助听器与人工耳蜗的联合使用

人工耳蜗植入技术的适用范围已经从全聋患者扩宽到有残余听力的重度聋者，成为重度以及极重度聋患者恢复听力的重要康复手段。对于术后对侧耳仍具有残余听力的患者或者由于人工耳蜗植入电极的限制，使得植入耳的低频残余听力不能得到利用的患者，其残余频率段的言语识别率可能在随后的几年里呈进行性下降，     

人工耳蜗植入术中保存残余听力的手术技巧

近些年来,随着声电联合刺激(Electric Acoustic Stimulatlion,EAS)技术的发展,学者们越来越重视保存人工耳蜗植入患者的残余听力.EAS是一种结合了助听器功能的新型人工耳蜗装置,它通过联合使用人工耳蜗与助听器来改善患者的听觉.中、高频重度听力损失,低频区有残余听力,配戴助听器效果不佳的患者,EAS植入后能够获得良好的听功能.EAS的作用原理是中、高频区借助人工耳蜗的电刺激产生听觉,而低频区的残余听力由助听器来放大,从而有效提高植入后耳聋患者的听力表现,尤其是声音的定位、音调的感知以及噪声环境下的言语识别率[1,2].     

微创人工耳蜗植入术后残余听力保留的效果观察

目的报道解放军总医院微创人工耳蜗术后残余听力保留情况的初步观察结果,探讨术后听力稳定性以及低频残余听力与言语功能的关系。方法解放军总医院2011年对29例有残余听力的患者行微创人工耳蜗植入术,并对其术后低频残余听力及听觉言语能力进行随访1-2年,探讨分析不同低频残余听力水平及其他因素对言语识别能力的影响。结果29例患者术后1周低频残余听力保留率100%,完全保留率72.4%（21/29）,部分保留率27.5%（8/29）。25例随访成功,平均随访时间为18.8个月,低频残余听力保留率100%,完全保留率72%（18/25）,部分保留率28%（7/25）。术后18个月pre-GLFH组言语识别率高于pre-PLFH组,post-GLFH组言语识别率高于post-PFLH组,但均无统计学意义（P＞0.05）。研究中术后言语识别率与植入前耳聋时间、植入年龄、性别等未见明显相关性,语前聋患者术后言语识别率高于语后聋患者（P＜0.05）。结论微创人工耳蜗植入术能很好的保留患者低频残余听力,保留率可达到100%;较好的术前低频残余听力可能预示较好的术后听觉言语功能;CI患者术后残余听力可较长时间保留,为术后获得较好的听觉言语功能提供基础;语后聋患者术后言语感知能力要优于语前聋患者,尤其是在困难聆听环境下。     

语前聋患儿一侧人工耳蜗对侧助听器效果分析

目的:通过对人工耳蜗植入对侧耳不同听力损失的患儿联合使用助听器与人工耳蜗语前聋患儿的听觉、语言及学习能力进行评估和比较,探索对患儿更为有效的助听方法,帮助患儿获得最大限度的言语交流。方法:将30例3～6岁语前聋患儿按照植入人工耳蜗对侧耳听力损失程度及是否佩戴助听器,分为一侧人工耳蜗+对侧重度听力损失助听器组(CI+SHA组)、一侧人工耳蜗+对侧极重度听力损失助听器组(CI+PHA组)、单耳人工耳蜗组(CI组)。评估各组在康复3、6、9、12、15、18个月时听觉、语言及学习能力,并记录结果。结果:随着术后康复时间的延长,聋儿听觉、语言及学习能力逐渐提高(P<0.05),CI+SHA组听觉能力优于CI+PHA组及CI组(均P<0.05),语言能力及学习能力无明显差异(P>0.05)。结论:语前聋患儿单耳人工耳蜗植入后,若对侧耳尚有残余听力,佩戴助听器后听觉能力效果显著,长期佩戴有助于患儿的康复。     

耳虫呙死区的诊断和临床应用

近些年来,由于听力学及现代科学技术的飞速发展,促进了助听器和人工耳蜗技术不断发展,耳聋患者可以通过佩戴助听器和人工耳蜗植入来改善听力,提高言语交流能力,因此,助听器和人工耳蜗成为耳聋患者接受耳聋教育和进行社会交流不可缺少的工具。然而,仅有部分耳聋患者反应佩戴助听器或行人工耳蜗植入术后,听力改善效果较好,有些患者表示听力仍较差,不能获得很好的听力及言语理解力[1-3]。这些问题引起了听力师和临床耳鼻咽喉科医生极大地关注和研究。Moore等[2]于2000年提出重度至极重度聋患者的耳蜗存在“死区”,该死区的存在导致助听器增益无效,     

极重度感音神经性聋佩戴助听器与人工耳蜗植入患儿残余听力的比较分析

目的:通过回顾性比较分析极重度感音神经性聋患儿接受佩戴助听器和人工耳蜗植入手术2种不同干预方式人群的听力学评估参数,探讨极重度感音神经性聋患儿有效残余听力的临床判断方法.方法:选取听力学评估和言语康复训练资料完整的22例双耳极重度感音神经性聋患儿,其中10例佩戴助听器并接受超过3个月的言语康复训练,另外12例接受人工耳蜗植入手术,其中有10例年龄区间与佩戴助听器组一致.佩戴助听器组患儿,根据言语康复训练效果分为良好(7例)和较差(3例),分别统计其佩戴助听器前ASSR和听力言语康复训练期间裸耳纯音测听在500、1000、2000、4000 Hz 4个频点的听阈阈值情况.年龄与佩戴助听器组一致的10例接受人工耳蜗植入术患儿,根据术前有否佩戴助听器情况,分为曾佩戴助听器但听力言语康复效果差者(5例)和未接受佩戴助听器者(5例),分别统计其佩戴助听器前和(或)手术前的ASSR在500、1000、2000、4000 Hz 4个频点的听阈阈值情况.结果:①ASSR的阈值情况.佩戴助听器且言语康复训练效果良好的7例(14耳)患儿,平均每耳有2.71个频点可引出ASSR反应,所引出的ASSR平均阈值为(110.92±7.43 )dB HL;佩戴助听器言语康复训练效果较差的3例患儿,再加上曾佩戴助听器但听力言语康复效果差而接受人工耳蜗植入术的5例,共8例(16耳),平均每耳只有1.06个频点可引出ASSR反应,所引出的ASSR平均阈值为(110.88±8.52 )dB HL.②裸耳纯音测听情况.佩戴助听器且言语康复训练效果良好的7例(14耳)患儿,所测频点的平均听阈为(96.11±7.81) dB HL;其中,每耳平均有3个频率点的裸耳纯音测听阈值≤100 dB HL.而在效果差的3例(6耳)患儿中,所测频点的平均听阈为(112.19±5.15) dB HL,裸耳纯音测听阈值≤100 dB HL耳的数量为0.结论:500、1000、2000、4000 Hz 各频率引出ASSR的频点数量和裸耳纯音测听阈值≤100 dB HL的数量,是临床上判断极重度感音神经性聋患儿有否存在可利用助听残余听力的有效指标.     

人工耳蜗植入后对侧耳联合使用助听器的康复效果研究

人工耳蜗可以帮助重度或极重度聋人恢复或获得听力。近几年，随着植入技术的发展和言语编码策略的进步，人工耳蜗的适用范围已经扩展到双耳中到重度的耳聋患者。越来越多的患者在植入人工耳蜗后，对侧非植入耳仍有残余听力，但是大部分患者在手术后对侧耳不使用或不再使用助听器。那么人工耳蜗术后对侧耳联合使用助听器究竟可以为患者带来哪些帮助？它们之间是否会有不利影响？助听器应如何调整？本文将对以上问题加以阐述。     

语前聋患儿一侧人工耳蜗植入对侧佩戴助听器聆听效果分析

目的：分析语前聋患儿一侧人工耳蜗植入（cochlear implant ,CI）对侧佩戴助听器模式下的聆听效果,以及非植入耳残余听力对聆听效果的影响。方法选取一侧人工耳蜗植入对侧佩戴助听器的语前聋患儿18例,分别测试其在单侧人工耳蜗植入、一侧人工耳蜗植入对侧佩戴助听器的双耳聆听模式（ bimodal fitting ,BIM ）安静环境及稳态噪声环境下标准中文短句、双音节词、单音节词的识别率。结果安静状态下本组患儿CI、BIM 模式单音节词言语识别率分别为82．67％±12．23％、83．61％±12．22％,双音节词分别为76．00％±16．13％、78．11％±14．84％,标准中文短句分别为60．11％±17．18％、65．43％±16．76％;信噪比10 dB环境下CI、BIM 助听模式患儿单音节词识别率分别为75．50％±14．12％、76．83％±14．15％,双音节词分别为68．22％±17．15％、77．18％±16．83％,标准中文短句分别为49．39％±19．26％、56．33％±19．55％,除两种模式下单音节词外其余言语识别率差异均有统计学意义（P＜0．05）,且非植入耳250、500 Hz助听听阈与BIM 模式言语识别率呈负相关。结论语前聋患儿双耳双模式聆听时有一定优势,这种优势可能主要来自低频残余听力。     

糖皮质激素在人工耳蜗植入残余听力保护中的应用

随着人工耳蜗植入适用范围的扩大,许多有一定残余听力的重度聋患者已被纳入其列,他们在人工耳蜗植入后对声音的定位、音调感知、回声及噪声下的言语识别率及音乐欣赏能力等方面较全聋患者更具优势.因此,最大限度的保存残余听力成为目前研究热点,而围手术期使用糖皮质激素是保护残余听力的人工耳蜗植入术重要措施之一.     

老年及老年前期人工耳蜗植入的临床初步研究

目的 探索人工耳蜗在双耳重度或极重度聋和全聋的老年患者中的临床应用安全性和效果.方法 2008年11月至2009年11月解放军总医院先后对8例50岁以上患者行人工耳蜗植入术,其中男5例,女3例;年龄52～76岁,中位数58岁.所有患者术前均为双侧极重度感音神经性听力损失,佩戴助听器无效或效果不佳.观察患者手术耐受及并发症情况.开机后3个月进行助听听阈评估和言语评估.结果 8例患者手术顺利,术中神经反应遥测均引出反应.术后康复顺利,无任何并发症.开机3个月后声场内言语频率平均助听听阈啭音(听力级)为35～50 dB,但言语测听结果个体差异较大.部分患者单音节、双音节、安静及噪声环境下的句子可实现较好识别率.结论 老年前期及老年患者可耐受全身麻醉状态下的人工耳蜗植入,只要术前准备充分则为安全的手术,但部分病例为中耳炎(胆脂瘤)或颞骨外伤等因素导致,需要特别注意中耳情况.老年重度以上听力损失患者人工耳蜗植入可明显改善言语识别能力.     

Speech perception for adults who use hearing aids in conjunction with cochlear implants in opposite ears.

This study aimed to (a) investigate the effect of using a hearing aid in conjunction with a cochlear implant in opposite ears on speech perception in quiet and in noise, (b) identify the speech information obtained from a hearing aid that is additive to the information obtained from a cochlear implant, and (c) explore the relationship between aided thresholds in the nonimplanted ear and speech perception benefit from wearing a hearing aid in conjunction with a cochlear implant in opposite ears.Fourteen adults who used the Nucleus 24 cochlear implant system in 1 ear participated in the study. All participants had either used a hearing aid in the nonimplanted ear for at least 75% of waking hours after cochlear implantation, and/or, hearing loss less than 90 dB HL in the low frequencies in the nonimplanted ear. Speech perception was evaluated in 3 conditions: cochlear implant alone (CI), hearing aid alone (HA), and cochlear implant in conjunction with hearing aid in opposite ears (CIHA). Three speech perception tests were used: consonant-vowel nucleus-consonant (CNC) words in quiet, City University of New York style (CUNY) sentences in coincident signal and noise, and spondees in coincidental and spatially separated signal and noise. Information transmission analyses were performed on the CNC responses.Of the 14 participants tested, 6 showed significant bimodal benefit on open-set speech perception measures and 5 showed benefit on close-set spondees. However, 2 participants showed poorer speech perception with CIHA than CI in at least 1 of the speech perception tests. Results of information transmission analyses showed that bimodal benefit (performance with CIHA minus that with CI) in quiet arises from improved perception of the low frequency components in speech. Results showed that participants with poorer aided thresholds in the mid-to-high frequencies demonstrated greater bimodal benefit. It is possible that the mid-to-high frequency information provided by the hearing aids may be conflicting with the cochlear implants.     

Natural history of contralateral residual hearing in unilateral cochlear implant users - long-term findings

Abstract Conclusion: The long-term stability of low-frequency residual hearing found in a significant number of bilateral-bimodal users (cochlear implant (CI) in one ear and a hearing aid (HA) on the other ear; CI/HA) with severe-to-profound or profound hearing loss in the non-implanted ear justifies bilateral-bimodal fitting efforts in this group. Since low-frequency residual hearing tends to deteriorate in some of these CI/HA users, periodic evaluation, which includes pure-tone thresholds and speech perception tests, is mandatory for determining the point in time at which CI/HA hearing is no longer effective, and the patient should accordingly be considered as a candidate for contralateral cochlear implantation. Objective: To determine, in bilateral-bimodal (CI/HA) users with severe-to-profound or profound hearing loss in the non-implanted ear, the rate of residual hearing deterioration in the non-implanted ear after cochlear implantation. Methods: Pure-tone aided and unaided thresholds in the non-implanted ears of 39 CI/HA users at 0.25-4.0 kHz were recorded prospectively up to 6 years after implantation. Results: Group mean threshold values in the non-implanted ears remained stable over 3, 4, 5 and 6 years post-implantation, except for significant deterioration at 4.0 kHz of both unaided (4.2, 5.2, 9.0 and 8.2 dB, respectively) and aided thresholds (8.1, 4.6, 6.1 and 8.3 dB, respectively).     

听障儿童电声双模式助听的应用效果

目的 研究调查听障儿童一侧耳植入人工耳蜗后对侧耳配戴助听器,这种电声双模式同时刺激的应用效果.方法 随机测试78名儿童人工耳蜗植入者在使用人工耳蜗和助听器(CI+HA)及单独使用人工耳蜗(CI)时听觉事件相关电位MMN和P300潜伏期及波幅的变化,比较同一患者在三种环境下(安静、S/N-0dB,S/N-15dB)的听觉言语识别率,并进行家长问卷调查.结果 患者使用CI+HA与CI的MMN 引出率分别是 80%和75%,P300引出率分别是93.1%和89%;CI+HA组与CI组MMN和P300潜伏期以及CI+HA组与正常组P300波幅的比较有显著差异(P<0,05);在S/N-0dB时CI+HA组单音节、双音节和声调的识别率均高于CI组(P<0.05),而安静环境下和S/N-15dB时组内比较无统计学意义;开放式问卷调查结果 显示60.26%的患者认为使用CI+HA模式能获得更多不同的听觉帮助.闭合式问卷结果 显示使用CI+HA和单用CI的聆听效果有差别.结论 本文大多数听障儿童使用电声同时刺激的助听模式.大脑中枢处理系统并不拮抗,能发挥协同作用,尤其在改善噪声环境下的言语识别和声调感知.以及声源定位和声信息的利用等方面具有优势.     

Binaural-bimodal hearing: concomitant use of a unilateral cochlear implant and a contralateral hearing aid

CONCLUSION: The benefit obtained with a contralateral hearing aid (HA) in unilateral cochlear implantees improves over time, at least during the first year after implantation. OBJECTIVE: To evaluate binaural-bimodal auditory ability and its early changes over time after unilateral cochlear implantation in patients with residual hearing in the non-implanted ear, in which they use an HA. MATERIAL AND METHODS: Sentence identification in background noise was tested in 12 patients (3 post-lingual adults and 9 pre-lingual adults and older children) under 3 listening conditions: cochlear implant (CI) alone, HA alone and CI+HA. The presentation level was 55 dB HL with a signal-to-noise ratio of +10 dB. Subjects were tested after 1-6 months of concomitant use of both devices and again after a further 7-12 months. RESULTS: At the first testing session, the mean score in background noise was 34.9% with CI alone (range 0-90%) and 41.1% with both devices (range 0-100%). Seven patients could recognize sentences in noise with CI alone, and four of them showed further improvement with added amplification. At the second session, at which all subjects could recognize sentences in noise with the CI alone, seven showed further improvement with added amplification. The mean score was 60.6% with CI alone (range 10-99%) and 75.5% with both devices (range 52-100%).     

Access to aidable residual hearing in adult candidates for cochlear implantation in the UK

Guidance from the National Institute for Health and Care Excellence (NICE) permits candidates to receive a cochlear implant provided they only hear sounds louder than 90?dB HL at 2 and 4?kHz. In some patients, their level of residual hearing may be sufficient to warrant the use of a hearing aid in their non-implanted ear. A survey of unilaterally implanted adults indicated that those implanted since the publication of NICE guidance were almost seven times more likely to use a hearing aid than those implanted prior to this. If contralateral hearing aid use provides additional benefits over implant use alone, it may be appropriate to consider the capacity to use residual hearing following implantation when determining candidacy.     

Communication abilities of children with aided residual hearing: comparison with cochlear implant users

OBJECTIVE: To compare the communication outcomes between children with aided residual hearing and children with cochlear implants. DESIGN: Measures of speech recognition and language were administered to pediatric hearing aid users and cochlear implant users followed up longitudinally as part of an ongoing investigation on cochlear implant outcomes. The speech recognition measures included the Lexical Neighborhood Test, Phonetically Balanced-Kindergarten Word Lists, and the Hearing in Noise Test for Children presented in quiet and noise (+5 dB signal-to-noise ratio). Language measures included the Peabody Picture Vocabulary Test: Third Edition (PPVT-III), the Reynell Developmental Language Scales, and the Clinical Evaluation of Language Fundamentals-Revised.Subjects The experimental group was composed of 39 pediatric hearing aid users with a mean unaided pure-tone average threshold of 78.2 dB HL (hearing level). The comparison group was composed of 117 pediatric cochlear implant users with a mean unaided pure-tone average threshold of 110.2 dB HL. On average, both groups lost their hearing at younger than 1 year and were fitted with their respective sensory aids at 2 to 2.6 years of age. Not every child was administered every test for a variety of reasons. RESULTS: Between-group performance was equivalent on most speech recognition and language measures. The primary difference found between groups was on the PPVT-III, in which the hearing aid group had a significantly higher receptive vocabulary language quotient than the cochlear implant group. Notably, the cochlear implant group was substantially younger than the hearing aid group and had less experience with their sensory devices on this measure. CONCLUSION: Data obtained from children with aided residual hearing can be useful in determining cochlear implant candidacy.     

Binaural–bimodal hearing: Concomitant use of a unilateral cochlear implant and a contralateral hearing aid

Conclusion. The benefit obtained with a contralateral hearing aid (HA) in unilateral cochlear implantees improves over time, at least during the first year after implantation. Objective. To evaluate binaural–bimodal auditory ability and its early changes over time after unilateral cochlear implantation in patients with residual hearing in the non-implanted ear, in which they use an HA. Material and methods. Sentence identification in background noise was tested in 12 patients (3 post-lingual adults and 9 pre-lingual adults and older children) under 3 listening conditions: cochlear implant (CI) alone, HA alone and CI?+?HA. The presentation level was 55 dB HL with a signal-to-noise ratio of +10 dB. Subjects were tested after 1–6 months of concomitant use of both devices and again after a further 7–12 months. Results. At the first testing session, the mean score in background noise was 34.9% with CI alone (range 0–90%) and 41.1% with both devices (range 0–100%). Seven patients could recognize sentences in noise with CI alone, and four of them showed further improvement with added amplification. At the second session, at which all subjects could recognize sentences in noise with the CI alone, seven showed further improvement with added amplification. The mean score was 60.6% with CI alone (range 10–99%) and 75.5% with both devices (range 52–100%).     

Natural history of contralateral residual hearing in binaural-bimodal hearing

Conclusions. The range of evaluation tools used in deciding which ear to implant and which to designate for a hearing aid (HA) should be expanded to include additional aspects to those tested by audiometry and basic speech perception. Residual hearing in non-implanted ears remains stable for at least 3 years after unilateral cochlear implantation, but regular refitting and monitoring of the HA function combined with cochlear implant (CI) mapping are mandatory for maximizing benefit from binaural-bimodal hearing. Objectives. To examine whether the clinical decision-making tools currently used to assess hearing are reliable guides when choosing the preferred ear for CI, and to determine the rate of residual hearing deterioration in the non-implanted ear over 36 months post-CI as a guide to recommending subsequent continued use of a contralateral HA as opposed to CI. Patients and methods. This was a retrospective evaluation of patients’ charts. The pre-CI choice of the ear for implantation in a group of 37 binaural-bimodal users was re-evaluated. In a second group of 22 patients, residual hearing deterioration was followed for 36 months post-implantation. Results. In the group of 37 patients, subjective identification of the worse-hearing ear was in agreement with audiometric results in 28 cases, but disagreed with the unaided audiometric results in the other 9. Mean threshold values for the group of 22 patients remained stable over 36 months post-CI, except for the aided threshold at 4.0kHz, which deteriorated by 10.9dB (p=0.003).     

Combined electric and contralateral acoustic hearing: word and sentence recognition with bimodal hearing.

PURPOSE: The authors assessed whether (a) a full-insertion cochlear implant would provide a higher level of speech understanding than bilateral low-frequency acoustic hearing, (b) contralateral acoustic hearing would add to the speech understanding provided by the implant, and (c) the level of performance achieved with electric stimulation plus contralateral acoustic hearing would be similar to performance reported in the literature for patients with a partial insertion cochlear implant. METHOD: Monosyllabic word recognition as well as sentence recognition in quiet and at +10 and +5 dB was assessed. Before implantation, scores were obtained in monaural and binaural conditions. Following implantation, scores were obtained in electric-only and electric-plus-contralateral acoustic conditions. RESULTS: Postoperatively, all individuals achieved higher scores in the electric-only test conditions than they did in the best pre-implant test conditions. All individuals benefited from the addition of low-frequency information to the electric hearing. CONCLUSION: A full-insertion cochlear implant provides better speech understanding than bilateral, low-frequency residual hearing. The combination of an implant and contralateral acoustic hearing yields comparable performance to that of patients with a partially inserted implant and bilateral, low-frequency acoustic hearing. These data suggest that a full-insertion cochlear implant is a viable treatment option for patients with low-frequency residual hearing.