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.     

双耳双模式助听患者汉语普通话声调识别特征

目的 比较双耳双模式助听患者在安静环境和不同背景噪声下的声调识别率,探讨不同信噪比和不同基频噪声下的双模式优势.方法 12例一侧植入人工耳蜗、对侧佩戴助听器[双模式(CIHA)]的汉语普通话患者参加本研究,所有患者双模式使用时间均为半年以上.使用天使语训i-CAST测试软件的人工耳蜗科研项目模块,采用闭合式测试方法,分别测试受试者在安静环境和不同背景噪声环璋下单独使用人工耳蜗(CI)、单独使用助听器(HA)和双模式下(CIHA)的声调识别率,测试环境包括安静环境、男信号男背景、男信号女背景三种,每种背景噪声包含10、5和0 dB三种信噪比(以下将6种背景噪声简称为男男10、男男5、男男0、男女10、男女5和男女0),即每位患者进行21组测试;每组分别测试/Ba/、/Bi/、/Bo/、/Bu/4个音的一、二、三、四4个声调;测试声通过扬声器发出,强度为65 dB SPL;记录患者上述三种模式下的助听听阈及助听侧裸耳听阈.结果 患者在CIHA与CI模式下的助听听阈差异无统计学意义(P>0.05),但均与HA模式和非植入侧的裸耳听阈差异有统计学意义(P<0.05).声调识别率受背景环境的显著影响(F=24.77,P<0.001),安静环境、男男5和男男0背景噪声环境下双模式无明显优势(P>0.05),在男男10、男女10、男女5和男女0背景噪声环境下双模式均有显著优势(P值分别为0.010,0.012,0.015和0.001).结论 本组患者在安静环境下的声调识别双模式无显著优势,信号声与背景噪声基频不同时,双模式优势显著.     

双模式助听儿童的皮层听觉诱发电位特征研究北大核心CSCD

目的探讨人工耳蜗及助听器(hearing aids,HA)双模式助听与单独人工耳蜗植入(cochlear implant,CI)患者皮层听觉诱发电位(cortical auditory evoked potential,CAEP)中P1及失匹配负波(mismatch negativity,MMN)的分化特征,对双模式助听效果进行客观评价。方法双模式助听儿童7例(双模式使用时长均不少于6个月),在CI与助听器达到最佳助听模式后,分别在双模式及单侧CI两种助听模式下,以/ba1/、/ba4/(即/ba/一声和四声)作为标准刺激与偏差刺激声进行声场下CAEP测试,分析两种模式下P1波和MMN的潜伏期与幅值的差异。结果双模式助听下CAEP的P1的潜伏期、幅值以及MMN的潜伏期、幅值分别为159.29±31.80 ms、1.86±3.12μV、245.29±58.82 ms、-2.16±1.34μV;单侧CI助听时分别为172.00±43.84 ms、1.26±2.85μV、288.29±54.00 ms、-1.63±1.19μV。双模式助听下P1及MMN潜伏期较单侧助听CI时显著缩短(P<0.05),P1及MMN幅值较单侧CI时呈现增大趋势,但差异无统计学意义(P>0.05)。结论CI及助听器双模式助听下CAEP的P1及MMN潜伏期较单侧CI助听时显著缩短,提示双模式助听下患者听觉辨别能力提高。     

人工耳蜗和助听器双模式聆听中助听器的匹配和调试

随着人工耳蜗技术的发展和对双耳听觉优势的深入研究,针对单侧人工耳蜗植入的患者,其对侧耳只要有残余听力,都建议尽早使用助听器,形成双模式干预,以达到最佳听觉效果.由于人工耳蜗和助听器两种助听装置在工作原理上的不同,二者在声音的放大、压缩、传输时间等方面都还不能做到同步,所以如何让二者相互补充、协同,更好的整合声音从而发挥...     

人工耳蜗和助听器同时使用的听觉事件相关电位研究

目的探讨人工耳蜗和助听器同时使用者的听觉事件相关电位(ERP)的变化,对人工耳蜗和助听器同时使用所产生的2耳听效果进行客观评价。方法分别在同时使用人工耳蜗和助听器(CI&HA)及单独使用人工耳蜗(CI)两种状态下测定ERP的主要成分P300、N200和N100的潜伏期及P300振幅。结果CI&HA时P300的平均潜伏期为(388.96±62.61)ms,N200为(267.00±45.43)ms,N100为(94.58±9.10)ms,P300平均振幅为(13.69±3.26)μV;CI时P300的平均潜伏期为(412.08±54.32)ms,N200为(289.21±37.40)ms,N100为(99.38±13.15)ms,P300平均振幅为(12.23±2.97)μV。P300平均潜伏期和N200平均潜伏期在CI&HA时较CI时缩短,差异有统计学意义。结论2耳同时使用声音处理方式完全不同的人工耳蜗和助听器,中枢处理过程并不拮抗,能够得到2耳听效果。     

24例双模式患者声源定位能力研究初步探索

目的 探索双模式患者是否能在日常使用设备设置条件下在声源定位方面获益。方法 研究共纳入24名双模式助听患者,对其进行安静环境水平方位声源识别任务测试。测试阵列由前方37个间隔5°的扬声器组成,刺激声信号为0.25,0.5,1,2,4,8 kHz啭音,强度为人工耳蜗（Cochlear Implant, CI）助听听阈阈上30 dB SPL。采用均方根误差（Root-mean-square error, RMSE）为评估指标。结果 单侧CI和双模式助听条件下受试者声源定位得分分别为81.95±11.33°和78.98±8.12°,无显著差异（t=1.232,P=0.230）。14名受试者双模式助听条件下声源定位能力优于仅CI助听,10名差于仅使用CI。上述两亚组受试者双耳助听听阈差值无显著差异（z=0.147, P=0.886）。年龄、耳聋时长、双模式助听时长与受试者声源定位能力无显著相关性（年龄：r=-0.102,P=0.636;耳聋时长：r=-0.312,P=0.137;双模式助听时长：r=0.360,P=0.867）。结论 双模式助听方式并没有显著改善单侧CI植入患者声源定位能力,同...     

中耳炎患者人工耳蜗植入术后双模式的效果分析

目的 探讨患有慢性化脓性中耳炎或既往中耳炎术后残留乳突开放腔的双侧重度感音神经性聋患者行人工耳蜗植入术（cochlear implantation,CI）的安全性和有效性、保留非手术耳的助听功能,双模式助听优势。方法对4例慢性化脓性中耳炎伴鼓膜穿孔的患者同期行CI+鼓膜修补术,4例既往行中耳乳突根治术、具有乳突开放腔且长期不干耳或中耳胆脂瘤复发的患者同期行CI+脂肪填塞术腔+外耳道及咽鼓管封闭术,8例患者对侧耳均继续佩戴助听器（Hearing-aid,HA）,观察切口愈合、术后并发症等情况。在术后开机6月时,测试患者单纯CI状态下的听阈（T）和言语识别率（Word recognition score,WRS）,同术前进行比较,同时比较单纯CI与CI-HA双模式下的WRS值。结果 1例患者术后切口感染,经加强换药10天后愈合。其余7例术区无感染、脑膜炎、迷路炎等并发症,手术安全,整个随访过程中未见中耳炎复发、电极脱落等异常;术后T明显降低、WRS明显增高,CI-HA状态下的WRS（双音节词和短句）高于单纯CI状态下的WRS,差异具有统计学意义(P<0.05)。结论 慢性化脓性中耳炎...     

全球助听技术的应用现状和发展

全球约有2.78亿听力障碍人士需要听力服务和助听技术.助听技术是指能帮助听力障碍患者改善和提高听觉能力,进而提高与他人交流能力的工具、设备、装置和仪器等[1].最早的助听技术可以追溯到17世纪末的集声器,此后助听技术随着耳科学、临床听力学、自然科学技术的发展而不断提高.     

不同听觉干预手段对聋儿声调辨别能力的影响

目的了解聋儿对声调的识别能力,以指导聋儿的言语康复训练。方法将受试对象分为3组:人工耳蜗组、助听器组和对照组。人工耳蜗组和助听器组均为双耳重度或极重度听力损失患儿。人工耳蜗组43例,其中男20例,女23例,人工耳蜗植入年龄在2.5～7岁;助听器组41例,男22例,女19例;对照组28例为听力正常儿童,男13例,女15例,年龄3～6岁。测试3组儿童对单音节词声调、扬扬格词声调的识别能力。结果人工耳蜗组对单音节词、扬扬格词声调的识别能力显著优于助听器组(P<0.01),但弱于正常对照组(P<0.01)。结论不同的听觉干预手段对聋儿声调识别能力有影响,人工耳蜗对重度或极重度听力损失的儿童较助听器有更好的声调识别能力。     

接受人工耳蜗植入或传统助听设备聋哑儿童的心智发展

失聪儿童的心智(theory-of-mind，TOM)发展速度明显低于正常儿童，而这种明显的发育延迟现象，也同时出现在选配传统助听装置学习说话的儿童身上。本研究致力于探索接受人工耳蜗植入的失聪儿童的心智发展特点，将采用特别的理论对其进行比较。研究对象是52例4～12岁的儿童。26例聋哑儿童，其中一半接受了人工耳     

Bimodal benefit depends on the performance difference between a cochlear implant and a hearing aid

Abstract

Objectives

The present study characterizes the relationship between bimodal benefit and hearing aid (HA) performance, cochlear implant (CI) performance, and the difference in the performances of the two devices.

Methods

Fourteen adult bimodal listeners participated in the study. Consonant, vowel, and sentence recognition were measured in quiet and noise (at a +5 and +10 dB signal-to-noise ratio (SNR)) with an HA alone, a CI alone, and with the combined use of an HA and CI in each listener. Speech and noise were presented directly in front of the listener.

Results

The correlation analyses showed that bimodal benefit was significantly associated with the difference in performances of a CI and an HA in all testing materials, with HA-alone performance in vowel recognition, and with CI-alone performance in sentence recognition. However, regression analyses showed that the independent contribution of the difference in performance across ears to bimodal benefit was significant, irrespective of the testing material or the SNR: the smaller the difference, the greater the benefit. Further, the independent contributions of HA-only performance and CI-alone performance were not significant factors in predicting the existence of bimodal benefit across testing materials and SNRs when the effect of the difference between CI and HA performance was removed from the model.

Conclusion

The results suggest that bimodal benefit is limited by how effectively the modalities integrate, rather than HA-only or CI-alone performance, and that this integration is facilitated when the performances of the modalities are similar.     

Bimodal studies using adaptive dynamic range optimization (ADRO) technology

This study investigated the effects of adaptive dynamic range optimization (ADRO®) processing for six bimodal listeners who used a hearing aid in one ear and a cochlear implant in the other. ‘Bimodal’ refers to the use of acoustic and electrical stimulation together. Bimodal speech recognition thresholds with the Japanese hearing in noise test were significantly lower for two ADRO devices than two non-ADRO devices in quiet, in noise from the front, and in noise from the implanted side. When the noise was presented from the non-implanted side there was no significant difference between the ADRO and non-ADRO conditions. The hearing aid measure of contrast questionnaire indicated that participants preferred ADRO in 77.3% of situations. ADRO was especially preferred in more difficult situations. The ADRO processing was designed for use in bimodal prostheses, and this study confirmed that speech intelligibility and sound quality improvements are obtainable by using ADRO in a bimodal context.     

Does acoustic fundamental frequency information enhance cochlear implant performance?

Abstract

Objectives

Low-frequency information via an acoustic aid has been shown to increase speech intelligibility in noise for cochlear implant (CI) listeners. It has been suggested that fundamental frequency (F0) provides this advantage. This study aimed to investigate the contribution of F0.

Methods

Seven cochlear implant users having residual hearing at 125, 250, and 500 Hz contralateral to the implant were recruited. Speech intelligibility in noise was measured using an adaptive procedure for three listening conditions: (1) CI alone, (2) CI plus filtered acoustic information contralaterally, and (3) CI plus acoustic F0 contralaterally. In condition 2, the sentence material was low-passed at 500 Hz and presented via an insert earphone into the contralateral ear. In condition 3, F0 was extracted using Praat and presented as a sine wave with the same F0 variation over time as the original sentence.

Results

Although benefit was observed when low-frequency information was added for the majority of participants, on average no statistically significant difference was found for the three listening conditions.

Discussion

These results are not consistent with current literature. It is proposed that glimpsing cues may be responsible for the advantage observed in previous studies; in this study, both target and masker were presented in the acoustic condition and this may explain the discrepancy.

Conclusion

The benefit of additional acoustic information may be highly variable and individual to participants, but on average no statistically significant difference was seen.     

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。     

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.     

植入人工耳蜗与配戴助听器儿童背景噪声下的声调识别

目的 探讨植入人工耳蜗与配戴助听器儿童在声调识别方面是否存在差异,分析背景噪声对听障儿童声调识别的影响.了解在噪声环境中听障儿童声调识别的特点.方法 采用2X4两因素混合实验设计,比较植入人工耳蜗与配戴助听器儿童在不同信噪比条件下(SNR=+12,+6,0 dB)的声调识别能力;采用单因素方差分析,比较不同声调组合识别对听障儿童的难易程度.结果 ①在重建或补偿听阈相似时,植入人工耳蜗与配戴助听器儿童声调识别能力的差异不显著;②在不同信噪比条件下,两组儿童声调识别能力的差异极其显著;③两组儿童均最易分辨一声与四声的差异,最难分辨二声与三声的差异.结论 只要重建或补偿听阈在最适范围,听障儿童便具有一定的声调识别能力,但噪声会对其产生极大的影响.     

人工耳蜗植入及其电刺激对不同频率残余听力的影响

目的 从听力学的角度评价人工耳蜗植入的安全性，并进一步探讨人工耳蜗植入及其电刺激对患者不同频率残余听力的影响。方法 筛选出手术前后能够良好配合纯音听力检查、中耳内耳无明显异常、测听条件基本相同的单侧Nucleus人工耳蜗植入者31例，了解并分析其耳蜗植入前后不同频率残余听力的变化情况。结果 经人工耳蜗植入手术及一段时间的耳蜗电刺激后，部分患者植入耳的残余听力会有所保留（66.67%）；植入侧1kHz以下频率段的残余听力较手术前有显著差别，损失最重的是500Hz或1kHz，其次是250Hz；植入侧2、4kHz较手术前无显著差别；非植入侧听力较手术前无显著差别。结论 人工耳蜗植入及耳蜗电刺激对植入耳的残余听力并非完全破坏，对不同的频率会造成不同程度的损害，且1kHz以下频率受损较重。