9例双侧人工耳蜗植入儿童双音节词识别效果分析

目的比较双侧人工耳蜗植入(CI)儿童安静和噪声条件下双耳与单耳开放式双音节词识别率的差异,以及噪声条件下易词与难词识别率差异,结合个案基本情况和CAP和SIR问卷评估结果,分析影响双音节词识别率的个性化因素。方法利用普通话儿童相邻性词表测试工具对9例双侧CI儿童进行安静和噪声条件下的双音节词测试,通过配对t检验,比较双耳与单耳双音节词识别率及易词与难词识别率差异。结果在安静和噪声条件下,双耳与单耳CI双音节识别率差异显著(P<0.05);在噪声条件下,双耳与单耳易词和难词识别率差异极显著(P<0.01);双音节词识别率受个体CI年龄、言语可懂度、内耳畸形类型等因素影响。结论在安静和噪声条件下,双耳CI可提高双音节识别率;在噪声条件下,双耳CI优势更加突出;儿童言语识别率受易词和难词以及儿童个性化等因素影响。     

多人谈话噪声及年龄对儿童言语识别中词汇学效应的影响

目的 探讨引入多人谈话噪声(babble noise,BN)后,词汇学效应在竞争性噪声环境下对正常听力儿童言语识别能力的影响及其随年龄增长的发展特性.方法 以212例3~6岁的正常听力儿童为研究对象,使用普通话词汇相邻性测试(Mandarin lexical neighborhood test,MLNT)材料(含双音节易词、双音节难词、单音节易词、单音节难词四类词表),在安静条件下给声强度70 dB SPL,多人谈话噪声下信噪比(signal to noise ratio,SNR)为4 dB,对所有对象进行开放式言语测试,分别获取四类词表在安静和噪声条件下的言语识别率,并比较3、4、5、6岁组儿童的结果.结果 在安静条件下正常听力儿童双音节易、难词及单音节易、难词的识别率分别为96.45%±5.17%、88.87%±7.73%、91.90%±7.31%、82.38%±7.95%,噪声下四类词表言语识别率分别为85.34%±11.23%、66.42%±11.08%、68.81%±15.99%、48.58%±12.81%,在噪声下的各词表言语识别率显著低于安静条件下(P<0.05).在安静和噪声条件下对词汇学效应的影响显示易词的识别率高于难词(P<0.05),双音节词言语识别率高于单音节词(P<0.05),且在噪声下比安静环境下影响更明显.噪声下不同年龄组中3岁组四类词表言语识别率分别为80.83%±12.65%、60.63%±9.13%、58.54%±12.98%、41.88%±11.69%,6岁组分别为92.38%±6.64%、71.90%±10.66%、76.90%±14.53%、57.14%±12.61%,3~6岁听力正常儿童噪声下言语识别能力随年龄增长显著提高(P<0.05).结论 在噪声下词汇学效应对听力正常儿童词汇提取的影响较安静环境下更明显,双音节词和易词更易获取,单音节词和难词更难获取;3~6岁听力正常儿童噪声下的言语识别能力随年龄增长而提高,且在6岁时仍未达到平台期.     

语前聋人工耳蜗植入儿童开放式听觉言语能力评估

目的对人工耳蜗植入（cochlear implant,CI）儿童的开放式听觉言语能力进行评估,以期获得其听觉言语发育特性。方法选取听觉言语能力已达到进行开放式言语测试的27例语前聋人工耳蜗植入儿童（CI组）,按照从易到难的测试方法和顺序,依次进行声场下普通话儿童词汇相邻性双音节易词-双音节难词-单音节易词-单音节难词及儿童版普通话噪声下言语测试（mandarin hearing in noise test for children,MHINT-C）的安静环境-非植入侧噪声-植入侧噪声-前方噪声的测试。将获得的数据与年龄相匹配的听力正常儿童进行比较。结果 27例CI儿童均能进行词汇相邻性测试,其中9例能进行安静环境下句子测试,7例能进行更高难度的噪声环境下的句子测试;双音节难易词表间、单音节难易词表间结果差异均有统计学意义（P〈0.05）,且易词得分均明显高于难词;能进行噪声下言语测试的儿童,噪声在非植入侧、植入侧和前方的言语识别阈（speech response threshold,SRT）分别为4.38&#177;3.43、8.76&#177;4.18、9.15&#177;3.39dB S/N,噪声在非植入侧与噪声在植入侧和前方得分相比差异均有统计学意义（P〈0.05）,噪声在前方与噪声在植入侧结果差异无统计学意义（P〉0.05）。在安静环境下CI儿童的MHINT-C的SRT与听力正常儿童相差31.5dB S/N,噪声在前方、非植入侧和植入侧环境下分别相差13.4、15.2、19.7dB S/N。结论 CI儿童与听力正常儿童一样均对语音表现出一定的敏感性,对易词的识别好于难词;两者听觉言语发育遵循同样的轨迹,但CI儿童相对滞后;聆听技巧的掌握及发挥双耳对噪声的压制作用对CI儿童言语理解尤其是噪声环境下的言语理解有帮助。     

噪声对低龄正常儿童言语感知的影响

目的探讨言语谱噪声(speech spectrum-shaped noise,SSN)和多人谈话噪声(babble noise,BN)对低龄正常儿童普通话词汇相邻性测试(Mandarin lexical neighborhood test,MLNT)言语感知的影响。方法 34例3~6岁正常听力儿童分为SSN组(21例)和BN组(13例),使用噪声下普通话词汇相邻性测试系统对两组儿童行声场下的言语测试,以听说复述方法获得不同信噪比下的言语识别率,比较两组两类噪声下的单音节易词表、难词表和双音节易词表、难词表的识别率-信噪比函数曲线(P-SNR曲线)和言语识别阈(SNR50)。结果 SSN组双音节易词表和难词表的SNR50阈值分别为-3dB、-0.5dB,单音节易词表和难词表的SNR50分别为-1dB、3.5dB;BN组双音节易词表和难词表的SNR50分别为-3dB、2dB,单音节易词表和难词表的SNR50分别为0.5dB、10dB。两组除双音节易词表SNR50相同外,其余各类词表BN组的SNR50均比SSN组高。词汇学因素对正常听力儿童噪声下的开放式言语识别的影响仍表现出易词识别率高于难词,双音节词识别率高于单音节词。结论对3~6岁正常听力儿童BN的掩蔽效应比SSN强,词汇学因素在噪声下仍然影响儿童的言语识别。     

普通话词汇相邻性词表在人工耳蜗植入儿童中的等价性验证

目的 在人工耳蜗植入(cochlear implant,CI)儿童中进一步验证四类普通话词汇相邻性测试词表(Standard-Chinese lexical neighborhood test,M-LNT)的表间等价性,同时比较词汇学特征对词汇识别的影响.方法 应用四类普通话词汇相邻性词表,在隔声室内对30名语前聋人工耳蜗植入儿童进行声场下的言语测试,按循环播放顺序获得各个测试词表的言语识别率,通过球形检验及方差分析,验证四类词表各表内的表间等价性,同时分析词汇学效应对各类词表识别率的影响.结果 3张双音节易词表识别率均值分别为80.00%±14.80%、83.00%±14.54%和80.50%±12.69%,3张双音节难词表识别率均值分别为65.33%±13.13%、68.83%±14.24%、66.33%±13.83%;3张单音节易词表识别率均值分别为72.33%±13.24%、74.50%±12.75%、72.33%±14.72%;3张单音节难词表识别率均值分别为53.33%±14.58%、58.17%±14.71%和57.83%±12.98%.各表间言语识别得分差异均无统计学意义(P>0.5,α=0.05).词汇学因素对CI儿童言语识别有显著影响,易词表识别率高于难词表(P<0.01),双音节词表识别率高于单音节词表(P<0.01).结论四类普通话词汇相邻性测试词表各表间具有等价性,其言语识别率可提供CI儿童语言辨识的基本过程,难易词表及单双音节词表间的识别率差异可反映CI儿童言语识别能力的词汇学发展是从易词到难词,从简单到复杂.     

听障儿童言语识别能力评估标准的修订

目的通过评估健听儿童的言语识别能力,修订听障儿童单音节词、双音节词和短句识别能力的评估标准。方法采用听觉语言识别能力评估词表分别对300名健听儿童进行单音节词、双音节词和短句识别能力评估,采用描述性统计方法对单音节词、双音节词和短句识别能力评估标准进行修订。结果单音节词、双音节词和短句识别率随年龄的增长而提高。2岁1个月～2岁12个月健听儿童的单音节词、双音节词和短句识别率都低于90％,3岁以上健听儿童的单音节词、双音节词和短句识别率均≥90％。结论①制定了2岁听障儿童单音节词、双音节词和短句识别能力评估标准。②对于3岁及以上各年龄段听障儿童可以用实际测试得分代表单音节词、双音节词和短句识别能力。     

噪声频谱特性对正常听力成人词汇识别影响

目的　探讨噪声频谱特性对词汇识别的影响作用。方法　31名听力正常成人参与研究,研究采用汉语普通话词汇相邻性测试,分别获得言语谱噪声（speech spectrum-shaped noise,SSN）和多人谈话噪声（babble noise,BN）下不同信噪比（signal noise ratio,SNR）的言语识别率,并计算词汇识别率为20%、50%和80%时所需要SNR和斜率,进而分析噪声频谱特性对词汇识别的影响作用。结果　SSN条件下单音节词和双音节词的言语识别阈,即正确识别率为50%所对应的SNR（SNR50）分别为-4.83 dB和-7.63 dB（t 50=11.918,P＜0.05）,对应斜率分别为5.61和11.14（t 50=-7.006,P＜0.05)。BN条件下单音节词和双音节词的SNR50分别为-3.34 dB和-5.52 dB（t 50=8.860,P＜0.05),对应斜率分别为6.04和9.28（t 50=-4.316,P＜0.05）。统计显示SSN和BN下单、双音节词识别阈均有统计学差异（t 50M=-5.037,t 50D=-10.275,P＜0.05）,两类噪声下双音节词的斜率有统计学差异（t 50D=2.920,P＜0.05）。结论　BN噪声频谱掩蔽效应比SSN更强。在两种噪声下,单音节词均需要更高的SNR,才能达到和双音节词相同的词汇识别。     

语前聋患儿一侧人工耳蜗植入对侧佩戴助听器聆听效果分析

目的：分析语前聋患儿一侧人工耳蜗植入（cochlear implant ,CI）对侧佩戴助听器模式下的聆听效果,以及非植入耳残余听力对聆听效果的影响。方法选取一侧人工耳蜗植入对侧佩戴助听器的语前聋患儿18例,分别测试其在单侧人工耳蜗植入、一侧人工耳蜗植入对侧佩戴助听器的双耳聆听模式（ bimodal fitting ,BIM ）安静环境及稳态噪声环境下标准中文短句、双音节词、单音节词的识别率。结果安静状态下本组患儿CI、BIM 模式单音节词言语识别率分别为82．67％±12．23％、83．61％±12．22％,双音节词分别为76．00％±16．13％、78．11％±14．84％,标准中文短句分别为60．11％±17．18％、65．43％±16．76％;信噪比10 dB环境下CI、BIM 助听模式患儿单音节词识别率分别为75．50％±14．12％、76．83％±14．15％,双音节词分别为68．22％±17．15％、77．18％±16．83％,标准中文短句分别为49．39％±19．26％、56．33％±19．55％,除两种模式下单音节词外其余言语识别率差异均有统计学意义（P＜0．05）,且非植入耳250、500 Hz助听听阈与BIM 模式言语识别率呈负相关。结论语前聋患儿双耳双模式聆听时有一定优势,这种优势可能主要来自低频残余听力。     

人工耳蜗植入儿童听觉康复效果观察

目的观察语前聋患儿在人工耳蜗开机后一年内听觉能力的发展状况,为康复教学工作提供参考。方法对52例在南京大学医学院附属鼓楼医院进行人工耳蜗植入手术并开机和定期调机的患儿,于开机后半年和一年时分别进行声场评估,得到每位患儿的术后平均听闽,同时由康复教师对患儿进行韵母、声母、声调、单音节词、双音节词、三音节词、短句和选择性听取等8项评估。使用SPSS10．0统计学软件对半年和一年时各项评估结果进行组内纵向统计学比较,并分别就两次言语识别能力评估中音节要素、词语方面各自所含测试项进行组间横向统计学比较。结果开机后半年与一年患几的平均听阈无显著性差异（P〉0．05）。各单项识别率开机后半年与一年纵向比较,差异均有统计学意义（P〈0．001）。组间横向比较,开机半年及一年时,韵母识别能力始终优于声母、声调识别能力,差异具有统计学意义（P〈0．001）,单音节词识别能力相对弱于双音节词、三音节词识别能力,差异亦具有统计学意义（P〈0．001）;两次评估中,选择性听取能力始终落后于其他各项。结论听觉康复过程符合从声音察觉、感知再到理解的规律,对语言的理解识别也符合先简单后复杂的规律,即从音节要素到词语、再到短句。康复过程需有侧重,人工耳蜗开机后前半年需注重听觉感知能力的提高,而后半年需注重对语言理解能力的培养。     

人工耳蜗植入儿童术后长期言语识别及语言理解表达能力研究

目的 评估人工耳蜗植入儿童术后长期的听觉、语言能力，探讨两种言语、语言测评结果之间的相关性。方法 以72例人工耳蜗植入儿童为研究对象，测试时平均生理年龄为7.88±1.24岁，平均植入年龄为2.84±1.04岁，人工耳蜗使用时长为5.03±0.52年，按植入年龄分为≤3岁组(43例)和>3岁组(29例)。分别采用普通话词汇相邻性测试(Mandarin lexical neighborhood test, MLNT)、《修订学前(学龄)儿童语言障碍评量表》(以下简称《量表》)及有意义言语使用量表(meaningful use of speech scale, MUSS)评估两组儿童的言语识别、言语及语言能力，分析《量表》与MUSS结果的相关性。结果 72例植入儿童的MLNT识别率由高到低分别为双音节易词85.00%±6.19%、单音节易词80.57%±6.20%、双音节难词76.56%±6.36%、单音节难词71.97%±6.85%(P<0.05);语言理解得分(72.43%±6.39%)优于口语表达得分(62.86%±7.50%)(P<0.05)。72例儿童MLNT得...     

The development of Cantonese Lexical Neighborhood Test: a pilot study

OBJECTIVE: This study aimed at developing a theoretically driven open-set speech recognition test for pediatric clinical population of cochlear implant and/or hearing aid users, with Cantonese Chinese as their first language, to track progress in speech recognition performance as an outcome measurement of their rehabilitation. METHODS: Six monosyllabic and six disyllabic word lists were generated from the Cantonese CHILDES language database, constructed according to the Neighborhood Activation Model. There were three lexically "easy" and three lexically "hard" word lists in each sub-test, with 25 items in each list. Four pediatric cochlear implant users and 10 hearing aid users, with bilateral congenital severe to profound sensorineural hearing impairment and below the age of 10, participated in the study. Their performances on word recognition and phoneme recognition with the new test lists, as well as the inter-list equivalency, inter-rater reliability, and face validity of the new materials, were investigated. RESULTS: Word recognition was higher among disyllables than monosyllables. Lexically "easy" disyllabic words were better recognized than their "hard" counterparts and the monosyllables. No significant difference was noted among the three lists in each combination of syllable structure and lexical property. High inter-rater reliability, as well as high correlation between Cantonese LNT score and a receptive vocabulary test score, were revealed. CONCLUSIONS: These newly developed test lists provided reliable information on spoken word recognition of pediatric hearing prosthesis users with severe to profound hearing impairment. Inter-list equivalency and inter-rater reliability allowed monitoring of rehabilitation progress on such specific pediatric clinical population with this new test. (255).     

Development of Mandarin monosyllabic speech test materials in China

In this study, monosyllabic Mandarin speech test materials (MSTMs) were developed for use in word recognition tests for speech audiometry in Chinese audiology clinics. Mandarin monosyllabic materials with high familiarity were designed with regard to phonological balance and recorded digitally with a male voice. Inter-list equivalence of difficulty was evaluated for a group of 60 subjects (aged 18–25 years) with normal hearing. Seven lists with 50 words each were found to be equivalent. These seven equivalent lists were used to measure performance-intensity (PI) functions for a group of 32 subjects with normal hearing and a group of 40 subjects with mild to moderate sensorineural hearing loss. The mean slope of PI function was found to be 4.1%/dB and 2.7%/dB, respectively. The seven lists of Mandarin monosyllabic materials were found to have sufficient reliability and validity to be used in clinical situations.     

Standard-Chinese Lexical Neighborhood Test in normal-hearing young children

Objective

The purposes of the present study were to establish the Standard-Chinese version of Lexical Neighborhood Test (LNT) and to examine the lexical and age effects on spoken-word recognition in normal-hearing children.

Methods

Six lists of monosyllabic and six lists of disyllabic words (20 words/list) were selected from the database of daily speech materials for normal-hearing (NH) children of ages 3-5 years. The lists were further divided into “easy” and “hard” halves according to the word frequency and neighborhood density in the database based on the theory of Neighborhood Activation Model (NAM). Ninety-six NH children (age ranged between 4.0 and 7.0 years) were divided into three different age groups of 1-year intervals. Speech-perception tests were conducted using the Standard-Chinese monosyllabic and disyllabic LNT.

Results

The inter-list performance was found to be equivalent and inter-rater reliability was high with 92.5-95% consistency. Results of word-recognition scores showed that the lexical effects were all significant. Children scored higher with disyllabic words than with monosyllabic words. “Easy” words scored higher than “hard” words. The word-recognition performance also increased with age in each lexical category. A multiple linear regression analysis showed that neighborhood density, age, and word frequency appeared to have increasingly more contributions to Chinese word recognition.

Conclusion

The results of the present study indicated that performances of Chinese word recognition were influenced by word frequency, age, and neighborhood density, with word frequency playing a major role. These results were consistent with those in other languages, supporting the application of NAM in the Chinese language. The development of Standard-Chinese version of LNT and the establishment of a database of children of 4-6 years old can provide a reliable means for spoken-word recognition test in children with hearing impairment.     

Effect of age and cognition on childhood speech in noise perception abilities

This research on children's speech in noise and cognitive abilities aimed to determine the age-related trends in speech in noise perception abilities and the relationship between speech in noise perception and cognitive abilities. Monosyllabic distinguishable (consonant-vowel-consonant) words was the most recognisable word category, followed by monosyllabic confusable words (consonant-vowel-consonant), disyllabic non-words (/aCa/) and monosyllabic syllables (/Ca/), demonstrating that phoneme distinctiveness and a reduction in word confusability contribute to their recognition. Older children outperformed younger children on all speech in noise tasks, indicating that there are age-related trends in speech in noise abilities. Children with higher cognitive abilities did not outperform children with lower cognitive abilities on speech in noise tasks, indicating that the ability to hear speech in noise may be an intrinsic feature of the auditory system that matures with age.     

3～7岁儿童筛查性言语测听方法初探

目的设计一组快速简易的儿童言语测听词表，验证此词表作为听力测试辅助项目之一的可行性。方法选取杭州某幼儿园中班教材词汇，在隔声室内由中文播音员录音，再用Spectrogram软件分析音频并筛选出特定频率范围的字，最后验证词表的有效性。结果健听组儿童不同年龄段之间无显著性差异（P〉0．05），听力障碍组儿童也无显著性差异（P〉0．05），言语词表低频得分最低。结论该言语词表适用于3～7岁儿童，并在≤50dB（A）的安静环境中以45～50dBSPL的强度给声达到80％以上的得分率者，可视其听力在正常范围。该词表对学龄前儿童的言语测听具有一定的参考意义。     

普通话单音节小词表正常人识别-强度函数

目的：对普通话言语测听材料（MSTMs）中等价性一致的一组单音节小词表进行有效性分析,以期描绘出听力正常人的识别-强度函数曲线,为临床听力检测提供快速有效的方法及量度。方法：选取年龄18～26岁,具有大专及以上学历,且以普通话作为日常交流方式的听力正常人37例。选取MSTMs中经过等价性评估的8张单音节小词表,每张20词,其中第1张前10个单音节词统一作为练习表使用。使用SPSS17．0软件对结果进行分析。结果：单音节小词表的言语识别率与给声强度间的Logistic曲线拟合方程为：x=98．557／{（1＋12．243exp[-0．17（P-15）]},x max=98．557;识别率为50％时的给声强度为29．6dBSPL,线性部分的回归方程为y=3．098X-43．149。结论：该研究初步建立了基于具有难度等价性的7张普通话单音节小词表的正常人识别-强度函数曲线,为临床听力学检测提供了一种快速有效的评估手段,并且为下一步测试和临床应用提供了基础。     

普通话儿童词汇相邻性单音节词表的编制

目的 根据心理语言学言语听辨领域的邻域激活模型(neighborhood activation model,NAM)理论,编制开放式的普通话儿童词汇相邻性单音节词表(mandarin monosyllable lexical neighborhood test,M-LNT-monosyllabie).方法 根据邻域激活模型对"难词"和"易词"的定义,计算儿童口语语料中各单音节词的出现频率和邻居词汇数日,获得出现频率和邻居词数目的 中位数,依据汉语语音和词性特点,编制出普通话儿童词汇相邻性单音节词表.选择3～5岁听力正常儿童34名为受试者,进行词表的初步验证.结果 儿童日常口语语料库中包括1 979个单音节词,出现频率从1至4 855,中位数为7;目标词邻居词数目从1至112,中位数为29.根据邻域激活模型定义出易词487个和难词419个.最终选择120个词作为测试条目,编制3张易词表,每张20个词;3张难词表,每张20个词;1张练习表,10个词.经统计学分析,3张易词表间和3张难词表间各测试条目出现频率、邻居词数、34名受试者测试得分比较差异均无统计学意义(P＞0.05);易词表和难词表间测试得分差异具有统计学意义(P＜0.01).结论 词汇相邻性言语测试结果可提供儿童语音感知信息,难易词表间的结果差异可反映儿童单音节词汇听辨能力的发育状况.