噪声对低龄正常儿童言语感知的影响

目的探讨言语谱噪声(speech spectrum-shaped noise,SSN)和多人谈话噪声(babble noise,BN)对低龄正常儿童普通话词汇相邻性测试(Mandarin lexical neighborhood test,MLNT)言语感知的影响。方法 34例3~6岁正常听力儿童分为SSN组(21例)和BN组(13例),使用噪声下普通话词汇相邻性测试系统对两组儿童行声场下的言语测试,以听说复述方法获得不同信噪比下的言语识别率,比较两组两类噪声下的单音节易词表、难词表和双音节易词表、难词表的识别率-信噪比函数曲线(P-SNR曲线)和言语识别阈(SNR50)。结果 SSN组双音节易词表和难词表的SNR50阈值分别为-3dB、-0.5dB,单音节易词表和难词表的SNR50分别为-1dB、3.5dB;BN组双音节易词表和难词表的SNR50分别为-3dB、2dB,单音节易词表和难词表的SNR50分别为0.5dB、10dB。两组除双音节易词表SNR50相同外,其余各类词表BN组的SNR50均比SSN组高。词汇学因素对正常听力儿童噪声下的开放式言语识别的影响仍表现出易词识别率高于难词,双音节词识别率高于单音节词。结论对3~6岁正常听力儿童BN的掩蔽效应比SSN强,词汇学因素在噪声下仍然影响儿童的言语识别。     

多人谈话噪声及年龄对儿童言语识别中词汇学效应的影响

目的 探讨引入多人谈话噪声(babble noise,BN)后,词汇学效应在竞争性噪声环境下对正常听力儿童言语识别能力的影响及其随年龄增长的发展特性.方法 以212例3~6岁的正常听力儿童为研究对象,使用普通话词汇相邻性测试(Mandarin lexical neighborhood test,MLNT)材料(含双音节易词、双音节难词、单音节易词、单音节难词四类词表),在安静条件下给声强度70 dB SPL,多人谈话噪声下信噪比(signal to noise ratio,SNR)为4 dB,对所有对象进行开放式言语测试,分别获取四类词表在安静和噪声条件下的言语识别率,并比较3、4、5、6岁组儿童的结果.结果 在安静条件下正常听力儿童双音节易、难词及单音节易、难词的识别率分别为96.45%±5.17%、88.87%±7.73%、91.90%±7.31%、82.38%±7.95%,噪声下四类词表言语识别率分别为85.34%±11.23%、66.42%±11.08%、68.81%±15.99%、48.58%±12.81%,在噪声下的各词表言语识别率显著低于安静条件下(P<0.05).在安静和噪声条件下对词汇学效应的影响显示易词的识别率高于难词(P<0.05),双音节词言语识别率高于单音节词(P<0.05),且在噪声下比安静环境下影响更明显.噪声下不同年龄组中3岁组四类词表言语识别率分别为80.83%±12.65%、60.63%±9.13%、58.54%±12.98%、41.88%±11.69%,6岁组分别为92.38%±6.64%、71.90%±10.66%、76.90%±14.53%、57.14%±12.61%,3~6岁听力正常儿童噪声下言语识别能力随年龄增长显著提高(P<0.05).结论 在噪声下词汇学效应对听力正常儿童词汇提取的影响较安静环境下更明显,双音节词和易词更易获取,单音节词和难词更难获取;3~6岁听力正常儿童噪声下的言语识别能力随年龄增长而提高,且在6岁时仍未达到平台期.     

给声方法对人工耳蜗植入儿童词汇识别的影响研究

目的分析不同的给声方法（口声给声／录音给声）对人工耳蜗（CochlearImplant,CI）植入儿童开放式词汇识别能力的影响,为CI儿童词汇识别能力评估给声方法的选取提供借鉴。方法分别采用口声给声和录音给声方式对39名能够进行开放式词汇识别测试的语前聋CI儿童进行评估。采用标准版汉语普通话儿童词汇相邻性测试（LexicalNeighborh00dTest,LNT）词表为评价素材,分别获得不同给声方法下的正确识别率。结果①口声给声组受试儿童双音节易词、双音节难词、单音节易词及单音节难词平均正确识别率依次为78．67％、65．18％、68．32％$n58．41％。分析显示双音节词正确识别率显著高于单音节词（P〈0．001）,易词正确识别率显著高于难词（P〈0．001）,②录音给声组受试儿童双音节易词、双音节难词、单音节易词及单音节难词平均正确识别率依次为64．67％、50．81％、58．32％和45．14％。研究显示双音节词正确识别率高于单音节词（P〈0．001）,易词正确识别率高于难词（P〈0．001）。③口声给声组的双音节易词、双音节难词、单音节易词和单音节难词得分均显著高于录音给声组（P〈0．001）,且口声给声组的个体差异高于录音给声组。结论录音给声时测试结果具备较好的一致性。在言语识别能力纵向跟踪和多中心研究中,录音给声为首选的给声方法。     

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。     

听障儿童言语识别能力评估标准的修订

目的通过评估健听儿童的言语识别能力,修订听障儿童单音节词、双音节词和短句识别能力的评估标准。方法采用听觉语言识别能力评估词表分别对300名健听儿童进行单音节词、双音节词和短句识别能力评估,采用描述性统计方法对单音节词、双音节词和短句识别能力评估标准进行修订。结果单音节词、双音节词和短句识别率随年龄的增长而提高。2岁1个月～2岁12个月健听儿童的单音节词、双音节词和短句识别率都低于90％,3岁以上健听儿童的单音节词、双音节词和短句识别率均≥90％。结论①制定了2岁听障儿童单音节词、双音节词和短句识别能力评估标准。②对于3岁及以上各年龄段听障儿童可以用实际测试得分代表单音节词、双音节词和短句识别能力。     

双侧人工耳蜗植入术后言语识别效果的评估

目的评估双侧人工耳蜗植入者汉语普通话短句、双音节词单音节词及汉语声调的识别效果,探索双侧人工耳蜗植入者双耳听觉产生的机制及对言语识别率的影响。方法选取双侧人工耳蜗植入患者6人,自制问卷收集受试者的基本信息并评估他们的主观听觉状况。首先测试受试者在使用双侧人工耳蜗（BCI）、单独使用一侧人工耳蜗（RCI/LCI）的听阈,随后测试他们在BCI和RCI/LCI两种听觉模式下的七音节短句、双音节词、声调、韵母、声母识别率,测试背景环境包括安静环境和嘈杂语噪声环境,言语信号强度为65dB SPL,固定信噪比为+10 dB SPL。随后将BCI和RCI/LCI两种听觉模式下的识别效果进行比较。结果除噪声状态下韵母识别测试中其余测试结果均为BCI言语识别率得分高于RCI/LCI。结论对于符合双侧人工耳蜗植入术适应证标准的患者而言,双侧植入人工耳蜗可以在不同程度上提高安静和噪声环境下的短句、双字词、声母、韵母及声调的识别率,降低其声场听阈。     

听力正常人噪声下汉语普通话声调识别成绩-强度函数的研究

目的　获得噪声下声调识别测试（t o n e identification in noise test,TINT）材料的听力正常人识别成绩-强度（performance-intensity,PI）函数。方法　利用已确立的TINT测试材料对16名年龄在21～28岁、以普通话作为日常交流语言的听力正常人进行声调识别测试,使用SPSS17.0统计软件对结果进行分析。结果　听力正常成人PI 斜率分别为8.6%/dB（男声）、7.3%/dB（女声）（P =0.11）;听力正常成人PI函数信噪比50阈值分别为男声（-12.9±0.8）dB、女声（-13.6±1）dB（t =2.7,P =0.016）;声调类型和播音者性别对PI曲线阈值的影响即存在交互作用（F =11.7,P＜0.001)、亦存在独立作用（声调类型：F =83.7,P＜0.001;播音员性别：F =31.0,P＜0.05),其中听力正常人一声和四声识别阈值明显低于二声和三声识别阈值。结论　本研究初步建立基于TINT测试材料的听力正常人噪声下声调识别PI函 数,以期为临床工作和科学研究提供一个可选择的测量工具。     

一例神经纤维瘤患者植入人工耳蜗的效果观察

目的：探讨神经纤维瘤听力下降患者人工耳蜗植入手术可行性及疗效。方法对一例多发性神经纤维瘤伽马刀术后患者带瘤行CS-10A人工耳蜗植入,术前和术后3个月分别进行裸耳/助听听阈评估、单音节和双音节言语识别测试。结果患者术前右侧重度、左侧极重度感音神经性聋,术前言语识别率左耳最大声输出患者无反应,右耳最大单音节词言语识别率为12%,双耳双音节词言语识别率均为0%。听觉行为分级量表为2级。患者右侧成功植入人工耳蜗。术后3个月助听后声场评估右耳（人工耳蜗植入耳）平均听力42.5 dB HL,单音节词最大言语识别率为64%,双音节词最大言语识别率为47%,听觉行为分级量表为7级。结论在影像学证明听神经完整的情况下,神经纤维瘤伽马刀术后重度聋患者可植入人工耳蜗,以提升听力水平。     

不同年龄成人语后聋患者人工耳蜗植入的疗效研究

目的　探讨不同年龄成人语后聋患者人工耳蜗植入术后的听觉言语康复效果。方法　回顾性分析44例成人语后聋患者资料，根据患者年龄分为中青年组（年龄＜60岁）、老年组（60岁≤年龄＜70岁），高龄老年组（年龄≥70岁）。记录人工耳蜗植入前后所有患者听觉行为分级、言语可懂度分级、安静情况下言语识别率和术后12个月信噪比分别为15、10、5和0 dB噪声条件下的言语识别率。分析比较不同年龄患者手术并发症及术后疗效。结果　术后12个月，3个组患者听觉行为分级分别与同组术前比较 （t 中青年组=12.90，t 老年组=9.55，t 高龄老年组=10.55，P 均＜0.01）、言语可懂度分级（t 中青年组=10.30，t 老年组=10.94，t 高龄老年组=9.98，P 均＜0.01）和安静情况下言语识别率（t 中青年组=21.71，t 老年组=21.12，t 高龄老年组=14.03，P 均＜0.01）均较术前显著提高。相同治疗阶段内，3个组间比较差异均无统计学意义（P 均＞0.05）。噪声环境下，术后12个月，信噪比为5和0 dB时，3个组言语识别率比较，差异均有统计学意义（F 5 dB=4.120，F 0 dB=5.730，P 均＜0.05）。结论　此项研究表明人工耳蜗植入可安全有效提高不同年龄段成人语后聋患者的听觉言语能力，年龄不是决定和限制人工耳蜗植入疗效的因素，但会影响噪声下言语识别能力。     

9例双侧人工耳蜗植入儿童双音节词识别效果分析

目的比较双侧人工耳蜗植入(CI)儿童安静和噪声条件下双耳与单耳开放式双音节词识别率的差异,以及噪声条件下易词与难词识别率差异,结合个案基本情况和CAP和SIR问卷评估结果,分析影响双音节词识别率的个性化因素。方法利用普通话儿童相邻性词表测试工具对9例双侧CI儿童进行安静和噪声条件下的双音节词测试,通过配对t检验,比较双耳与单耳双音节词识别率及易词与难词识别率差异。结果在安静和噪声条件下,双耳与单耳CI双音节识别率差异显著(P<0.05);在噪声条件下,双耳与单耳易词和难词识别率差异极显著(P<0.01);双音节词识别率受个体CI年龄、言语可懂度、内耳畸形类型等因素影响。结论在安静和噪声条件下,双耳CI可提高双音节识别率;在噪声条件下,双耳CI优势更加突出;儿童言语识别率受易词和难词以及儿童个性化等因素影响。     

时域精细结构与包络信息在噪声下声调识别中的作用

目的 探讨时域精细结构信息(temporal fine structure,TFS)和时域包络信息(envelope,Env)在噪声下声调识别中的作用.方法 自行编制噪声下声调识别能力测试材料,对20例年龄19～30岁、母语为汉语普通话的听力正常人进行五种信噪比(SNR)条件下(SNR分别为-18、-12、-6、0、+...     

人工耳蜗植入儿童听觉康复效果观察

目的观察语前聋患儿在人工耳蜗开机后一年内听觉能力的发展状况,为康复教学工作提供参考。方法对52例在南京大学医学院附属鼓楼医院进行人工耳蜗植入手术并开机和定期调机的患儿,于开机后半年和一年时分别进行声场评估,得到每位患儿的术后平均听闽,同时由康复教师对患儿进行韵母、声母、声调、单音节词、双音节词、三音节词、短句和选择性听取等8项评估。使用SPSS10．0统计学软件对半年和一年时各项评估结果进行组内纵向统计学比较,并分别就两次言语识别能力评估中音节要素、词语方面各自所含测试项进行组间横向统计学比较。结果开机后半年与一年患几的平均听阈无显著性差异（P〉0．05）。各单项识别率开机后半年与一年纵向比较,差异均有统计学意义（P〈0．001）。组间横向比较,开机半年及一年时,韵母识别能力始终优于声母、声调识别能力,差异具有统计学意义（P〈0．001）,单音节词识别能力相对弱于双音节词、三音节词识别能力,差异亦具有统计学意义（P〈0．001）;两次评估中,选择性听取能力始终落后于其他各项。结论听觉康复过程符合从声音察觉、感知再到理解的规律,对语言的理解识别也符合先简单后复杂的规律,即从音节要素到词语、再到短句。康复过程需有侧重,人工耳蜗开机后前半年需注重听觉感知能力的提高,而后半年需注重对语言理解能力的培养。     

Monosyllable speech perception of Japanese hearing aid users with prelingual hearing loss: implications for surgical indication of cochlear implant

OBJECTIVE: The monosyllable speech perception ability after years of educational intervention was compared between prelingually deafened pediatric hearing aid users and their cochlear implant counterparts. DESIGN: An open-set monosyllabic speech perception test was conducted on all subjects. The test required subjects to indicate a corresponding Japanese character to that spoken by the examiner. Fifty-two subjects with prelingual hearing impairment (47 hearing aid users and 5 cochlear implant users) were examined. RESULTS: Hearing aid users with average pure-tone thresholds less than 90 dB HL demonstrated generally better monosyllable perception than 70%, which was equivalent or better performance than that of the cochlear implant group. Widely dispersed speech perception was observed within the 90-99 dB HL hearing-aid user group with most subjects demonstrating less than 50% speech perception. In the cluster of >100 dB HL, few cases demonstrated more than 50% in speech perception. The perception ability of the vowel part of each mora within the cochlear implant group was 100% and corresponding to that of hearing aid users with moderate and severe hearing loss. CONCLUSION: Hearing ability among cochlear implant users can be comparable with that of hearing aid users with average unaided pure-tone thresholds of 90 dB HL, after monosyllabic speech perception testing was performed.     

The Words-in-Noise (WIN) test with multitalker babble and speech-spectrum noise maskers

The Words-in-Noise (WIN) test uses monosyllabic words in seven signal-to-noise ratios of multitalker babble (MTB) to evaluate the ability of individuals to understand speech in background noise. The purpose of this study was to evaluate the criterion validity of the WIN by comparing recognition performances under MTB and speech-spectrum noise (SSN) using listeners with normal hearing and listeners with hearing loss. The MTB and SSN had identical rms and similar spectra but different amplitude-modulation characteristics. The performances by the listeners with normal hearing, which were 2 dB better in MTB than in SSN, were about 10 dB better than the performances by the listeners with hearing loss, which were about 0.5 dB better in MTB with 56% of the listeners better in MTB and 40% better in SSN. The slopes of the functions for the normal-hearing listeners (8-9%/dB) were steeper than the functions for the listeners with hearing loss (5-6%/dB). The data indicate that the WIN has good criterion validity.     

汉语普通话单音节测听表的建立与评估

目的 建立一套普通话单音节测听表并验证其效度、信度和敏感度,期望成为国内标准化的言语识别率测听材料.方法 遵循简短、音位平衡、常用、覆盖等原则,生成30张音位平衡单音节表,每表对应25个常用汉字.由专业男性播音员朗读,经数字化录音及声学处理,录制成CD.研究分为三个阶段:①招募60名听力正常年轻人,采用随机区组设计:言语测听表号与测听强度均衡排布,每一受试者均变换6种强度(言语听力级-1、5、11、15、21、27 dB)以循环顺序聆听全部30张单音节表.计算每表每一声级下的言语识别率得分,以logistic曲线回归来拟合识别率-强度(P-I)函数.对30张词表的识别率进行双因素(表号、强度)方差分析和Post-Hoc两两比较,得到22张等价表.②北京22名听力正常年轻人,采用拉丁方设计,在言语听力级10 dB强度下依次测试22张等价表的识别率.间隔6～35 d,在完全相同的条件下重新进行第二轮识别率测试.两轮测试的识别率经"合理化"的反正弦变换后,逐表汇总两轮测试分差,该分差值在22名受试者中的标准差为9.3%,转化成95%置信度下的临界分差为18.3%.③采用拉丁方设计方案,对18名感音性听力损失患者在其纯音平均听阈上30 dB或最大舒适级,测试其对18张等价表的识别率.间隔1～16 d在相同条件下再次进行测试.两轮测试的识别率经"合理化"的反正弦变换后,分别为(68.0±15.9)%和(69.2±14.6)%,配对t检验,P=0.107.两轮测试分差,在18名患者中的标准差为8.3%,转化成95%置信度下的临界分差为16.3%.结果 创建了一套22张等价的标准化的言语识别率测听表.每表由音位平衡的25个单音节构成,播放时间约2 min.听力正常人的单音节识别阈为言语听力级(8.30±0.84)dB,P-I函数的斜率为(4.0±0.3)%/dB.临床评判受试者言语识别率差异时,只要分差超过临界分差--正常人(18.3%)、患者(16.3%),即可确认具有统计学意义上的显著性差异.结论 成功建立起一套普通话单音节测听表,具有较高的效度、信度和敏感度,便于临床应用.     

Hearing threshold levels and speech recognition in noise in 7-year-olds

International standards define normal hearing threshold levels (HTLs) and many studies describe speech recognition in noise (SRN) for adults. Less has been published on these characteristics for children. This study aims to establish ranges of HTLs and SRN for otologically normal 7-year-olds. Air conduction HTLs were measured in 189 7-year-olds within an audiometric booth. Speech recognition was measured adaptively for BKB sentences in noise presented binaurally through headphones, determining the speech-to-noise ratio (SNR) required to score 71% correct. The mean HTLs of otologically normal 7-year-olds were significantly lower (better) than those published for young adults at 1 and 2 kHz. Speech recognition in noise was unrelated to HTLs and was higher (worse) for 7-year-olds (SNR = -4 dB) than has been found for young otologically normal adults (SNR = -6 dB). It is concluded that although the HTLs of 7-year-old children are generally better than those of young adults, their speech recognition in noise is worse. This confirms that their ability to recognise speech in noise is not fully developed at this age.     

Recognition of speech produced in noise.

A two-part study examined recognition of speech produced in quiet and in noise by normal hearing adults. In Part I 5 women produced 50 sentences consisting of an ambiguous carrier phrase followed by a unique target word. These sentences were spoken in three environments: quiet, wide band noise (WBN), and meaningful multi-talker babble (MMB). The WBN and MMB competitors were presented through insert earphones at 80 dB SPL. For each talker, the mean vocal level, long-term average speech spectra, and mean word duration were calculated for the 50 target words produced in each speaking environment. Compared to quiet, the vocal levels produced in WBN and MMB increased an average of 14.5 dB. The increase in vocal level was characterized by increased spectral energy in the high frequencies. Word duration also increased an average of 77 ms in WBN and MMB relative to the quiet condition. In Part II, the sentences produced by one of the 5 talkers were presented to 30 adults in the presence of multi-talker babble under two conditions. Recognition was evaluated for each condition. In the first condition, the sentences produced in quiet and in noise were presented at equal signal-to-noise ratios (SNR(E)). This served to remove the vocal level differences between the speech samples. In the second condition, the vocal level differences were preserved (SNR(P)). For the SNR(E) condition, recognition of the speech produced in WBN and MMB was on average 15% higher than that for the speech produced in quiet. For the SNR(P) condition, recognition increased an average of 69% for these same speech samples relative to speech produced in quiet. In general, correlational analyses failed to show a direct relation between the acoustic properties measured in Part I and the recognition measures in Part II.