感音神经性听力损失患者助听后言语感知能力的评价

目的本研究对感音神经性听力损失患者助听器选配后的言语识别能力进行评价,并分析听力损失程度与年龄对助听后言语康复效果的影响。方法 30名感音神经性听力损失受试者,男13名,女17名,年龄26-86岁,双侧听力损失程度对称,双耳0.5-4 k Hz频率下纯音听力阈值(PTA0.5-4 k Hz)平均值40~75 d B HL。所有受试者均选配PhonakBolero Q50系列耳背式助听器。使用汉语普通话言语测试软件(Mandarin Speech Test Materials,MSTMs)进行裸耳和助听后安静与噪声环境下言语识别能力测试。结果(1)助听后,安静环境下的双音节识别率平均提高35.1±19.5%;噪声环境下语句识别率平均提高32.8±22.8%;(2)助听后言语识别能力与听力损失程度呈显著负相关关系;(3)助听优势高于平均水平的受试者纯音听阈均大于50 d B HL,但存在个体差异大的特点。结论助听器选配可以有效帮助感音神经性听力损失患者提高言语识别能力,但听力损失程度不是唯一影响助听效果的因素,助听后言语识别能力的改善存在较大个体差异。     

浅谈声场校准在临床中的应用

2006年第二次全国残疾人抽样调查结果显示,我国有听力残疾2 004万,每年新生聋儿3万余名,为了对这部分聋儿进行早期干预,科学地验配助听器及调试人工耳蜗非常重要,需要具备专业的听力师、听力测试及助听器和人工耳蜗调试设备。临床上由于不易较为准确的得到婴幼儿行为测听结果,听力师需要进行一系列的观察及主观测试以得到小儿的听力情况及配戴助听器或植入人工耳蜗后的效果,常用的方法就是声场测听,因此声场校准作为声场测听中的重要环节,临床上应引起足够的重视。     

助听器的声场验配法

在声场测听条件下，对17名儿童（33耳）进行助听前和助听后的声场听阈测试。以助听后听阈值能否进入言语香蕉图范围来评价助听效果，为使助听效果满意，在测试时可调节助听器的各种调节使扭；测试结果显示，该法不失为助听器验配的有效方法之一。本文亦对影响本方法的一些因素做了讨论。     

行为测听和ABR在聋儿验配助听器中的效果比较

目的 探讨行为测听在准确评估聋儿听力及验配助听器中的作用。方法 对41例1.2～12岁聋儿分别进行行为测听或听性脑干诱发电位(ABR)测试,获得聋儿的听阈。助听器选配用DSL 验配方法,以真耳测试及声场测试判断助听效果,进行随访并定期调试助听器。结果 ABR测试组仅有4例助听听阈进入LATSS(长期平均言语会话谱),而行为测听组有19例助听听阈进入LTASS。结论 行为测试结果验配助听器的效果明显优于ABR,有显著性差异(P<0.05)。     

组合听力测试在聋儿早期验配助听器中的作用

目的：探讨短声听觉脑干反应（ABR）和行为测听2种测试组合在聋儿早期验配助听器中的作用。方法：对52例1～9岁聋儿进行行为测听或ABR测试,找到较准确的听阈值。采用理想感觉级配方法选配助听器,以真耳测试及声场测试判断助听效果,进行随访并定期调试助听器。结果：单纯ABR测试有反应耳与组合听力测试有反应耳比较,差异有统计学意义（P〈0．05）。助听效果明显改善41例,无效4例,失访7例。结论：聋儿听力评估应主、客观测听联合使用,助听器验配应遵循“三早”原则,即早期发现,早期诊断,早期进行听力康复。     

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。     

助听器干预对西藏高原地区听障患者的疗效分析

目的 探讨助听器干预对久居(超过40年)西藏高原地区听障患者的疗效情况。方法 选取49例(63耳)助听器佩戴者进行分析，包括听力情况、听阈、助听器后言语及助听器效果国际问卷主观感受相关分析等，并对助听器补偿效果进行了综合评价。结果 63耳中，中度听力损失34耳，重度听力损失25耳，极重度听力损失4耳。其中单耳35例，问卷平均得分(20.34±4.39)分；双耳14例，问卷平均得分(27.07±4.16)分；双耳得分高于单耳分数。助听言语分辨率与问卷主观评估呈正相关(r=0.528,P<0.01)。助听阈值显示大多数患耳未得到最佳的听力补偿，但助听器干预前后听力比较具有统计学意义(P<0.05),高频听力补偿更为明显。助听后言语测听显示，助听后言语最大分辨率较助听前高(P<0.05)。结论 高原地区听障者对助听器的使用客观听力参数与主观评价相对一致，助听效果较为显著而且双耳验配较单耳验配更具优势，总体助听效果持肯定态度。     

听力损失老年人佩戴助听器前后皮层听觉诱发电位与言语感知的研究

目的 探讨皮层听觉诱发电位(cortical auditory evoked potential,CAEP)用于中度与重度听力损失老年人助听前后言语识别能力评估的可靠性和有效性.方法 26例中度与重度听力损失老年人均验配同一型号测试用助听器,于佩戴助听器前后在声场中分别测试/m/、/g/、/t/三个刺激声在65 dB ...     

小儿助听器选配中的真耳测试

为弱听孩子选配合适的助听器对其日后言语康复的效果具有十分重要的意义。新生儿听力筛查工作的有效开展为早期佩戴助听器创造了条件，除了必要的小儿行为测听，科学选配手段的设计和验证也越来越受重视。资料显示，在给儿童测听和选配助听器的过程中，言语辨别率的测试和音质的判断在儿童身上很难实现，因此，传统的助听器评估使用功能增益法或者助听声场听阈法往往得不到准确的结果，     

听性稳态反应(5)

3.4.2 助听器验配及助听效果评估 婴幼儿和智力障碍者常因不能配合行为测听而难以得到行为听阈(裸耳和助听)和言语识别功能的资料,ABR及40 Hz AERP虽然能检测受试者生理反应阈值,但所采用的声音为瞬态刺激声,经助听器和人工耳蜗处理后产生畸变,而且不能用于自由声场测听,难以评估助听效果.近年国外许多研究者将ASSR应用于婴幼儿助听器验配及助听效果的评估.     

Assessment of the psychological stress experienced before and after the use of a hearing aid in elderly patients

Hearing aids are useful instruments for elderly patients with impaired hearing. However, the psychological effects of wearing a hearing aid have remained unclear until recently. A study was therefore performed at the Tokyo Metropolitan Geriatric Hospital to determine such effects. Eighteen out of 50 questions included in the "Psychological Stress Response Scale (PSRS)" were selected and used to produce a questionnaire. The questionnaire was then given to and completed by 31 elderly patients who received and willingly used hearing aids. Of these patients, 20 were female and 11 were male. Their average age was 80.4 years (+/- 5.3 years ranging from 66-89 years). The questionnaire was completed by each patient on two separate occasions: before the hearing aids were fitted and after. In addition to the PSRS questionnaires, a second "hearing satisfaction" questionnaire was also completed, both before and after the hearing aids were fitted. The scores for depression, anxiety and anger were significantly lower after the hearing aid had been fitted. The score for depression showed a particularly distinctive decrease. The statistics also showed that the use of a hearing aid produced a significant improvement in the level of satisfaction patient's felt regarding their hearing. We conclude that the use of hearing aids by elderly patients not only alleviates their dissatisfaction with being unable to hear, but has additional psychological advantages. These results suggest that the use of a hearing aid not only improves hearing but may also delay or offset the development of dementia. Accordingly, suitable hearing aids should be provided to elderly patients so that they may recover their hearing and benefit from the associated psychological advantages.     

Pilot study on the effectiveness of the conventional CROS, the transcranial CROS and the BAHA transcranial CROS in adults with unilateral inner ear deafness

The objective of the present pilot study is to evaluate the effectiveness of three conventional contralateral routing of sound (CROS) hearing aids in adults with unilateral inner ear deafness. The study included tertiary referral center. Ten patients with unilateral inner ear deafness and normal hearing in the contralateral ear were selected to evaluate three different methods of amplification: the CROS hearing aid, the completely in the canal hearing aid and the bone-anchored hearing aid CROS (BAHA). Each of the three hearing aids was tried in a random order for a period of 8 weeks. Audiometric performance, including speech-in-noise, directional hearing and subjective benefit were measured after each trial period, using the APHAB, SSQ and single-sided deafness questionnaire. Sound localization performance was essentially at chance level in all four conditions. Mixed results were seen on the other patient outcome measures that alternated in favor of one of the three CROS devices. After the trial, three patients chose to be fitted with the BAHA CROS and one with the conventional CROS. In conclusion, most of the patients experienced some degree of benefit with each of the three hearing aids. Preference for one of the three hearing aids was independent of the order in which they were tried. It would be worthwhile to formulate selection criteria; still, we recommend that all patients with unilateral inner ear deafness should be offered a trial with at least the BAHA CROS.     

Factors influencing binaural hearing aid use

Two hundred patients who had been fitted with binaural hearing aids were chosen as subjects for a questionnaire survey to determine the factors which would influence the use of binaural hearing aids. From the analysis of the 16 factors used which included audiological, physical and social factors, the following results were obtained: (1) A significantly greater proportion of male patients used binaural hearing aids than female patients. (2) A significantly greater proportion of patients with a different hearing loss configuration in the two ears used binaural hearing aids as compared with those with a symmetrical hearing loss. (3) Frequent users of binaural hearing aids were males, who had had additional help to reduce their hearing disability, and had a more severe hearing loss in the better ear. The use of binaural hearing aids in noisy situations and in localising sounds was also investigated.     

Degree of satisfaction of patients fitted with hearing aids at a high complexity service

Some individuals with hearing loss choose to be fitted with hearing aids. Compliance is significantly affected by how satisfied patients are with their hearing aids. Patient satisfaction can be assessed through questionnaires and scales.ObjectiveTo assess the degree of satisfaction of patients fitted with hearing aids.MethodScale “Satisfaction With Amplification in Daily Life” (SADL) was applied to 180 patients fitted with hearing aids; results were categorized based on the mean values observed for global satisfaction scores and scores attained on each subscale. Patients were interviewed for additional information.ResultsMean global score was 5.6; 48.9% of the subjects were very satisfied, 47.2% were satisfied, and 3.9% were dissatisfied. The mean score on subscale Positive Effects was 5.6; the mean score for Service and Cost was 6.2; for Negative Factors the mean score was 4.9; and the mean score on subscale Personal Image was 5.8. Of the patients fitted with in-the-ear hearing aids, 83.3% were very satisfied. Fifteen percent of the individuals were dissatisfied with their Personal Image. Sensorineural and profound hearing loss patients were less satisfied, with 5.4% and 50.0% of the subjects revealing dissatisfaction with their hearing aids.ConclusionPatients were generally very satisfied with their hearing aids. Satisfaction rates were higher among patients fitted with in-the-ear hearing aids. Dissatisfaction was higher in subscale Personal Image. Lesser degrees of satisfaction were seen in patients with sensorineural and profound hearing loss.     

Reported benefits and shortcomings of cochlear implantation by patients and their significant others

Ninety four consecutive adults who had been fitted with cochlear implants for at least six months were sent open-ended questionnaires asking them to list the benefits and shortcomings they experienced as a result of their implants. Partners of the patients were asked to complete similar questionnaires. A wide range of benefits was reported, predominantly acoustical and psychosocial. Most of the shortcomings were acoustical and practical. Significant others reported fewer benefits and fewer shortcomings than the patients. However, the overall pattern of responses was similar. More acoustical and psychosocial benefits were reported by those fitted with cochlear implants than by those with hearing aids or bone-anchored hearing aids.     

A comparison of behind-the-ear high-fidelity linear hearing aids and two-channel compression aids, in the laboratory and in everyday life

Eight patients suffering from sensorineural hearing losses with recruitment took part in a trial comparing their own hearing aids (or no aid if they did not normally wear one) with 'high-fidelity' linear aids and with aids incorporating two-channel syllabic compression. All aids were worn behind the ear. Speech intelligibility was measured both in quiet and in noise, and the patients were given questionnaires enquiring about the effectiveness of the aids in everyday situations. Both the intelligibility tests and the questionnaires indicated that the linear aids were substantially better than own/no aid, and the compressor aids were substantially better than the linear aids, allowing good speech discrimination over a wide range of sound levels. Six out of the eight patients derived significant benefit from being fitted with two aids rather than one. The use of directional microphones in the linear and compressor aids allowed a significant improvement for speech intelligibility in noise when the speech and noise were spatially separated.     

配戴助听器儿童单元音基频和共振峰的测量及分析

目的：观察配戴助听器儿童和健听儿童单元音基频和共振峰的差异。方法分别选取20位3～8岁配戴助听器儿童及健听儿童形成实验组与对照组,用语音工作站VS 3.0分析软件对其/a、o、e、i、u、u/6个元音3秒稳定段进行声学分析,提取基频和共振峰,并进行对比分析。结果实验组的基频和F1共振峰与对照组相比,基频和元音/a、o/的共振峰无显著差异,P〉0.05;元音/e、u/和/u/的共振峰均有显著差异,P〈0.05。结论配戴助听器儿童的基频和单元音共振峰与健听儿童不同。     

Experience with a subcutaneous implantable bone conduction hearing aid (Xomed Audiant) in a district general hospital.

Patients with a conductive hearing loss may find conventional hearing aids unsatisfactory for a variety of reasons. Efforts to overcome some of these difficulties have led to the development of the osteointegrated hearing aid. Implantable bone conduction hearing aids are an important advance in the treatment of well selected patients. Only 18 patients, who have been implanted with the Xomed Audiant bone conduction hearing aid, have so far been reported on in the UK. This report concerns a further six patients who have been implanted in one centre. Five of these patients continue to use their Audiant hearing aid 14 to 24 months after being fitted. They regard it to have significant advantages over their previous hearing aids. Four of the five patients use an ear level processor. Two of the patients who had previously used conventional bone conduction hearing aids now use the ear level processor.     

Hearing aids and tinnitus--an experimental group study

From a waiting list consisting of hearing-impaired patients waiting for hearing aids to be fitted, 39 subjects who at interview also stated that they had tinnitus took part in an experimental group study with the aim of investigating the effect of a hearing aid on tinnitus. No subject had any previous experience of hearing aids. The subjects were randomly allocated to a treatment and a waiting list control group. After an initial interview, the routine programme for the fitting of hearing aids started in the treatment group, while the waiting list control group had to wait for 6 weeks before starting the same hearing aid rehabilitation programme. The hearing aids were fitted exclusively for hearing purposes. As expected, the hearing aids improved the hearing capacity, but they did not reduce tinnitus as recorded on a visual analogue scale. According to information obtained at the final interview, there were significant differences in tinnitus between subjects who used their aid for more than 2 hours daily and those who used it for less than 2 hours. However, the results of scaling (pre- and post-fitting) did not support this finding. The discrepancy between the scaling and interview data is probably due to demand characteristics.