聋儿康复中心进行言语康复训练;采用听觉行为分级标准(categories of auditory performance,CAP)和言语可懂度分级标准(speech intelligibility rate,SIR)对两组术后康复效果进行评估,比较两组患儿术后不同阶段的CAP和SIR分级.结果 所有患儿人工耳蜗植入术后均获得听觉反应和不同程度的言语交流能力,随着康复时间延长两组患儿CAP及SIR分级均呈上升趋势;研究组术后6、12和24个月CAP平均分级分别为2.571±0.416、3.714±0.496、5.000±0.492级,SIR平均分级分别为1.357±0.133、2.143±0.275、3.071±0.245级,与对照组CAP(分别为2.688±0.313、3.875±0.364、5.000±0.354级)及SIR(分别为1.500±0.129、2.313±0.176、2.875±0.221级)比较,差异均无统计学意义(P>0.05).结论 伴脑白质病的语前极重度感音性聋患儿经过术前充分评估后可以实施人工耳蜗植入,术后2年内听觉言语康复效果与不伴脑白质病的同龄患儿相当.     

Pre-operative Brain Imaging Using Functional Near-Infrared Spectroscopy Helps Predict Cochlear Implant Outcome in Deaf Adults

Currently, it is not possible to accurately predict how well a deaf individual will be able to understand speech when hearing is (re)introduced via a cochlear implant. Differences in brain organisation following deafness are thought to contribute to variability in speech understanding with a cochlear implant and may offer unique insights that could help to more reliably predict outcomes. An emerging optical neuroimaging technique, functional near-infrared spectroscopy (fNIRS), was used to determine whether a pre-operative measure of brain activation could explain variability in cochlear implant (CI) outcomes and offer additional prognostic value above that provided by known clinical characteristics. Cross-modal activation to visual speech was measured in bilateral superior temporal cortex of pre- and post-lingually deaf adults before cochlear implantation. Behavioural measures of auditory speech understanding were obtained in the same individuals following 6 months of cochlear implant use. The results showed that stronger pre-operative cross-modal activation of auditory brain regions by visual speech was predictive of poorer auditory speech understanding after implantation. Further investigation suggested that this relationship may have been driven primarily by the inclusion of, and group differences between, pre- and post-lingually deaf individuals. Nonetheless, pre-operative cortical imaging provided additional prognostic value above that of influential clinical characteristics, including the age-at-onset and duration of auditory deprivation, suggesting that objectively assessing the physiological status of the brain using fNIRS imaging pre-operatively may support more accurate prediction of individual CI outcomes. Whilst activation of auditory brain regions by visual speech prior to implantation was related to the CI user’s clinical history of deafness, activation to visual speech did not relate to the future ability of these brain regions to respond to auditory speech stimulation with a CI. Greater pre-operative activation of left superior temporal cortex by visual speech was associated with enhanced speechreading abilities, suggesting that visual speech processing may help to maintain left temporal lobe specialisation for language processing during periods of profound deafness.

     

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。