老年感音神经性听力障碍患者助听器验配效果分析

在我国,感音神经性听力障碍患者对助听器的认知度和接受度较低,已验配助听器的患者助听器常戴率不高,助听器使用者对助听器综合效果的满意率也不高。老年感音神经性听力障碍患者助听器效果差异化非常明显。本文重点讨论如何依据听力障碍的类型、听力曲线特征以及临床表现,为不同类型的老年感音神经性听力障碍患者进行个性化的助听器验配,力求使助听器效果最大化。     

周岁内聋儿的助听器验配

目的：探讨耳聋婴儿助听器验配的方法。方法：3个月以内的小儿，可通过观察在适宜声刺激下，听性反射动作的出现与否来判断助听器验配的效果；3个月以上的小儿，主要通过观察患儿的声定位反应来确定助听器验配的适合度。结果：凡在周岁以内验配了助听器的小儿，其言语康复的效果均优于同龄的周岁以后验配助听器的小儿，其中已进入正常幼儿园和小学的小儿，言语交流几乎没有障碍。结论：本文提出的助听器验配方法适合于周岁内听力障碍的聋儿。     

中老年听力障碍者助听器验配特点

目的通过123例50岁以上听力障碍患者的纯音听阈测试及助听器验配情况,了解其听力特点及助听器选配的特点。方法感音神经性聋患者123例,以每10岁为一年龄组,统计他们125～8000Hz的纯音听阈,根据听力情况验配西门子数字式助听器,记录最终验配情况并了解未验配的原因。结果各年龄段就诊的中老年聋者总体听力水平大致相仿,均为中重度感音神经性聋,纯音听阈测试表现为下降型听阈曲线。就诊者以70～岁年龄段者最多,最终接受助听器者以70岁以下年龄段者为多。70岁以上者多因戴上助听器后效果不理想或经济原因拒绝验配,70岁以下拒绝验配者则主要担心社会影响。结论中老年感音神经性聋患者的纯音听阈曲线主要为下降型,早诊查、早干预有助于提高生活质量。     

老年听力障碍患者的听觉行为与助听器验配的干预和康复

我国已经开始步入老龄社会，这将会带来很多相应的社会问题，其中，老年性听力损失引起的听觉和交流障碍问题将严重影响老年人的生活质量，应该积极地给予干预和康复。助听器验配是对老年听力障碍患者听力干预和康复的最有效的手段，也是改善老年听力障碍患者听觉交流障碍的主要途径。因此，老年听力障碍患者助听器的验配就成为临床老年听力干预和康复关注的热点问题。本文从心理和听觉行为的角度阐述老年听力障碍患者助听器验配的干预和康复内容。     

2635例助听器验配情况分析

目的:调查具备助听器适应证的患者未成功验配助听器的原因。方法:回顾性分析2005-2010年2 635例患者验配助听器的资料,对其中助听器验配未验成功者的数据进行分析。结果:2 635例患者中,1 700例成功验配了助听器,验配总成功率为64.52%,验配成功率总体变化趋势为逐年上升。对935例助听器验配失败患者的数据分析结果表明,在影响助听器成功验配的众多因素中,经济因素所占比例最大(23.64%),其次是患者不接受助听器(18.61%),对专业机构的认可度及满意度(10.27%),此外患者对助听器效果不满意占8.13%。听力专科门诊的验配成功率要高于普通耳鼻咽喉科门诊(P<0.05)。935例助听器验配失败的患者中年龄≥50岁者有568例;<50岁者助听器验配成功率(61.29%)低于≥50岁者(66.33%),差异有统计学意义(P<0.05)。结论:针对经济因素、患者对助听器的接受程度、验配机构专业性等诸多影响助听器成功验配的重要因素,在日常工作中,助听器验配人员需要针对性地开展工作,包括加大听力康复知识的宣传力度和提高自身的专业素质和水平。只有这样,才能有效增进患者对助听器验配人员和助听器本身的信任,有效提高助听器验配成功率。     

自主验配与常规验配助听器的短期效果对比研究

目的 比较成年听力减退患者常规验配与自主验配助听器后的短期效果差别，探讨非处方自主验配助听器在我国中老年弱听人群中的应用前景。方法 招募20例中度至中重度感音神经性听力减退的55～75岁中老年人，随机分为甲乙两组，每组10例，参与两款助听器验配效果的前瞻性二阶段随机对照研究；一款为由听力师优化调配的常规助听器，另一款为由使用者操控的自主验配助听器。在实验不同阶段交替佩戴常规助听器与自主验配助听器各4周。入组时及第一、二阶段结束时均采用纯音听阈、安静条件下的语句识别率等指标及助听器收益缩略简表(abbreviated profile of hearing aid benefit, APHAB)、筛查版老年听力障碍量表(hearing handicap inventory for the elderly-screening version, HHIE-S)等主观指标，比较在未助听、常规验配、自主验配助听三种状态下的结果，评价两类助听器的配戴效果。结果 最终14例患者完成试验。在常规验配与自主验配两类助听器后，受试者的纯音听阈(37.9±12.8、42.6±6.3 dB HL)相较未助听时(...     

现代助听器验配、评估中的真耳测试

真耳测试是通过一套系统测量鼓膜处实际声压级的方法,客观地测量助听器佩戴者鼓膜处的增益是否符合目标值,用于评估助听器的验配效果。近年来,真耳测试日益受到关注,听力学研究者们普遍认为其有助于提高助听器验配者的满意度,倡导使用真耳测试方法评估助听器效果,并指出真耳测试应作为助听器验配的必须步骤[1],可见真耳测试对现代助听器选配的重要性。然而,目前国内的助听器验配服务中心仍以主观选配方法为主,鲜有使用     

小儿助听器验配指导

为能建立一套科学、规范又适合我国国情的助听器验配指南 ,现将几位在助听器验配工作中积累了丰富经验的专家拟定的助听器验配方案刊登如下 ,供大家参考。适当的时候《听力学及言语疾病杂志》编辑委员会助听器验配专业学组将组织有关专家进行讨论 ,综合各方意见 ,完善助听器验配方案     

助听器验配方案

为能建立一套科学、规范又适合我国国情的助听器验配指南,现将几位在助听器验配工作中积累了丰富经验的专家拟定的助听器验配方案刊登如下,供大家参考.适当的时候《听力学及言语疾病杂志》编辑委员会助听器验配专业学组将组织有关专家进行讨论,综合各方意见,完善助听器验配方案.     

探管麦克风测试技术对儿童助听器个性化精准验配的效果评估

目的助听器选配是听力障碍人群改善听觉的重要有效途径,由于儿童处于听觉言语发育的重要阶段,因此儿童助听器精准选配至关重要。本文将采用探管麦克风测试技术(Probe Microphone Measurement, PMM),对儿童进行助听器个性化精准验配,分析个性化精准验配对儿童助听下听敏度及言语识别能力的影响作用。方法共12名配戴助听器儿童参与本次研究,平均月龄72.83±3.96。分别采用助听器软件推荐的验配公式和PMM技术完成助听器常规验配和个性化验配,在两种验配模式下对受试儿童进行声场下助听听阈测试和言语识别率测试。采用配对样本t检验对测试数据进行分析,对比两种验配方法结果间差异,取0.05为显著性水平。结果(1)采用PMM技术进行个性化验配,其助听听阈与NAL公式目标值差异均小于常规验配。在两种不同验配模式下,受试儿童助听听阈与NAL目标值差值在0.25 k、0.5 k和2 kHz处具有统计学差异;(2)经统计学分析,在两种验配模式下,儿童安静/噪声下言语别率均具有显著性差异,在采用PMM技术进行个性化精准验配模式下,儿童言语识别率表现出提高迹象。结论(1)PMM技术可优化儿童助听器个性化精准验配流程,有效提高儿童助听后言语识别能力,改善助听效果及使用成效。(2)采用NAL公式助听听阈目标值计算方法来评估助听器聆听效果,并非适用于所有儿童,婴幼儿及低龄儿童助听器效果评估也应结合PMM技术、言语识别率及听觉言语评估量表。     

“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。     

The relationship between the acoustic reflex threshold and levels of loudness categories in hearing-impaired listeners

When applied as a tool for hearing aid fitting, categorical loudness scaling (CLS) is time consuming and not feasible in all subjects. It is therefore desirable to use objective measures for accurate prediction of loudness categories among hearing-impaired individuals. The present study aimed at exploring whether loudness perception at the ART is constant with varying hearing threshold. Seventy-five subjects with various degrees of hearing impairment, measurable acoustic reflex and normal middle ear function participated. The HTLs, ARTs and the levels of six loudness categories at frequencies 0.5, 1, 2 and 4 kHz were determined for all subjects. Loudness at the ART was found to be correlated with the amount of hearing loss. On the basis of these results, it is concluded that the ART cannot be used for accurate estimation of loudness in hearing-impaired subjects.     

改良Contour试验测试正常听力与感音神经性听力损失儿童响度增长

目的 应用改良Contour试验测试听力正常与感音神经性听力损失儿童的响度增长,探讨改良Contour试验的临床应用价值.方法 对26例(26耳)听力正常儿童、25例(25耳)感音神经性听力损失儿童采用临床对照试验用改良Contour试验进行响度测试.在初测2～3周后进行复测.采用多因素方差分析进行统计学分析.结果 在听力正常组、不同程度听力损失组间(F=1386.32,P值＜0.001)及不同响度分级间(F=682.21,P＜0.001)响度的差异均有统计学意义.听力正常组与听力损失组动态范围间差异有统计学意义(F=214.26,P＜0.001).感音神经性听力损失儿童响度增长特征:听力损失越重,响度增长越快,动态范围越小.听力正常组与听力损失组初复测结果高度相关(r值分别为0.97和0.91),可信度较高.结论 儿童助听器验配应尽可能获取个体的响度测试结果以帮助助听器调试到最适合该患儿使用.改良Contour试验易为儿童接受、可靠性好,值得进一步研究用于临床,以帮助提高助听器验配质量.     

Loudness perception is influenced by long-term hearing aid use.

The aim of this study was to explore possible differences in the perception of loudness between long-term hearing aid full-time users and non-users. Categorical loudness scaling using pure-tone stimuli was carried out by hearing-impaired subjects. The mean levels of loudness categories at one frequency (hearing threshold: 50-75 dB HL) in a group of 18 hearing aid users (daily use < or = 15 hours per day) were compared with the corresponding levels found in 18 hearing-impaired non-users with the same distribution of hearing thresholds. The results show that, for hearing losses of 50-75 dB HL, the mean level rated as 'loud' by long-term full-time users of hearing aids is 4.5 dB above the mean level of the corresponding category rated by non-users. This difference is statistically significant (P<0.05). No significant differences were found for the lower categories. Among those subjects who had been wearing hearing aids for at least six months, no significant correlation was found between the levels of the 'loud' category and the length of time that hearing aids had been used.     

Untersuchungen zur Hörflächenskalierung im Rahmen der Hörgeräteversorgung

The loudness perception of patients with hearing aids was measured with a one-stage category loudness scaling procedure. Data were obtained from 102 ears and were studied primarily in older patients who represented the majority of patients with hearing disorders evaluated in our department. In all, 75% of the patients were older than 45 years and had a mean age of 58 years. The reduction of dynamics at high frequencies was considered to be typical for age-related hearing disorders and was easily quantified with loudness scaling. Findings demonstrated that prediction of recruitment was not possible from pure-tone thresholds or even together with uncomfortable loudness levels, since the slopes of the level-loudness functions revealed a high interindividual variability. In contrast, the desired compression ratio can be easily calculated with data from the loudness scaling. In this study the loudness perception of patients with mainly non-linear hearing aids fitted with customary procedures was evaluated. The benefit from the hearing aids was proven with the outcome from the loudness scaling, with testing also allowing for a better fitting of the aids.     

Preliminary studies on the use of an ABR amplitude projection procedure for hearing aid selection

Hearing aid selection in young nonverbal children is difficult and objective selection procedures are needed. Kiessling (Scand Audiol 1982;11:269-275; Arch Otorhinolaryngol 1983;238:233-240) has proposed an objective hearing aid selection method based on an unaided ABR amplitude projection procedure. However, Kiessling's ABR projection method is based on the assumption that ABR amplitude is directly related to the loudness of a signal--an assumption which has not been tested. This assumption was investigated in a group of ten normally hearing and three hearing-impaired listeners. The results indicated that ABR amplitude measures obtained in a single trial do not always correlate well with perceived loudness, but ABR amplitudes averaged over several trials do correlate well with estimates of perceived loudness. The hearing-impaired listeners then participated in a second phase of the investigation in which hearing aids chosen by the ABR projection procedure were compared with hearing aids chosen by more conventional methods. The results indicated that the projection procedure prescribed appropriate gain and compression characteristics for two of the three hearing-impaired listeners.     

Comparison of three procedures for initial fitting of compression hearing aids. I. Experienced users, fitted bilaterally

We compared the effectiveness of three procedures for the initial fitting of hearing aids with multi-band compression: (1) CAMEQ, which aims to amplify speech so as to give equal loudness per critical band over the frequency range important for speech intelligibility, and to give similar overall loudness to 'normal': (2) CAMREST, which aims to amplify speech so as to restore 'normal' specific loudness patterns, over a wide range of speech levels; (3) DSL I/O, which aims to map the dynamic range of normally hearing people into the reduced dynamic range of hearing-impaired people, with 'full' restoration of audibility. Ten experienced hearing aid users with moderate sensorineural loss were fitted bilaterally with Danalogic 163D digital hearing aids, using each procedure in turn; the order was counterbalanced across subjects. The fitting required specification of gains for input levels of 55 and 80 dB SPL at six centre frequencies. Real-ear measurements were made to ensure that target gains were reached (+/-3 dB). Immediately after fitting with a given procedure, and one week after fitting, the gains were adjusted when required by the minimum amount necessary to achieve acceptable fittings. The amount of adjustment required provides one measure of the adequacy of the initial fitting. On average, the adjustments were smallest for the CAMEQ procedure. The gain changes were slightly larger for the CAMREST procedure and were largest of all for DSL I/O. For the latter, the gain changes were mostly negative, especially for high frequencies and the higher input level. This indicates that the DSL I/O procedure prescribes more high-frequency gain than is preferred by adult users. After these gain adjustments, users wore the aids for at least three weeks before filling out the APHAB questionnaire and taking part in laboratory measurements of the speech reception threshold (SRT) for sentences in quiet and in steady and fluctuating background noise at levels of 60 and 75 dB SPL. Following these tests, the hearing aids were re-fitted with the next procedure. The scores on the APHAB test and the SRTs did not differ significantly for the three procedures. We conclude that the CAMEQ and CAMREST procedures provide more appropriate initial fittings than DSL I/O.