为听力障碍婴幼儿验配助听器的新方法

背景 各国已普遍认同新生儿听力筛查(Univerisal Hearing Screening)的重要性。1999年11月30日,中国残联、卫生部、教育部等10个部门已联合发文:“卫生部门要贯彻预防为主的方针,并计划将新生儿听力筛查纳入妇幼保健的常规检查项目,达到早期发现,早期干预康复的目标。”一项提高全国婴幼儿生活素质的听力保健运动已正式在全国展开。但对于筛查后发现患有听觉障碍的婴幼儿,如何为他(她)们验配合适助听器? 便显得十分迫切和重要。"1 早期听力干预的重要性" 美国Yoshinaga-Itano’s指出:“生后6个月前接受干预的听力障碍的儿童,经适当言语…     

婴幼儿助听器验配

新生儿听力筛查工作已在我国广泛开展,并取得了初步成效.众所周知,新生儿听力筛查工作包括听力筛查、早期诊断评估和干预、听觉言语和语言康复训练以及后期的追踪随访等诸多环节.目前,我国早期听力诊断评估及早期干预工作仍存在着严重的不足,尤其是早期干预质量堪忧.因此针对早期听力干预问题,应该制定相应的技术规范,以提高干预的力度和质量.     

真耳与2cc耦合腔差值在小儿真耳测量中的应用

0～3岁是婴幼儿言语发育的最佳时期,适当的声刺激输入是听觉系统正常发育及言语能力健康发展的基本前提,因此聋儿听力言语康复十分强调早期干预.随着新生儿听力筛查的逐渐普及,听力损伤可望在婴幼儿出生后的6个月内确诊,如何科学、精确、简便地为有听力损失的儿童进行早期助听器验配一直以来是听力学工作者面临的挑战.     

助听器验配人员资质认证的重要性

1助听器验配师职业的由来临床上有相当一部分听力障碍患者通过治疗手段无法得到治愈。从听力损失程度粗分,这部分患者可分为有残余听力和残余听力甚少两大类。在世界范围内,对有残余听力且符合助听器使用条件的患者可通     

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.     

108例重及极重度聋幼儿助听效果观察

目的　为双耳重、极重度感音神经性聋患儿选配助听器 ,并进行定期调试 ,观察助听效果。方法　用功能增益法评估助听器效果。结果　佩戴助听器 1～ 3年后的助听器效果较初戴时好 ,两者之间有显著性差异 (P<0 .0 1) ,高频差异更大。结论　聋儿佩戴经验配后的助听器 ,听敏度特别是高频部分的听敏度有提高     

婴幼儿听力客观评估

新生儿听力早期筛查干预项目规定听力学评价和医学评价应在出生后3个月内进行,诊断为永久性听力损失的婴幼儿,应在6个月内接受多学科参加的干预.听力学评价须确定有无听力损失,以及听力损失的侧别、性质、程度、听力图的类型,必要时还须了解听力损失的原因.主要测试方法包括行为听力测试和生理测试.     

移频助听器的验配体会

作为一种特殊助听装置,移频助听器的原理与传统助听器有本质的不同,所以其验配技术对很多业内人士来讲也是一个难题。随着移频助听器验配人数的快速增长,这一挑战日渐突出。本人通过近3年为200多例极重度听力障碍患者验配移频助听器得到了一些验配心得,希望与大家分享。1、病人的选择:一般情况下当病人低频有一定的残余听力,而高频残余听力大于65dB或配戴非移频助听器后4000～7000Hz范围内的听力补偿达不到45dB时应考虑配戴移频助听器。2、听阈的输入:如果患者2000Hz(包括2000Hz)以上频率的听阈大于100dB时,此频率听阈应记为NR。3、真耳…     

助听器效果评估简表的临床应用

听障患者验配助听器后,究竟如何准确评估其助听效果一直是参与助听器验配的临床听力学工作者非常关注的问题.尽管可以用声场测试的方法了解听障患者的助听听阈,从而在一定程度上大致判断助听器的效果,但是用于声场测试的纯音（pure tone）远不能代替生活中各种各样的声音.因此,各种让听障患者自己参与的助听器主观效果评估工具——自测问卷（self-assessment questionnaire）应运而生,并且成为判断助听器是否选配成功的主要依据之一[1～6].     

为严重至极度听力损失儿童验配大功率数码助听器的体会

为双耳重度及极度聋儿童验配助听器的策略问题至今仍是个值得探讨的课题。一般来说婴幼儿听力早期诊断时单独使用客观测听法所得到的结果 ,对于成功验配助听器是不够的。无论是听性脑干反应测试法还是镫骨肌反射测试法 ,都不能给出听阈或不适响度级的频率分布特性 ,只能给出残余听力动态范围频率分布特性的一般提示。因此 ,听力诊断方法中还应包括行为测听法。尽管单用行为测听法也不足以确定残余听力动态范围 ,但这也是必要的。考虑到这些限制因素 ,为婴幼儿验配助听器并不总能成功。甚至采用通常用于较年长儿童和成人的助听器验配方法 ,如…     

Bone-anchored hearing aids in infants and children younger than 5 years

OBJECTIVE: While bone-anchored hearing aids (BAHAs) are currently indicated for rehabilitation in children older than 5 years with bilateral maximal conductive hearing loss, our objective was to capitalize on potentially important stages of auditory and speech-language development by providing BAHAs to children younger than 5 years. DESIGN: A retrospective review of surgical data of children receiving BAHA implants over a 10-year period. SETTING: The Hospital for Sick Children, Toronto, Ontario. PATIENTS: Twenty children 5 years or younger (mean +/- SD age, 3.21 +/- 1.65 years) served as the study group, while 20 older children (mean +/- SD age, 7.63 +/- 1.55 years) served as the comparison group. INTERVENTIONS: All patients received BAHA implants. Children with cortical bone thickness less than 2.5 mm underwent a 2-stage procedure; children with cortical bone thickness greater than 4 mm underwent a single-stage procedure. MAIN OUTCOME MEASURES: Traumatic and skin revision complication rates and implantation interstage intervals were compared between groups. RESULTS: The mean +/- SD interstage interval was 7.72 +/- 3.81 months for the younger children, which was significantly longer than for the older children (4.41 +/- 2.51 months) (P<.003). Two traumatic fixture losses occurred in the younger children, while 4 occurred in the older children. Skin site revision was required in 3 younger children. All children are currently wearing their BAHAs. CONCLUSION: Two-stage BAHA implantation with a prolonged interval between stages yields surgical success in younger children comparable to that routinely observed in older children.     

听障儿童助听器选配中确保持续可听度的若干因素

随着医疗水平的逐步提高,临床检测手段的日益完善,越来越多的听力障碍儿童得到了早期诊断。在实际的临床工作中,并不是所有听力较好的儿童就一定达到满意的康复效果,相反,一些听力损失很重的儿童最终达到的效果也有的超过我们的预想,这些现象带给我们思考。助听器作为听障儿童听力语言康复过程中重要的辅具,哪些因素对于言语康复是最重要的呢?本文主要就这些问题展开讨论。     

Evaluation of hearing improvement due to hearing aids

A method to assess the hearing improvement due to hearing aids is described. This method has been used routinely at a local hospital for 2 years on 200 patients. This method is based on the assessment of the speech reception threshold for sentences ("Marburger Satztest") in silence and in various noise levels (speech simulating noise). The following were used for the assessment of the hearing aid: the improvement of the speech reception threshold in silence with or without a hearing aid, the maximum tolerable noise level (i.e. the noise level at which everyday speech becomes subliminal for patients with hearing aids) and the noise level at which the speech reception threshold with the hearing aid is worse than without.     

Selection of hearing aids for severely deaf children

Procedures are described for selecting the gain and frequency response of hearing aids for deaf children and for evaluating aided hearing. These include a comparison of aided thresholds with the speech spectrum to determine how much of the frequency range is functional for each child. This provides a basis for deciding whether to select an aid having a "conventional" (C) response, which de-emphasises the low frequencies, or a low frequency (LF) response which provides more low frequency gain, although not necessarily low frequency emphasis. It is concluded that, for optical aid fitting, some children require "C" responses for both ears, others "LF" responses for both ears and others a "C" response for one ear and an "LF" response for the other. These three possibilities are all required sufficiently commonly that exclusive use of any one would inevitably result in relatively ineffective amplification for many deaf children.     

The effect of the frequency characteristics of hearing aids on speech perception in children with neurosensory hearing loss

The efficacy of sound reinforcement at two bandwidths (high frequency at 250-5000 Hz and low frequency at higher than 1000 Hz frequencies with a steepness of 14 dB in the octave) in the hearing aids of children with hypoacusis was investigated. Altogether 67 children at the age of 11 to 14 years with an average hearing impairment of 35 to 97 dB were examined. In the low frequency range, 3% of the children showed a better, 33% a lower and 64% an unchanged discriminatory capacity of speech when compared to the high frequency range. The lack of the filtration effect on the discriminatory capacity was seen in children with a moderate hearing loss at high frequencies (in 50% children) due to adequate hearing perception at the above bandwidths or in children in whom hearing thresholds at 2000 and 4000 Hz were so high that failed to provide proper speech perception at both bandwidths. Therefore when hearing aids are regularly used, the high frequency range of the spectrum is sufficiently informative for the overwhelming majority of children with hearing loss, i. e. for 83%. These results give evidence that a high frequency range is adequate for children with hearing loss if they begin to use hearing aids from an early stage.     

Practice guidelines for bone-anchored hearing aids in children

After more than 20 years of clinical experience in children, bone-anchored hearing aids, essentially BAHA(?), have become the standard treatment for conductive or mixed hearing loss. Based on a general review of the literature and the authors' own experience, this article reviews the use of bone-anchored hearing aids in children. The main indications for bone-anchored hearing aids are a minimum age of 5 years at the time of implantation and/or cortical bone thickness ≥ 3 mm. Fixture loss is observed in 40% of children under the age of 5 years versus 8% for children aged 5 to 10 years and 1% for children over the age of 10 years, i.e. identical to the rate observed in adults. Skin complications are similar to those observed in adults and must be prevented by parental education and regular follow-up. Surgery is generally performed in two stages or as a one-stage procedure for fixtures ≥ 4 mm. The functional success rate, correlated with medium- and long-term use of BAHA(?) is about 96%. BAHA(?) may be indicated in children with profound unilateral hearing loss following a trial period wearing a BAHA(?) headband for several weeks with the child's active participation. Sequential bilateral implantation requires complementary investigations and appears to provide improved perception in noise. This type of hearing aid provides an improvement of the quality of life of children with bilateral conductive and/or mixed hearing loss which should be further improved as a result of recent technical developments.     

浅谈全数字式助听器验配经验

目的随着数字化技术的不断发展,助听器对声学信号处理的技术越来越先进,采用多套程序设置,多频段的实时频谱分析技术,可自动剔出噪声而将语音占优势的频段突出出来,以提高信噪比来增加噪声环境中对言语的理解能力。全数字助听器对验配手段提出了更高的要求。方法依据频响曲线对新旧助听器的参数进行调校。结果此方法在实际验配中,收到满意效果。结论全数字编程助听器的验配必须循序渐进,不断跟踪调校,观察患者言语发展情况。     

助听器中的堵耳效应

堵耳效应是由于外耳道被封闭而造成的骨导听阈变好的现象。这一效应在纯音测听中会造成低频骨导听阈下降，还会对护耳器的配戴效果产生影响。在助听器配戴中堵耳效应会造成配戴者耳部闷胀、感觉自己说话的声音空洞不适或者响度过大。如何将通过骨传导方式到达耳道的低频声音能量有效地降低或通过耳道发散出去是