增强患者满意度的新解决方案——耳内受话器（RIC）技术

研究表明用户希望助听器使用简易有效、美观、配戴舒适并能够长时间稳定工作。近年新出现的耳内受话器（receiver in the canal,RIC）技术和一系列创新自动技术结合在一起可以满足这些需求。耳内受话器技术能为更宽范围的听力损失患者提供无反馈和无堵耳的选配,行为研究表明该技术在实际生活中也具有显著的接受度。以下将以CENTRA Active为例讨论耳内受话器技术独特的声学特性及应用。     

助听器耳模的堵耳效应及解决方案

目的分析佩带助听器耳模造成的堵耳效应的特点,并寻求适宜的解决方案.方法应用真耳探管传声器测量系统,用两种给声方式(受试者自主发出低频元音、或以骨振器振动颅骨给声),测试了用海绵耳塞、助听器耳模堵耳后的堵耳效应增益曲线.实验分三个部分:1.以海绵耳塞堵耳,骨振器给声强度逐渐增强,了解堵耳效应值是否随骨导信号强度而变化;2.以海绵耳塞和助听器耳模堵耳,骨振器给声强度为35dBHL,了解堵耳效应的频率特征.3.由受试者自主发出低频元音,在耳模上施加不同尺寸的通气孔,评价其解决堵耳效应的实际效果.结果1.探管麦克风在外耳道中记录的堵耳响应REOR随骨导强度增强呈1:1线性增长;2.堵耳效应主要表现在1000Hz以下的低频,250Hz、500Hz、1000Hz的堵耳效应依次为24.1±1.6dB,19.3±0.8dB,9.7±0.5dB(n=10),性别间差异不显著;3.配戴助听器耳模后的堵耳效应在400Hz以下的低频最为显著.普通的2mm平行通气孔可使该频带的堵耳效应平均下降15dB以上,短的2mm通气孔则可使堵耳效应降低约20dB.结论堵耳效应不因骨导信号的强度变化而改变,主要集中在1000Hz以下的低频;配戴助听器耳模后,堵耳效应在400Hz以下最为显著,加开通气孔可显著解决堵耳效应问题.     

控制声反馈助听器通气孔的设计及临床使用

助听器通气孔是由外向里贯穿定制机或助听器耳模全程的通道．定制助听器或耳模时，在不影响声孔位置的前提下，应尽量选择。通气孔的主要作用在于：①平衡耳内气压：即使通气孔很小，也能缓解耳内胀满感，减轻耳内压力，②保持耳道与外界的通风：耳道通风可减少耳内潮湿，降低继发感染的可能；同时保持耳内干燥对保养助听器有很大益处：③减轻堵耳效应：堵耳效应可使听力障碍者觉得自己的说话声音很响、很空．象闷在桶里说话一样．这是因为耳道堵塞后，听力障碍者自己的说话声可通过骨导作用使低频声增强.     

30例中度感音神经性聋老年人堵耳效应研究

目的通过对患有中度感音神经性聋老年人的堵耳效应（occlusion effect）特点的研究,为临床上该类老年人在助听器验配时减轻堵耳效应提供参考。方法通过电耳镜观察和纯音测听筛选出30例中度感音神经性听力损失的老年人,对这30例分别进行裸耳气骨导测试,在外耳道按不同的深度放置耳样,再测试相应位置受试者的骨导听力变化。结果耳样深度超过外耳道峡2mm时测得的堵耳效应与耳样深度至外耳道峡处和耳样在外耳道峡前2mm时测得的堵耳效应值在0.25、0.5和1kHz处有显著性差异。男女性别间堵耳效应差异无统计意义。结论堵耳效应主要发生在低频且外耳道软骨部可以自由振动的情况下,但如果耳样深至骨部则堵耳效应明显减弱或几乎没有,无性别差异。     

反馈截除技术在开放式助听器选配中的应用

目的验证基于不同平台的PureWave反馈截除技术与AFI主动反馈截除技术在开放式助听器选配中的临床应用效果。方法 40例（40耳）感音神经性听力损失患者,年龄16～70岁,平均40±18.04岁,测试耳0.5～4kHz平均纯音听阈55.7±14.8dB HL。分别佩带50dB增益的畅听系列RIC瑞克（Purewave反馈截除技术）和ZON神（AFI主动反馈截除技术）助听器,采用相同扬声器与中号（3号）开放式耳塞,测试并比较两者的附加稳定增益值（added stable gain,ASG）及开启反馈功能状态下的最大稳定增益（maximum stable gain,MSG）曲线。结果 PureWave反馈截除技术与AFI主动反馈截除技术的ASG值分别为25.12±3.47dB与20.33±3.28dB,两者比较差异有显著统计学意义（P〈0.001）,两者的最大稳定增益在3.0kHz和6.5kHz最大差值分别可达8dB和6dB。结论 PureWave反馈截除技术可显著提高开放式助听器选配中的附加稳定增益;其应用可扩大开放式助听器选配的使用人群,提高选配的舒适性与美观性。     

助听器反馈消除系统

引言 助听器的发展日新月异．数字助听器更是拥有广阔的发展空间。随着时代的进步和人民生活水平的提高，助听器已由起初简单的声音放大器，发展为现在的多功能与人工智能一体的高端数字助听器。但是．在助听器的发展过程中．助听器的反馈声处理问题一直困扰着广大厂商及听力学者．尤其是近来被助听器行业所推崇的开放耳（openfit）技术，虽然解决了耳朵的闭塞感．使得配戴非常的舒适．但是在开放耳道的同时．必然会提高引起反馈啸叫的可能．因此如何抑制反馈显得尤为重要．下面就助听器反馈问题进行一些讨论。     

自动听力计罩耳式耳机堵耳效应研究

目的测定罩耳式耳机在自动听力计骨导听阈检测过程中的低频区堵耳效应。方法招募健听青年志愿者,采用心理声学方法,检测SFTest 330型听力计在手动、自动两种模式下骨导振子安置于前额时测试耳在250、500、1000、2000及4000 Hz处堵耳效应,并与临床诊断听力计检测结果相比较。结果共21名(42耳)受试者入组,随着测试频率增高,堵耳效应逐渐减小;至4000 Hz处,3种情况下的堵耳效应降低至1.00±4.27~4.38±6.52;自动模式下于250 Hz处堵耳效应达8.75±6.96 dB,但小于AC40诊断型听力计于250 Hz处堵耳效应值(14.00±6.32),其SFTest 330型听力计手动、自动模式下堵耳效应无统计学差异(P>0.05)。结论SFTest 330型听力计自动测听模式下低频堵耳效应明显,进一步行更大内腔容积的罩耳式耳机测试有望降低该种情况下的堵耳效应。     

全耳道内助听器的声学特点与选配

全耳道内助听器的声学特点与选配窦红伟１王永华２全耳道内（Ｃｏｍｐｌｅｔｅｌｙｉｎｔｈｅｃａｎａｌ，ＣＩＣ）助听器，是完全置放于外耳道内的助听装置。由于具有隐蔽性好、佩戴舒适、声学效应明显等优点，优于耳背式（ＢＴＥ）和耳内式（ＩＴＥ）及传统式助听器，因...     

笛听1600真耳测试功能在助听器选配中的应用

目的 验证笛听1600自带的真耳测试功能在助听器选配中的准确性和有效性.方法 选择22例(30耳)配戴笛听1600(其中4耳是BTE),年龄9～70岁,平均40岁,测试耳裸耳纯音听阈≤90 dB HL,言语分辨率﹥60%.进行两步评价,第一次在最佳选配(不使用RECD测试)6周后进行验证和评估,第二次在应用笛听1600的RECD测试6周后进行验证和评估.评估分别采用言语分辨率测试和IOI-HA国际性助听器效果调查表,比较两次不同方法选配后的结果.结果 使用笛听1600 RECD测试6周后71.4%的患者平均言语识别率比第一次测试(不使用真耳测试)6周后平均言语识别率有所提高,14耳平均言语识别率提高5.4%.IOI-HA助听器调查效果调查表结果显示,使用笛听1600真耳测试后患者对助听器的作用的肯定和满意度均提高.结论 笛听1600真耳测试能快速简便地测量个人RECD值,使助听器选配更加精确,提高了选配的满意度.特别是在儿童选配中由为重要.     

高频陡降型听损患者助听前后ANL的研究

目的探讨可接受噪声级(acceptable noise level,ANL)测试是否适用于评估高频陡降型听力损失人群的助听器选配效果。方法选取佩戴助听器半年以上的20位高频陡降型的听障患者,对其进行裸耳和助听后的ANL测试、助听情况下的Speechmap测试,通过软件SPSS19.0分析对比助听前后的ANL值和真耳分析的测试结果,比较其差异性,评估助听器效果,得出结果。结果 (1)20位听障者在裸耳状态时最舒适响度级(most comfortable level,MCL)为80.70±8.05d B HL,助听情况下MCL为65.80±9.03d B HL,具有统计学意义;裸耳状态下背景噪声级(back-ground noise level,BNL)值为73.75±7.16d B HL,助听后BNL值为59.25±6.93d B HL,该结果具有统计学意义(P<0.001),而助听前后ANL值分别为6.95±4.20 d B HL和6.55±4.21 d B HL,该结果无统计学意义(P<0.05),表明患者ANL值与配戴助听器与否无相关性;(2)助听后Speechmap得分验证了裸耳ANL值小于7d B HL时,助听效果很好;但裸耳ANL值大于7d B HL时患者Speechmap得分偏低,助听效果不好。结论通过测试裸耳的可接受噪声级(ANL值)可以较为准确地预测高频陡降型听力损失患者选配助听器的效果,并对此类患者是否选配助听器进行指导。     

Cochlear implant telemedicine: Remote fitting based on psychoacoustic self-tests and artificial intelligence

Objective: This study aims to assess the feasibility of autonomous cochlear implant (CI) fitting by adult CI recipients based on psychoacoustic self-testing and artificial intelligence (AI).

Design: A feasibility study was performed on six adult CI recipients implanted with a Nucleus device. Two weeks after processor activation in the clinic, a ‘self-fitting’ session was organized in a supervised simulated home environment. The CI recipient performed pure tone audiometry and spectral discrimination tests as self-tests. The AI application FOX analysed the results and recommended a new map. The participants filled out a questionnaire and were tested again after 2 months of take-home experience.

Results: Four out of six patients performed the self-tests without any help from the audiologist and four were fitted by FOX without any manual intervention. All patients were comfortable with the concept of self-testing and automated fitting. Patients acknowledged that at this stage the remote supervision of an audiologist remains essential.

Conclusions: The study showed that audiological self-assessment and remote CI fitting with AI under the supervision of an audiologist is feasible, at least in a number of CI recipients. Currently, there are still some technical and regulatory challenges to be addressed before this can become routine practice.     

Acclimatization in first-time hearing aid users using three different fitting protocols

OBJECTIVE: To study auditory acclimatization and outcome in first time hearing aid users fitted with state of the art hearing aids as a function of different hearing aid fitting protocols. METHODS: Twenty-eight adult subjects participated in the study. Each subject was assigned to one of three study groups (named audiologist driven, AD; patient driven, PD; set-to-target, STT according to the fitting protocol used) and fitted with digital hearing aids (Bernafon Symbio). Speech recognition scores were measured in aided and unaided conditions over a 6-month period. RESULTS: Five subjects (three from the PD-group, two from the STT group) decided to withdraw from the study during the 6-month-study period, leaving a total of 23 complete data sets for analysis. Aided speech understanding increased significantly over this time period in all three groups. However, average hearing aid insertion gain changes were small over the same period. There were no statistically significant differences in aided or unaided speech recognition scores between the three groups after 2 weeks or after 6 months. On average, twice as many fine tunings of the hearing aids were requested by the patients in the AD and the STT group than in the PD group and subjects in the AD and STT group used their hearing aids approximately twice as much as subjects in the PD group. CONCLUSIONS: The substantial increase in speech intelligibility without significant changes of the insertion gain of the hearing aids over a 6-month period in all three groups suggests a significant acclimatization effect. Although the speech recognition with hearing aids did not differ significantly among the three study groups after 6 months, the lower average wearing time and the higher number of withdrawals from the study in the PD group suggest that the patients' needs are not adequately met. In terms of aided speech recognition scores and hearing aid wearing time the STT group and the AD group were very similar. However, comments of the patients and the higher rate of withdrawals in the STT group suggest an over-all advantage for the AD fitting protocol.     

128例儿童真耳-耦合腔差值临床分析

目的探索各年龄段听障儿童真耳-耦合腔差值的特点以及耳道容积、声阻抗、耳模的变化等因素对真耳-耦合腔差值的影响。方法选取128例6个月～7岁配戴助听器的听障儿童,采用美国Fonix6500-cx真耳分析仪,用探管测试方法,使用扫频纯音分别测试鼓膜处的声压级和耦合腔中的声压级,两者之间的差即是真耳-耦合腔差值。结果①RECD值随小儿年龄增长而变小,年龄跨度≤3岁无统计学差异(P>0.05);年龄跨度≥4岁有统计学差异(P<0.05);年龄跨度≥5岁有极显著差异(P<0.01)。②外耳道声压级比分析仪中2cc耦合腔声压级高约3～19dB。③RECD值受探管插入深度、位置及耳模声管等因素的影响。结论RECD值是儿童验配助听器中重要的个体化指标,在2cc耦合腔中调试助听器参数时应重视加入个人的RECD值,才能准确获得助听器实际所需要的增益量及限制输出量。     

Comparison of two adaptive procedures for fitting a multi-channel compression hearing aid

We compared two adaptive procedures for fitting a multi-channel compression hearing aid. “Camadapt” uses judgements of the loudness of speech stimuli and the tonal quality of music stimuli. “Eartuner” uses judgements of the loudness and clarity of speech stimuli with differing spectral characteristics. Sixteen new users of hearing aids were fitted unilaterally, using each procedure. The fittings were assigned to Programs 1 and 2 in the aid, in a counter-balanced order. Subjects kept a diary of their experiences with each program in everyday life. Following 2-4 weeks of experience, they filled in the APHAB and other questionnaires and were re-fitted using both procedures. Camadapt generally led to higher low-level gains and lower high-level gains than Eartuner. Gains recommended by the procedures did not change following experience. Eight subjects preferred the Camadapt fitting and eight preferred the Eartuner fitting. Most subjects gave high overall satisfaction ratings for both procedures. Test-retest reliability was better for Eartuner than for Camadapt. Preference for the Camadapt fitting was associated with slightly better speech communication with Camadapt, while preference for the Eartuner fitting was associated with fewer problems with aversion for that procedure.     

Counselling of hearing aid users is highly cost-effective

Hearing aids (HAs) are often left unused. Several investigations have shown that the use of HAs and the skills to use them can be significantly improved through counselling. Follow-up counselling is often restricted by increased cost. The objective of the study was to assess the cost and the effect of follow-up counselling on HA use. In a prospective pre-post design study, 98 first-time HA users were counselled 6 months after the fitting of a HA, and the use of and benefit from HAs were measured by means of an interview and the short form of the hearing handicap inventory for the elderly (HHIE-S) and the EuroQoL (EQ-5D) questionnaires. The results obtained before and 6 months after counselling were compared and the cost of counselling was calculated. After follow-up counselling, over half of the occasional users of a HA and as many as one third of the non-users became regular users. The number of regular users increased by 16 subjects, and non-users decreased from 29 subjects to 17. The HHIE-S results showed a significant positive change, but the EQ-5D results showed practically no change. The additional expense of follow-up counselling at home was approximately 8.8% (€83 per visit) of the calculated €942 cost of fitting a HA. Bringing one unused HA into regular use required €508. The results show that HA use and the consequent benefit can be significantly increased through counselling. The expense caused by follow-up counselling at home is highly acceptable in addition to the cost of fitting a HA.     

听障儿童双耳双模式配戴的声源定位能力初探*

目的探讨双耳双模式配戴能否帮助听障儿童改善声源定位能力以及哪些因素可能影响双耳双模式声源定位优势的发挥。方法采用强迫二选一任务,比较16名听障儿童在不同助听模式及不同声源角度下的声源定位能力。结果声源位于90°/270°时,38%的被试体现出双耳双模式的声源定位优势;位于45°/315°时,优势比例下降到25%。进一步分析表明,人工耳蜗麦克风的位置以及术前双耳配戴助听器的经验与双耳双模式声源定位优势的发挥密切相关。结论声源定位能力是听障儿童日常生活中的难点,即使双耳双模式配戴,也仅在声源位于左右方时,比单侧耳蜗状态体现出一定优势,随着声源角度的减小,双耳强度差和时间差线索减弱,双耳双模式的声源定位优势也随之减小。人工耳蜗的麦克风须放置在正确位置,否则会影响声源定位能力。此外,术前助听器配戴经验可能会影响听障儿童利用双耳线索的能力。     

家长／教师助听器效果评估问卷在听障儿童助听器验配中的应用

目的客观、全面地评估听障儿童助听器验配效果。方法采用家长／教师助听器效果评估问卷来评估听障儿童配戴助听器后的效果,探讨该方法在听障儿童助听器效果评估中的可行性。结果家长、教师对助听器效果的满意度逐渐提高。家长、教师关于“非常满意”评价结果的一致性逐渐提高。结论家长／教师助听器效果评估问卷可应用于听障儿童助听效果评估。     

听障老年人的助听器验配

目的探讨听障老年人助听器验配的方法和技巧。方法对112名受试者进行跟踪随访，客观记录他们使用助听器的感受，分析助听器验配方法和技巧对助听器效果的影响。结果老年人的行为认知和听觉反应能力极大地左右着助听器的配戴效果；气骨导听阈，舒适阈，不适阈、言语识别阈的检查和使用对于老年人助听器验配十分重要；低频部分的听力补偿要低于目标值，高频部分要略高于目标增益值；老年人助听器配戴的适应期平均为3个月；双耳配戴的效果明显优于单耳。结论完全按照助听器验配软件设计的程序给老年人验配助听器很难达到理想的效果，而验配经验、技巧和验配后的适应性训练在其中发挥着巨大的作用。     

Immediate activation after cochlear implantation: Preliminary Study

ObjectiveTo assess the feasibility of immediate activation of cochlear implants.Material and methodsA retrospective study compared speech audiometry results at 6 months post-implantation, implant fitting data and complications, on Student test, between 19 patients receiving day-1 implant activation (immediate activation: IA) and 10 patients with activation at 2 weeks (classical activation: CA).ResultsMean speech comprehension, using Fournier bisyllabic word lists at 60 dB 6 months after implantation, was 61.58% in IA and 71% in CA (P > 0.05). Mean intelligibility thresholds for 50% word-recognition were respectively 39.74 dB and 36.5 dB (P > 0.05). Speech audiometry results at 6 months were not affected by immediate versus classical activation. Comfort-level settings at 1 month in IA were not significantly different (Student test: P > 005) from intraoperative neural response thresholds: i.e., were practically stable. One IA patient required delayed activation at 1 month because of hematoma interfering between the external and internal parts of the implant. There were no other complications. The mean number of fitting sessions during the first year was 6.05 in the IA group and 6.55 in the CA group (P > 0.05).ConclusionGiven certain precautions during follow-up, immediate activation after cochlear implantation was feasible, and did not impair audiometric results.     

“对证选配”助听器

【摘要】助听器配戴者的舒适度和清晰度最大化是助听器验配的两大目标。助听器验配师在为感音神经性聋患者验配助听器时,应进行准确的听力学评估,对证选择助听器,对证调试助听器,科学评估助听器的效果。掌握必要的心理学知识,并具备良好的亲和力、表达能力和沟通能力。