成人语前聋和语后聋人工耳蜗植入效果分析

目的分析成人人工耳蜗植入术后听觉及言语康复效果情况,探讨成人行人工耳蜗植入适应症的选择。方法对中国医科大学附属第一医院耳鼻咽喉科收治的18岁以上行人工耳蜗植入术患者52例进行测试,分为语前聋无干预组(9例)、语前聋佩戴助听器组(27例)、语后聋(16例)三组。采用声场助听听阈测试、电刺激听觉反应阈值(Threshold,THR)、最大舒适阈值(Maximum comfort level,MCL)评价其声音感知能力;采用普通话言语测听材料MSTMs中双音节词表评价其言语分辨能力。分别在开机6个月及24个月进行评估。结果开机6个月后三组声场助听阈值、THR、MCL均值无统计学差异。双音节识别率在开机6个月时语前聋无干预组8.78%、语前聋助听器组16.44%、语后聋组53.13%;在开机24个月时各组双音节识别率均上升,语前聋无干预组达18.22%、语前聋助听器组达52.89%、语后聋组达84.31%,语前聋助听器组提高明显。结论成人语前聋患者术后可获得与语后聋相近的听觉感知水平,长期使用人工耳蜗可加强言语识别能力,对术前有听觉言语基础的成人语前聋患者应积极行人工耳蜗植入术。     

语前聋儿童人工耳蜗植入效果的评估

目的探索语前聋儿童人工耳蜗植入效果的评估方法.方法受试者为18名接受人工耳蜗植入的语前聋儿童,耳蜗植入时平均年龄6岁.按人工耳蜗使用时间长短分为四个阶段进行评估:第一阶段18名患儿,使用人工耳蜗1～12个月;第二阶段12名,使用人工耳蜗13～24个月;第三阶段8名,使用人工耳蜗25～36个月;第四阶段6名,使用人工耳蜗在36个月以上.描述性分析,以问卷的形式了解儿童在人工耳蜗植入后声音接受、言语表达及行为等方面的变化;言语测试,进行言语识别能力和发声能力测试.结果第一阶段患儿,能够感知和辨别来自家庭和环境中的声音;第二阶段患儿,封闭项词识别率是51%,开放项词识别开始启动;第三阶段患儿,封闭项词识别率达到72%,开放项词识别率是40%,能正确发出的单词数是42%;第四阶段患儿,封闭项词识别率和开放项词识别率分别达到84%和53%,能正确发出的单词数达62%,部分患儿已有自发的口语表达.结论人工耳蜗植入对语前聋患儿的言语发育有帮助,患儿的言语能力随着人工耳蜗使用时间的推移不断进步.     

语后聋长期全聋耳的人工耳蜗植入

目的 探讨语后聋长期全聋耳的人工耳蜗植入术后效果.方法 双侧听力下降时间不同步、双侧耳聋程度不一致的语后聋患者4例,对重度聋时间较长(均>10年)、耳聋程度较重侧进行植入人工耳蜗,分别在开机后6个月、12个月,使用心理物理学测试(T/C值),术后声场内最佳助听条件下言语频率平均听阈(pure-tonethreshold average,PTA).安静及噪声环境巾的言语识别率(HINT句表),单音节词识别率(HOPE词表),汉语声调识别(MESP),听觉行为分级标准(CAP),成人生活质量调奁问卷等评价指标,评价其术后听觉言语康复效果.结果 4例受试者在开机半年至一年内均达到了较为理想的康复效果,PTA接近或达到正常水平;安静环境中的言语识别率平均达到90%以上,噪声环境中平均达到70%;植入者可以很好地识别汉语声调;人工耳蜗为植入者带来了较高的社会效益.患者对人工耳蜗的植入效果均表示满意.结论 4例受试者都选择重度聋时间较长侧作为人工耳蜗植入侧,开机后均在较短时间内获得了良好的听觉言语康复效果,充分发挥了人工耳蜗的功能和优势的同时.听力相对较好侧耳还町继续佩戴助听器,保留了患者双耳聆听和日后接收其它治疗的机会,最大限度地为患者创造了最佳聆听条件.     

语后聋成年人工耳蜗植入者术后生活质量的跟踪性评价

目的 研究语后聋成年人工耳蜗植入者术后生活质量随时间变化的发展趋势和影响因素.方法 对28例语后聋成年人工耳蜗植入者(男16例,女12例,年龄39.82±16.38岁)分别在人工耳蜗植入术前、开机后1、3、6、12个月时,采用Nij megen人工耳蜗植入量表(NCIQ中文版,包括基本声音感知、高级声音感知、言语能力、...     

多通道人工耳蜗在语前聋儿童及青少年中的应用

目的　通过对植入人工耳蜗的语前聋儿童和青少年的听力和语言能力的评估 ,探讨我国儿童在使用人工耳蜗后的听力和言语能力发展规律及影响因素。方法　 2 5例行人工耳蜗植入的语前聋儿童及青少年患者参与本组测试。选用《聋儿听觉言语康复评估方法》作为测试材料 ,分别进行声音、言语声和环境声的辨别 ,数词、单字词、双字词、3字词、韵母、声母、声调、封闭项列短句的识别 ,开放项列字词和开放项列短句识别 ,语言清晰度 ,模仿句长 ,听话识图和看图说话等方面测试。结果　受试者术后均能感知到声音 ,辨别不同类别的声音。封闭项列测试结果全部大于机会水平 ,正确识别率随人工耳蜗使用时间而不断增加 ,随植入时年龄的增长而呈下降趋势。术后约半年显现开放项列识别能力 ,使用人工耳蜗后对患儿的言语发育具有较大帮助。结论　尽早对语前聋患儿植入人工耳蜗及进行术后康复 ,以达改善听力 ,提高语言能力 ,促进身心全面发展的目的。     

语后聋成人人工耳蜗植入对于音乐感知的影响的研究

语后聋成人耳聋患者在接受人工耳蜗植入后在音乐感知方面远不如其听力及言语方面的提高令人满意。人工耳蜗植入是目前治疗重度-极重度感音神经性聋的重要手段,其在音乐感知方面的不理想在近年来人工耳蜗的研究中比较深入。本文通过综述近年来国内外相关文献,探讨语后聋成人接受人工耳蜗植入后对音乐感知的现况及分析其可能影响因素,以及可能的方法以助于音乐感知的提高。     

语后聋患者多通道人工耳蜗植入后听觉效果分析

目的:探讨使用心理物理测试及听觉行为分级、言语可懂度分级对语后聋多通道人工耳蜗植入患者听觉言语康复效果进行评估的意义,比较语前聋和语后聋患者术后康复效果.方法:1997-03-2007-06共植入人工耳蜗353例,选择语后聋植入者31例,语前聋植入者59例参加研究.对语后聋和语前聋受试者的纯音听阈、听觉行为分级标准(CAP)和言语可懂度分级标准(SIR)进行评估分析,并比较相同植入电极的语后聋和语前聋患者开机0.5年后的电听觉阈值、最大舒适强度和动态范围有无差异,用统计学方法加以分析.结果:所有受试者声场测试语言频率平均听阈(啭音)为25～45 dB(nHL).植入同种电极(澳大利亚直电极、澳大利亚弯电极、奥地利Medel C40+)的语前聋和语后聋患者之间听觉阈值最大舒适强度和动态范围差异无统计学意义(P>0.05).语后聋患者的CAP和SIR得分高于语前聋患者.结论:CAP和SIR是一种对人工耳蜗植入者日常生活中听说能力的方便有效的评估方法.植入相同电极的语前聋和语后聋患者之间的纯音听阈、电听觉阈值、最大舒适强度、动态范围无明显差异,但语后聋患者听觉水平和言语可懂度效果好与语前聋患者.     

人工耳蜗技术报告(Ⅵ):儿童植入的成效

人工耳蜗对于极重度语后聋成人最主要的作用是改善言语感知和口语单词的识别.相反,先天性或语前聋儿童的人工耳蜗植入可对交流的各个层面都带来深刻影响,用于儿童的评价体系也应能反映这些变化.因而,临床研究人员必须有足够多的、适用于儿童年龄的评价成效的方案,以面向交流发展的不同侧面[1].下面总结了人工耳蜗的使用对儿童发展言语感知、言语产出和语言技巧的效应.     

人工耳蜗技术报告(Ⅴ):成人植入的成效

1语后聋成人成人接受人工耳蜗植入的主体是语后聋患者。也就是说,他们的听力损失是在获得了言语和语言之后才出现或变为极重度聋的。由于接收到的听觉输入极为有限,这些成人在理解其他人的言语时都有很大的困难,但对他们言语技能的产生几乎没有损害。一旦接受了人工耳蜗植入,语     

多通道人工耳蜗在语前聋儿童及青少年中的应用

目的 通过对植入人工耳蜗的语前聋儿童和青少年的听力和语言能力的评估,探讨我国儿童在使用人工耳蜗后的听力和言语能力发展规律及影响因素。方法 ２５例行人工耳蜗植入的语前聋儿童及青少年患者参与本组测试。选用《聋儿听觉言语康复评估方法》作为测试材料,分别进行声音,言语声和环境声的辨别,数词,单字词,双字词,３字词,韵母,声母,声调,封闭项列短句的识别,开放项列字词和开放项列短句识别,语言清晰度,模仿句长,     

Speech perception in congenitally,pre‐lingually and post‐lingually deaf children expressed in an equivalent hearing loss value

Objectives: To investigate the speech perception performance of children with a cochlear implant (CI) after 3 and 4 years of follow‐up and to study the influence of age at implantation, duration of deafness and communication mode on the variability in speech perception performance. Study design: A broad battery of speech perception tests was administered to 67 children with a CI. The results were reduced into one measure: the ‘equivalent hearing loss (EHL)’. This outcome measure refers to the performance of a reference group of severely and profoundly hearing impaired children with conventional hearing aids. Participants: The population comprised 35 congenitally, 17 pre‐lingually and 15 post‐lingually deaf children implanted between 1989 and 1999. The population was homogeneous with respect to cognition, residual hearing and support at home as a result of conservative inclusion criteria. Results: During the first 2 years after implantation, post‐lingually deaf children showed the fastest rate of improvement in speech perception. After 3 years of implant use, the early implanted pre‐lingually deaf children and congenitally deaf children implanted under the age of 6 years caught up with the post‐lingually deaf children. Pre‐lingually deaf children implanted after a relatively long‐duration of deafness tended to show poorer performance than those with a shorter duration. Performance of congenitally deaf children implanted after the age of 6 years was poorer and progress was slower. In the congenitally deaf children, 36% of the variability in performance was explained by duration of deafness, whereas in the children with pre‐ and post‐lingually acquired deafness, communication mode explained 69% of the variance. Conclusions: All children derived benefit from their CI for speech perception tasks, but performance varied greatly. Several children reached EHL levels around 70 dB; their speech perception was equal to that of a child with conventional hearing aids who has 70 dB HL. After early implantation, the levels of performance that were eventually achieved differed no more than 10 dB, irrespective of whether the onset of deafness was pre‐lingual or postlingual. In congenitally deaf children, duration of deafness played a major role in speech perception performance, whereas in the children with pre‐lingually and post‐lingually acquired deafness together, mode of communication was a major factor.     

Familiar melody recognition by children and adults using cochlear implants and normal hearing children

This study investigated the effects of age at time of testing, hearing history (age at hearing loss) and hearing status on melody recognition. Four groups were compared: children with normal hearing thresholds, and three groups of cochlear implant recipients (children with prelingual deafness, children with postlingual deafness, adults with postlingual deafness). Participants were tested for recognition of familiar melodies (no lyrics) in a closed-set task. Groups differed in accuracy in the following rank order (most to least accurate): children with normal hearing thresholds, adult cochlear implant recipients, children with postlingual deafness, children with prelingual deafness. Melody recognition scores were correlated with age, variables regarding hearing history, musical background/experience and speech perception scores.     

The cochlear implant programme in Crete: a nine year experience

The aim of this study was to present data of the cochlear implant programme in Crete. Our series consists of 51 patients, 35 adults and 16 children, in a nine year period. The average age of our patients was 31 years (range from three to 68). The average duration of deafness among our patients was seven years (range from two to 22). Our series included 32 postlingual patients and 19 prelingual patients. The cause of deafness in our series was unknown in approximately 40 per cent of cases. Standard selection criteria and operative techniques were used for all cases. Postoperative programming and rehabilitation were performed according to the individual needs of each patient. Implantation was successful in all patients except one who had to undergo a second operation with good results. No major postoperative complications were noted, while minor complications included temporary facial weakness and undesired stimulation of the facial nerve during implant function in two and three patients, respectively. All patients showed significant improvement in perception and discrimination of sound and speech. Better results have been noted in prelingual patients under the age of six, as well as in postlingual adults with a recent history of deafness. As cochlear implant technology evolves and surgical techniques continue to improve, our department will continue its efforts to provide effective hearing rehabilitation of deaf children and adults in Crete.     

The cochlear implant programme in Crete: A nine year experience

Abstract

The aim of this study was to present data of the cochlear implant programme in Crete. Our series consists of 51 patients, 35 adults and 16 children, in a nine year period. The average age of our patients was 31 years (range from three to 68). The average duration of deafness among our patients was seven years (range from two to 22). Our series included 32 postlingual patients and 19 prelingual patients. The cause of deafness in our series was unknown in approximately 40 per cent of cases. Standard selection criteria and operative techniques were used for all cases. Postoperative programming and rehabilitation were performed according to the individual needs of each patient. Implantation was successful in all patients except one who had to undergo a second operation with good results. No major postoperative complications were noted, while minor complications included temporary facial weakness and undesired stimulation of the facial nerve during implant function in two and three patients, respectively. All patients showed significant improvement in perception and discrimination of sound and speech. Better results have been noted in prelingual patients under the age of six, as well as in postlingual adults with a recent history of deafness. As cochlear implant technology evolves and surgical techniques continue to improve, our department will continue its efforts to provide effective hearing rehabilitation of deaf children and adults in Crete. Copyright © 2008 John Wiley & Sons, Ltd.     

Effects of insertion depth of cochlear implant electrodes upon speech perception

OBJECTIVE: To investigate whether the insertion depth of a cochlear implant array affects postoperative speech perception. DESIGN: The subjects were 48 postlingually deaf adults who received either the Nucleus 22 or the Nucleus 24 cochlear implant with a straight array. A postoperative radiograph of the cochlear electrode was used to estimate insertion depth, as either the angle of the electrode tip (angle) or the intracochlear length of the electrode (length). Other estimates of insertion depth included the numbers of active electrodes and channels used by the speech processor. Electrode depth, together with the duration of deafness, hearing aid usage, pre-operative speech perception score and pre-operative pure-tone averages were independent variables in a forward stepwise multiple regression analysis, where the dependent variables were postoperative CNC words and CNC phonemes. RESULTS: Duration of deafness and insertion depth (angle, insertion length or active electrodes) were the predictive variables for CNC words or CNC phonemes. Angle was the best 'depth-related' predictor of postoperative speech perception. An even clearer relationship was found between CUNY sentences in noise and angle, in a subset of 26 patients. CONCLUSION: Depth of electrode insertion affects postoperative speech perception.     

Phrasing in the speech and reading of the hearing impaired

The study reported here explored a partial explanation for the fourth-grade "bottleneck" in literacy advancement by hearing-impaired students. Speech samples from 21 deaf subjects were rated for degree of evident phrasal quality. Likewise, reading comprehension scores for each student were obtained under four reading conditions: reading in whole sentences, in phrases, in fragmented word groups, and in single words. Degree of rated speech phrasality was found to relate significantly and positively to correct recall answers to questions based upon silent reading of passages typed in meaningful word groups (but not when the passages were typed in whole sentences, fragmented word groups, or in single words). The results were taken to suggest that--whereas staccato-speaking deaf students may lack a sense of the phrase altogether--phrasal-speaking deaf youngsters fail to independently apply their phrase sense in the normal reading situation. Thus, both types of deaf youngsters have difficulty affecting the transition to phrase reading that is common for hearing students at or about the fourth-grade level. Finally, I argue that this phrase sense can be instilled in hearing-impaired students and that they can be trained to use it in reading.     

Speech perception in adolescents with pre-lingual hearing impairment with cochlear implants

Profound hearing loss is a disability that affects personality and when it involves teenagers before language acquisition, these bio-psychosocial conflicts can be exacerbated, requiring careful evaluation and choice of them for cochlear implant.AimTo evaluate speech perception by adolescents with profound hearing loss, users of cochlear Implants.Study DesignProspective.Materials and MethodsTwenty-five individuals with severe or profound pre-lingual hearing loss who underwent cochlear implantation during adolescence, between 10 to 17 years and 11 months, who went through speech perception tests before the implant and 2 years after device activation. For comparison and analysis we used the results from tests of four choice, recognition of vowels and recognition of sentences in a closed setting and the open environment.ResultsThe average percentage of correct answers in the four choice test before the implant was 46.9% and after 24 months of device use, this value went up to 86.1% in the vowels recognition test, the average difference was 45.13% to 83.13% and the sentences recognition test together in closed and open settings was 19.3% to 60.6% and 1.08% to 20.47% respectively.ConclusionAll patients, although with mixed results, achieved statistical improvement in all speech tests that were employed.     

Environmental sound perception in adult patients with cochlear implants: a comparison with central auditory disorders

The aim of this study is to investigate the perception mechanism of environmental sounds in postlingual patients with cochlear implants compared with that in patients with central auditory disorders. Seventeen postlingual patients with cochlear implants were studied; six patients with auditory nerve disease (auditory neuropathy) and ten patients with cortical deafness were selected for the comparison. A taperecorded environmental sound perception test of 24 environmental sounds was carried out. This test is divided into two categories: the category of voice includes human voice, animal and bird sounds, and the category of non-voice includes musical instrument sound, natural sound and artificial sound. The percentage of correct perception of environmental sounds in postlingually deaf patients with cochlear implants was markedly higher than that in patients with cortical deafness, but was similar to that in patients with auditory nerve disease (auditory neuropathy).     

Bimodal benefits of cochlear implant and hearing aid (on the non-implanted ear): a pilot study to develop a protocol and a test battery

ABSTRACT This is a pilot study that aims (1) to help design a protocol for fitting and optimizing cochlear implants and hearing aids, (2) to help design a test battery that can help monitor children's progress and (3) to assess the benefit of using a cochlear implant with a contralateral hearing aid. Seven children between the ages of seven and 15 years completed the study. None of them had worn a contralateral hearing aid (HA) since cochlear implantation (five to seven years after implantation). The Listening Inventory for Education (LIFE), Life Situation Questionnaire (LSQ), and Client Orientated Scale of Improvement for Children (COSI-C) questionnaires together with subject's feedback were used as subjective measures, and speech perception tests - the City of New York (sentences list) (CUNY) and Bamford-Kowal-Bench (sentences list) (BKB) depending on child's speech perception skills - in quiet and in noise were used as objective measures. The results showed mixed subjective feedback, even though objectively all children improved their speech perception scores when wearing cochlear implants and hearing aids. The COSI-C proved to be the most successful tool to collect feedback from parents.