非线性频率压缩助听器对耳聋患者噪声下言语识别的影响

目的 探讨非线性频率压缩(nonlinear frequency compression, NLFC)助听器对以汉语普通话为母语的耳聋患者噪声下言语识别的影响,为耳聋患者助听器选配及助听效果评估提供参考.方法 25例以汉语普通话为母语的感音神经性聋患者,均双耳佩戴助听器,根据患者是否有NLFC助听经验分为A、B两组:A组13例有NLFC助听经验,日常使用NLFC技术;B组12例无NLFC助听经验,日常使用传统放大(conventional process, CP)技术.所有患者分别在NLFC和CP条件下进行噪声下句子识别测试,比较其结果.结果 A组患者在NLFC和CP条件下的噪声下言语识别率分别为82.33%±16.06%、76.70%±18.08%,前者高于后者,差异有显著统计学意义(P<0.01);B组分别为83.04%±12.56%、81.79%±20.07%(P=0.19),差异无统计学意义.A组患者在NLFC和CP条件下的高频(4、6、8 kHz)助听听阈分别为53.54±7.30、57.01±6.81 dB SPL,B组分别为57.42±8.38和61.21±7.42 dB SPL,两组NLFC条件下的助听听阈低于CP条件,差异均有统计学意义(P<0.01).经统计学回归处理,患者在NLFC和CP条件下的高频助听听阈差值与言语识别率差值呈线性相关(r=0.63,t=3.89,P=0.007).结论 NLFC技术可改善患者高频可听度及噪声下言语识别,一定的NLFC使用经验可使NLFC助听效果最大化.     

助听器验配中非听力因素的研究

科技的进步仍然不能解决助听器验配的所有问题。很多耳聋患者主观拒绝配戴助听器,或者“配而不用”,主要是由于非听力学因素的影响,包括配戴者的精神心理、外界支持及社会状态等。本文从上述几个方面重点介绍非听力学因素的影响。     

陡降型听力曲线者助听器选配效果观察

目的 为陡降型听力曲线的听障者选配助听器，使其能听清楚高频的声音。方法 听障者配戴助听器前和配戴普通线性放大助听器、多通道全数字电脑编程助听器后进行助听听阈、声源觉察率测试，并分别进行比较。结果 听障者配戴普通线性放大助听器与没有配戴助听器时助听效果没有明显差异；配戴多通道全数字电脑编程助听器和配戴普通线性放大助听器助听听阈在高频区有显著性差异，在对低频的正常耐受下大幅度补偿高频，从而助听听阈接近正常。结论 陡降型听力曲线听障者配戴多通道全数字电脑编程助听器，经过多次调整，对高频部分的听敏度有大幅度的提高。     

Effect of Hearing Aids on Psychosocial Dysfunctioning

The perception of communication abilities amongest adolescents with moderate and profound hearing loss was correlated with indices of psychosocial adjustment. This was done to determine whether the use of hearing aids could play a role in presence and improvement of psychosocial functioning among acquired hearing loss persons after the use of hearing aids. Amongest the deaf population, it was found that hearing loss did affect the social, the vocational, the personal and subjective well being, after intervention. The control group did not show any corresponding change except that the state anxiety among this group had increased.     

The Relative Importance Of Recovery Time in Compression Hearing Aids

Recovery time (RT) in compression hearing aids was studied using six aids of identical characteristics except for factory-modified RT. Recordings of CID W-22 lists were made through the aids and played to normally hearing and otopathologic (sensorineural) subjects. Speech intelligibility was measurably influenced by RT variation with attack time held constant (10 ms). The effect was much more pronounced with the normal than with the hearing-impaired listeners, a phenomenon not unexpected when testing such a subtle feature in a low-fidelity transmission system. When the RTs of the aids were re-specified according to a proposed standard (IEC) the data suggested that RTs for English in the vicinity of 90 ms may be most desirable. Additional work is required using more complex stimuli and background noise.     

113例聋儿的助听及言语发育调查分析

目的了解0~6岁聋儿的助听、言语发育及交流情况。方法自制调查问卷表,随机对2005年2~5月在北京同仁医院耳科门诊就诊的113例双侧听力损失儿童的助听、语训、言语发育及交流能力等进行调查,并对相关数据作统计学分析。结果113例中助听器佩戴者85例(75.22%),其中,助听后语训者占51.76%(44/85),助听后无语训者占48.24%(41/85),无助听无语训者28例,占24.78%(28/113);无助听无语训者中重度聋以上23例,占82.14%(23/28)。70%的中度聋儿存在构音障碍和言语交流障碍;重度和极重度聋儿中,97.03%存在构音障碍,88.12%有不同程度的言语障碍和交流障碍。结论中-重度聋以上聋儿,无助听和无语训比例偏高,言语障碍和交流障碍较明显。加强聋儿家长对佩戴助听器和言语训练必要性的宣传和教育具有非常重要和深远的意义。     

Presbyacusis,Hearing Aids and Aging

This paper considers the factors of presbyacusis and age-related psychological changes in older adults in terms of their effects on the use or potential use of hearing aids as a means of improving aural communication. Data are presented on the prevalence of hearing impairment and the extent of hearing aid use in aging listeners. Four major classes of presbyacusis are described (sensory, neural, metabolic, and cochlear conductive) and a hearing aid prognosis is made for each type of disorder. It is shown that aging produces deficits in pure-tone thresholds, the speech reception threshold, and speech discrimination, but not all losses can be 'corrected' with a hearing aid. Binaural (stereophonic) devices are psychoacoustically superior to monaural devices; however, behavioral and personality changes in older patients often create problems of adaptation to the binaural aid. These changes may also affect the fitting of an aid and the patient's ability to learn to use it. Some practical suggestions are offered on the evaluation of hearing aids and it is emphasized that adequate orientation and counseling are typically required if hearing aid treatment is to be successful in presbyacusis.     

语前聋儿童佩戴助听器后塞音发音特点

目的分析听力障碍患儿佩戴助听器后塞音的发音特点。方法以佩戴助听器的语前聋患儿30例(助听器组)和健听儿童30例(健听组)为研究对象,年龄3~6岁(分为3~、4~、5~6岁组,每组2类儿童各10例),日常均使用汉语普通话交流,具备一定的发音能力。以塞音词表进行测试,分析两组儿童塞音(/b/、/d/、/g/、/p/、/t/、/k/)的发音正确率和错误类型,分析不同生理年龄、助听时间与发音正确率的关系。结果助听器组儿童塞音发音的正确率从高到低为/b/>/d/>/g/>/k/>/t/>/p/,健听组儿童塞音发音的正确率从高到低依次为/b/>/g/>/k/>/p/>/d/>/t/;健听组儿童塞音/b/、/g/、/k/、/t/、/p/的正确率显著高于助听器组儿童(P<0.05)。助听组儿童发音错误规律包括:①发音方法相同的音互相替代,如不送气塞音的互相替代和送气塞音的互相替代;②发音部位相同的音互相替代;③发音方法和发音部位不同的替代,如:塞音擦音化,塞音塞擦音化,不送气化。4~、5~6岁组听障儿童塞音/g/、/p/、/k/发音的正确率明显高于3~岁组(P<0.05),助听器佩戴时间大于2年的听障儿童塞音/p/、/t/发音的正确率明显高于小于2年的儿童(P<0.05)。结论听障儿童塞音发音清晰度落后于健听组儿童,生理年龄、听觉干预的时间对听障儿童部分塞音发音的正确率有影响,需进行积极的干预和有针对性的康复训练。     

人工耳蜗植入术前助听器试戴的意义

对拟行人工耳蜗植入手术的双侧极重度耳聋患者进行助听器试戴和语言训练，并定期作言语识别记分（ＳＤＳ）。结果：３例患者戴助听器ＳＤＳ较未戴助听器时无明显提高，分值改变＜４０％，选择人工耳蜗植入且术后听觉效果好；另５例戴助听器后可进行一般交谈，以助听器为听力康复的最佳选择。对人工耳蜗植入术前助听器试戴的意义进行了讨论。     

Head Diffraction Effects on Ear-Level Hearing Aids

In this paper, head baffle and head shadow effects were measured at a front-oriented and at a back-oriented micro-phone in a hearing aid casing when worn by human subjects and when placed on a dummy head. Some differences in head baffle and head shadow effects were observed for the front- and back-oriented microphones in that greater head baffle effects were observed at the front microphone than at the back microphone while the reverse was true in terms of head shadow effects. Results obtained with the hearing aid mounted on a dummy head were similar in some respects and in other respects they differed from those observed when the hearing aid was worn by six subjects. Comparison of the results obtained in this study with the data of Wiener measured at the entrance to the ear canal indicated smaller head baffle effects but larger head shadow effects at the hearing aid microphone than at the canal entrance. Finally, it is suggested that reproduction of frequencies above 2000 Hz and that a resonance peak at about 3000 Hz in the frequency response curve of a hearing aid may be beneficial to the wearer     

Clinical Results of Hearing Aid with Noise-Level-Controlled Selective Amplification

We have developed a hearing aid which reduces the low-frequency energy of the input sound according to the input noise level and the spectrum of the environmental noise. The results of speech discrimination tests using speech in noise in 70 hearing-impaired subjects showed improvement in word discrimination scores in noise of over 15% for 50 of 53 subjects with sensorineural hearing loss. This group of hearing-impaired patients was subdivided into categories according to (a) audiogram type [flat, sloping (i.e. gradual high-frequency loss) and abruptly falling (steep high-frequency slope)]; (b) degree of hearing loss (less than or more than 50 dB average loss) and (c) etiology (familial deafness, presbyacusis). Results on 17 subjects with conductive or mixed hearing impairments showed no improvement, but expressed a preference for this system. The subject reported that the sound was more natural and quiet compared with the conventional AGC hearing aids.     

A Contemporary Review of Hearing Aids

A contemporary review of hearing aids is provided with a focus on current styles of amplification devices, the goals of a hearing aid fitting and the signal processing schemes that allow the clinician to meet these goals, and the need to couple outside devices to hearing aids. A variety of new features available on hearing aids that improve the listener's experience with amplification are described. Some future challenges in hearing aid design and hearing evaluation are presented.     

Threshold Improvement and Acoustic Gain with Hearing Aids

Aided speech reception thresholds were obtained from 20 hearing-impaired listeners with three hearing aids adjusted to comfort settings, and with the aids adjusted to deliver 40 dB of acoustic gain. The aided speech reception threshold under each condition was subtracted from the unaided speech reception threshold to yield a measure of threshold improvement. Threshold improvement and acoustic gain comparisons revealed that, at comfort settings, these two measures were quite similar. However, at the 40-dB gain setting, acoustic gain exceeded threshold improvement by an average of 5.6 dB. For the high-gain condition, it appeared that the threshold improvement obtained by subjects with relatively good unaided sensitivity was limited by the ambient noise in the test chamber     

三个预选公式在聋儿助听器验配中的效果评价

目的探索出适合聋儿的助听器预选公式。方法对重度和极度感音神经性聋的１５例（３０耳）患儿应用ＮＡＬ－Ｒ、Ｂｅｒｇｅｒ、１／３增益公式,进行了助听器验配,并对不同频率上的目标增益值、真耳介入增益值、助听前后的声场阈值方面进行了比较;探索适合于这类患者的最佳预选公式。结果１各公式助听前后的声场阈值之间有显著性差异（Ｐ＜０．０１）,经预选公式验配后有不同程度的助听效果;２助听效果最好的是Ｂｅｒｇｅｒ公式,助听效果最差的是１／３增益公式。结论虽然助听效果最好的是Ｂｅｒｇｅｒ公式,但是还应强调个体化。     

168耳选配的耳内式助听器特性分析

目的 研究耳内式助听器的特性,方法 应用ＧＳＩ－１６纯 听力计附声场测听系统,观察在６８耳不同类型助听器使用者助听前的和损失和助听后的听力补偿,测试裸耳及戴不同耳内式助听器后外耳道共振峰幅值,测试２２耳耳内式助扣器使用者的言语分经。结果 耳内式且听器１０００－４０００ＨＺ的听力补偿优于２５０－５００ＨＺ的听力补偿;４６耳裸耳及佩戴助听器后外耳道共振峰值分别为２９２９ＨＺ及３０１６ＨＺ,两者无明显差     

Performance of Hearing Aids with an Induction Loop Amplification System: Laboratory Versus Classroom Setting

This study was designed to investigate the acoustic response of ten body-type hearing aids when used with an induction loop amplification (ILA) system in the laboratory and in the actual classroom setting. Undesirable frequency response characteristics were discovered in the classroom ILA system used in this study. These consist of a slightly poorer low-frequency response and a deep notch at about 2 500 Hz. Had the frequency response of the classroom ILA system been flat, differences between laboratory and classroom measures would have been minimized. Findings of this study support the practicality of measurement in the classroom of the operating characteristics of ILA systems     

Surgical and Audiologic Comparison Between Sophono and Bone-Anchored Hearing Aids Implantation

Objectives Bone-anchored hearing aids (BAHA) occasionally cause soft tissue problems due to abutment. Because Sophono does not have abutment penetrating skin, it is thought that Sophono has no soft tissue problem relating to abutment. On the other hand, transcutaneous device’s output is reported to be 10 to 15 dB lower than percutaneous device. Therefore, in this study, Sophono and BAHA were compared to each other from surgical and audiological points of view.Methods We retrospectively reviewed the medical records of 9 Sophono patients and 10 BAHA patients. In BAHA cases, single vertical incision without skin thinning technique was done. We compared Sophono to BAHA by operation time, wound healing time, postoperative complications, postoperative hearing gain after switch on, and postoperative air-bone gap.Results The mean operation time was 60 minutes for Sophono and 25 minutes for BAHA. The wound healing time was 14 days for Sophono and 28 days for BAHA. No major intraoperative complication was observed. Skin problem was not observed in the 2 devices for the follow-up period. Postoperative hearing gain of bilateral aural atresia patients was 39.4 dB for BAHA (n=4) and 25.5 dB for Sophono (n=5). However, the difference was not statistically significant. In all patients included in this study, the difference of air-bone gap between two groups was 16.6 dB at 0.5 kHz and 18.2 dB at 4 kHz. BAHA was statistically significantly better than Sophono.Conclusion Considering the audiologic outcome, BAHA users were thought to have more audiologic benefit than Sophono users. However, Sophono had advantages over BAHA with abutment in cosmetic outcome. Sophono needed no daily skin maintenance and soft tissue complication due to abutment would not happen in Sophono. Therefore, a full explanation about each device is necessary before deciding implantation.     

聋儿戴助听器导致的听力下降(附2例报告)

通过对湖北省聋儿康复中心戴助听器半年以上的在训聋儿30名(58耳)的听力情况进行复查,发现这些聋儿中有2例(2耳)出现戴助听器后单耳听力下降情况.为了探讨聋儿听力下降的原因,对聋儿所配戴助听器的频响范围、增益、声输出情况、音量大小及聋儿家长或语训老师对聋儿进行语训的习惯进行了分析.比较戴助听器前后听力情况,提出可能导致聋儿听力下降的几个常见原因.对聋儿验配助听器过程中需注意的方面进行归纳.