助听器验配的新进展--开放耳选配技术

本文描述了助听器验配的新进展之一——开放耳选配技术,该技术主要解决助听器患者的堵耳效应问题。传统的做法是使用通气孔及开放的耳模,但不能做到真正的开放。开放耳选配技术的挑战在于如何提供合适的增益并控制反馈。近几年一种全新的数字信号处理技术(digitalsignalprocessing,DSP)即舒适技术(ComforTec)能够达到这一目的,提供清晰、自然的音质,还可以消除反馈和堵耳效应,确保聆听舒适。舒适技术包括复合宽动态范围和数字反馈抑制稳定器技术。此美观且配戴舒适的开放式助听器,必将给越来越多的听力障碍病人带来帮助。     

听障老年人的助听器验配

目的探讨听障老年人助听器验配的方法和技巧。方法对112名受试者进行跟踪随访，客观记录他们使用助听器的感受，分析助听器验配方法和技巧对助听器效果的影响。结果老年人的行为认知和听觉反应能力极大地左右着助听器的配戴效果；气骨导听阈，舒适阈，不适阈、言语识别阈的检查和使用对于老年人助听器验配十分重要；低频部分的听力补偿要低于目标值，高频部分要略高于目标增益值；老年人助听器配戴的适应期平均为3个月；双耳配戴的效果明显优于单耳。结论完全按照助听器验配软件设计的程序给老年人验配助听器很难达到理想的效果，而验配经验、技巧和验配后的适应性训练在其中发挥着巨大的作用。     

助听器验配指南

随着听力学的发展和听障者对助听器的需求增加,我国助听器验配工作,无论从数量上还是质量上,都有了长足的发展。为了进一步提高水平、规范操作模式,本刊编委会助听器验配专业学组组织专家几经讨论,制定了本指南。指南并非指令性文件,但具有较大的指导性,殷切希望本指南能为有关专业人员提供参考,更希望大家在使用中提出意见和建议。本刊将继续为指南的完善和修订提供平台。     

儿童助听器验配应注意的风险

自20世纪以来,听力学在中国发展迅速,儿童听力障碍“早发现、早诊断、早干预”的三早观念已经深入人心,新生儿听力筛查在我国逐渐普及,后期的干预工作,如助听器选配同样应该得到重视[1]。儿童助听器验配是一个系统工程,由于儿童听觉系统发育程度、心理状态、视觉、智力、反应能力等与成人有较大差异,儿童助听器验配必须依靠听力学家、助听器验配师、语训教师和家长共同配合才能达到理想的效果。因此,为儿童选择、调试和评估助听器效果一直是个巨大的挑战,如不能进行科学的选配干预,这些患儿的听力康复、言语发育、认知能力和社会情感的发展就有可能落后于同龄健听儿童。然而,目前国内儿童助听器验配的现状令人担忧,特别是存在以下4方面的风险,如果不能正确认识和及时预防,有可能给家长和听障儿童造成不可挽回的损失。     

助听器验配效果的评估方法及进展

近年来,助听器的验配技术有了很大的变化和发展,与此相应,各种评估方法也有较大的改善和提高.本文综述了助听器选配后的几种评估方法言语信号测试,非言语信号测试,自我评估测试等,以期为临床助听器的选配工作提供参考.     

应用成人选配策略为儿童验配助听器的可行性研究

近些年，助听器线路及外观设计方面的诸多改进多是基于成人特点发展起来的，然而这些先进技术是否对儿童助听器验配也具有同样益处尚未得到统一认识。本研究的目的在于评价低年龄组的听损伤儿童佩戴助听器的效果，以及新一代的声反馈抑制技术是否对婴幼儿的助听器选配有益。研究对象为4例年龄在8～10岁的不同     

中国小儿助听器验配程序指南

日前，经中国残疾人康复协会听力语言康复专业委员会相关专家讨论，制定并颁布了《中国小儿助听器验配程序指南》(中国聋儿康复研究中心陈振声教授执笔)。为满足我国小儿助听器验配的需要及解决存在的问题。更好地为广大听障儿童服务。2005年第一季度，中国残疾人康复协会听力语言康复专业委员会将会同中国聋儿康复研究中心在全国行业内推行该指南。本刊特全文刊发以飨读者。     

助听器验配公式的研发进展*

在过去的30年里,随着助听器技术的不断更新换代,越来越多的研究开始致力于增强听障人士的语音感知效果。由于听障患者在听力损失性质、类型和听力曲线特征等多方面存在差异,如何就不同声强、不同频率点设置目标增益是助听器验配公式要解决的一个问题。     

助听器效果国际性调查问卷在助听器效果评估中的应用

目的 探讨助听器效果自我评估问卷在助听器效果评估中的作用.方法 对76例助听器使用者,使用助听器效果国际性调查问卷(the international outcome inventory for hearing aids,IOI-HA)通过面对面问答或电话随访的方式,进行助听器效果及满意度评估.结果 89.5%的使用者认为助听器对他们有帮助,可以解决目前的听力障碍问题;97.3%的使用者认为使用助听器后生活质量有提高.小于60岁的使用者得分高于大于等于60岁者,差异有显著统计学意义(P<0.01);每天使用助听器时间大于8小时的使用者得分高于小于等于8小时者.差异有显著统计学意义(P<0.01);使用助听器时间大于6个月的使用者得分高于小于等于6个月者,差异有显著统计学意义(P<0.01).结论 助听器效果国际性调查问卷可以对助听器效果及满意度进行评估,由于它测试时间短,易操作,可作为配戴助听器后一个可靠的主观效果评估手段.     

父母和教师使用《听觉整合问卷》 评估听障儿童的一致性研究

目的 考查父母和教师使用《听觉整合问卷》(meaningful auditory integration scale,MAIS)评估听障儿童听觉发展情况的一致性.方法 请81名听障儿童的父母和康复教师分别利用MAIS中的父母问卷和教师问卷对儿童进行评估,对父母问卷和教师问卷的得分进行统计分析.结果 ①整体上,父母问卷的得分高于教师问卷的得分,差异极显著(t=4.970,P=0.000);②在信心分、警觉分和意义分3个维度上,父母问卷的得分也显著高于教师问卷得分(t1=2.115,p1=0.037;t2=5.340,P2=0.000;t3＝3.553,p3=0.001).结论 父母和教师在使用MAIS评估听障儿童的听觉发展情况时存在不一致,有待于扩大样本量或追踪进行进一步研究.     

Comparison of two adaptive procedures for fitting a multi-channel compression hearing aid

We compared two adaptive procedures for fitting a multi-channel compression hearing aid. “Camadapt” uses judgements of the loudness of speech stimuli and the tonal quality of music stimuli. “Eartuner” uses judgements of the loudness and clarity of speech stimuli with differing spectral characteristics. Sixteen new users of hearing aids were fitted unilaterally, using each procedure. The fittings were assigned to Programs 1 and 2 in the aid, in a counter-balanced order. Subjects kept a diary of their experiences with each program in everyday life. Following 2-4 weeks of experience, they filled in the APHAB and other questionnaires and were re-fitted using both procedures. Camadapt generally led to higher low-level gains and lower high-level gains than Eartuner. Gains recommended by the procedures did not change following experience. Eight subjects preferred the Camadapt fitting and eight preferred the Eartuner fitting. Most subjects gave high overall satisfaction ratings for both procedures. Test-retest reliability was better for Eartuner than for Camadapt. Preference for the Camadapt fitting was associated with slightly better speech communication with Camadapt, while preference for the Eartuner fitting was associated with fewer problems with aversion for that procedure.     

60岁以上听功能障碍者助听器远程验配86例

目的 分析186例60岁以上听功能障碍患者助听器验配情况,探讨老年听功能障碍者听力及助听器选配特点,为助听器验配寻找新思路。方法 统计186例250～8 000 Hz的纯音听阈,根据听力情况,进行常规助听器验配和调试100例, 利用网络远程助听器验配86例, 跟踪最终验配情况。结果 远程验配及常规验配两组患者佩戴助听器后听力提高和言语分辨率提高结果相同, 差异无统计学意义。结论 常规和远程验配均可以给听功能障碍患者选配正确的助听器, 能够有效改善老年患者耳聋症状,提高老年患者听力。远程验配可以减少患者验配成本, 更好地保障验配服务。     

听力语言康复过程中"表扬"策略的有效运用

人们普遍认为“表扬”是有积极意义的，然而，笼统地谈论表扬是积极还是消极的并没有意义。表扬要想获得预期的效果，要考虑如何满足一些基本的条件。从大量聋儿康复的成功例子及笔者多年的教学经验来看，“表扬”在聋儿听力语言康复过程中的重要作用不容忽视，适当的表扬是促进聋儿语言发展、提高学习动机、树立信心、战胜困难的有效方法。     

Surgical management of complications after hearing aid fitting

OBJECTIVES: Standard procedures for hearing aid fitting performed in accordance with established guidelines are well tolerated, safe, and effective. In this article, we present unusual complications after hearing aid fitting that required surgical management. METHODS: Four otologists at a major university center with a combined 65 years of experience performed a retrospective analysis of their surgical practice. Six patients were identified that had encountered severe complications from improper earmold fitting that required surgical intervention. RESULTS: One patient had a perforation of the tympanic membrane with earmold material found to have migrated into the middle ear cleft. The tympanic membrane healed spontaneously, resulting in persistent otalgia and a maximum air-bone gap. The earmold cast was successfully removed by means of a tympanomastoidectomy. Two patients with presbycusis and normal ear canals developed eardrum perforations and conductive hearing deficits. In both patients, earmold material was found partially occupying the middle ear cleft and removed by way of a transcanal approach. Three patients with prior canal wall down mastoidectomy defects and narrow external ear canals required microtoscopy under general anesthesia or canaloplasty for removal of impacted material. CONCLUSION: Proper fitting of hearing aids performed by well-trained medical professionals results in a very low incidence of significant complications. Perforation of the tympanic membrane with impaction of earmold material in the middle ear or mastoid bowl may occur and can be successfully managed by standard otologic surgical techniques.     

Detecting components of hearing aid fitting using a self-assessment-inventory

The evaluation of hearing-aid fitting includes numerous assessments such as electro- and psychoacoustic tests. The subjective estimation of the hearing aid user can be elicited with self-assessment inventories encompassing various parameters, e.g., benefit, satisfaction and usage. A questionnaire comprising 11 domains (disability, handicap, frequency and significance of the listening situation, importance of the hearing aid, expectation, demand, aided performance, benefit, satisfaction and usage) within three different conditions (speech in quiet and in noise and listening to sounds) was used to detect components underlying hearing aid fitting. The data show a three-factor structure (situation-, restriction- and aid-related variables) independent from the conditions. Usage depends on all of the three factors. Disability and handicap reveal the highest values for speech in noise, whereas the aid-related factor shows the lowest values for this condition. Global satisfaction with the hearing aid is significantly correlated with the aid-related factor, but independent from the restriction of hearing. The aid-related factor is positively influenced by the amount of social activity because more active persons report higher benefit and satisfaction for all listening conditions. Age does not exhibit a significant relationship to one of the components. Basically, all correlation coefficients are only intermediate, revealing that inter-individual differences of the patients are rather high. The data indicate that extra-audiological factors might also play an important role in the success of hearing aid fitting.     

中国基层助听器验配中心基本配置方案的有效性研究

目的本研究提出中国基层助听器验配中心基本设备配置、技术工作流程和人员培训方案,并通过为400名听力障碍儿童提供助听器供应服务,验证方案的有效性和可行性。方法设立北京对照组和广西实验组,对助听器验配中心基本配置和效果进行分析。①指导广西基层聋儿康复机构建设测听室并配置基本设备。②建立针对非听力学专业人员的培训课程。③建立助听器验配技术工作流程。④通过为听障儿童提供助听器验配、助听听阈测试、林氏六音识别及家长、教师助听器满意度问卷调查等听力学服务验证效果。结果①实验组5个地区的5名非听力学人员经理论与实践技能培训后均获得国家4级助听器验配师资质;②实验组4个新建助听器验配中心的测听室建设及设备配置基本能够满足工作需求;③助听器验配技术工作流程简便可行,容易掌握;④助听效果评估显示,在首次验配、验配后1个月和3个月评估达到最适及适合助听效果的听障儿童分别占总人数的93．2％、94．9％和98．2％,呈现增长趋势,卡方检验差异显著（P〈0．05）。在首次验配、验配后1个月和3个月,5m距离能够识别林氏六音的人数分别为59。4％、69．7%和73．7％,呈增长趋势（P〈0．01）。第3个月助听器效果家长和教师满意度问卷调查结果一致性分析二者均达到满意以上的占83％。结论中国基层助听器验配中心的基本配置方案总体有效并具有可行性。     

组合听力测试在聋儿早期验配助听器中的作用

目的：探讨短声听觉脑干反应（ABR）和行为测听2种测试组合在聋儿早期验配助听器中的作用。方法：对52例1～9岁聋儿进行行为测听或ABR测试,找到较准确的听阈值。采用理想感觉级配方法选配助听器,以真耳测试及声场测试判断助听效果,进行随访并定期调试助听器。结果：单纯ABR测试有反应耳与组合听力测试有反应耳比较,差异有统计学意义（P〈0．05）。助听效果明显改善41例,无效4例,失访7例。结论：聋儿听力评估应主、客观测听联合使用,助听器验配应遵循“三早”原则,即早期发现,早期诊断,早期进行听力康复。     

Counselling of hearing aid users is highly cost-effective

Hearing aids (HAs) are often left unused. Several investigations have shown that the use of HAs and the skills to use them can be significantly improved through counselling. Follow-up counselling is often restricted by increased cost. The objective of the study was to assess the cost and the effect of follow-up counselling on HA use. In a prospective pre-post design study, 98 first-time HA users were counselled 6 months after the fitting of a HA, and the use of and benefit from HAs were measured by means of an interview and the short form of the hearing handicap inventory for the elderly (HHIE-S) and the EuroQoL (EQ-5D) questionnaires. The results obtained before and 6 months after counselling were compared and the cost of counselling was calculated. After follow-up counselling, over half of the occasional users of a HA and as many as one third of the non-users became regular users. The number of regular users increased by 16 subjects, and non-users decreased from 29 subjects to 17. The HHIE-S results showed a significant positive change, but the EQ-5D results showed practically no change. The additional expense of follow-up counselling at home was approximately 8.8% (€83 per visit) of the calculated €942 cost of fitting a HA. Bringing one unused HA into regular use required €508. The results show that HA use and the consequent benefit can be significantly increased through counselling. The expense caused by follow-up counselling at home is highly acceptable in addition to the cost of fitting a HA.     

Interactive fitting of multiple algorithms implemented in the same digital hearing aid

The main purpose of this study is to examine the applicability of an adaptive and interactive optimization strategy to fine-tune three hearing-aid algorithms simultaneously: dynamic compression, temporal signal enhancement, and noise reduction. The optimal combination of these three algorithms was determined by a multidirectional pattern search with an adaptive step size. Additionally, we applied a round-robin procedure to validate the results of the optimization procedure. For both procedures the listeners were asked to compare two consecutive, differently processed sentences in continuous and fluctuating background noises on speech intelligibility. Ten hearing-impaired and four normal-hearing subjects participated. The reliability and consistency of the multidirectional pattern search was low, especially for the fluctuating noise condition. The results of the round-robin procedure did not correspond closely with the pattern search results. These findings suggest that the current implementation of a multidirectional optimization procedure has not yet proven to be applicable for the necessary individual fine tuning of complex signal processing strategies, when the objective is to maximize speech intelligibility.