听障儿童电声双模式助听的应用效果

目的 研究调查听障儿童一侧耳植入人工耳蜗后对侧耳配戴助听器,这种电声双模式同时刺激的应用效果.方法 随机测试78名儿童人工耳蜗植入者在使用人工耳蜗和助听器(CI+HA)及单独使用人工耳蜗(CI)时听觉事件相关电位MMN和P300潜伏期及波幅的变化,比较同一患者在三种环境下(安静、S/N-0dB,S/N-15dB)的听觉言语识别率,并进行家长问卷调查.结果 患者使用CI+HA与CI的MMN 引出率分别是 80%和75%,P300引出率分别是93.1%和89%;CI+HA组与CI组MMN和P300潜伏期以及CI+HA组与正常组P300波幅的比较有显著差异(P<0,05);在S/N-0dB时CI+HA组单音节、双音节和声调的识别率均高于CI组(P<0.05),而安静环境下和S/N-15dB时组内比较无统计学意义;开放式问卷调查结果 显示60.26%的患者认为使用CI+HA模式能获得更多不同的听觉帮助.闭合式问卷结果 显示使用CI+HA和单用CI的聆听效果有差别.结论 本文大多数听障儿童使用电声同时刺激的助听模式.大脑中枢处理系统并不拮抗,能发挥协同作用,尤其在改善噪声环境下的言语识别和声调感知.以及声源定位和声信息的利用等方面具有优势.

The Effects of Electric and Acoustic Stimulation on Children with Hearing Impairment

Objective To investigate the performances of children using a cochlear implant in one ear and a hearing aid in the opposite （CI＆HA）. Methods 78 children （31 females and 47 males） received the MMN and P300 tests when using the CI＆HA and the cochlear implant alone. The speech recognition abilities of these children were evaluated under different conditions （quiet, SIN=0 dB, S/N=15 dB） and a questionnaire was completed by their parents at the end of the study. Results The MMN was presented in 80% of the children while using CI and HA, and 75% when using CI alone. The P300 was elicited in 93.1% and 89% of the children for the two groups, respectively. There were significant differences between the CI＆HA group and CI group in MMN and P300 latencies and between the CI＆HA group and normal group in the amplitudes of P300（P〈0.05）. The monosyllable, bisyllable and tone recognition rates of the CI＆HA group were notably higher than those of the CI group at the SNR of 0 dB（P〈0.05）, but no significant difference was observed between the two groups in quiet environment or at the SNR of 15 dB. According to the open-ended questionnaire survey, 60.26% of the patients demonstrated a preference for CI＆HA mode, and the close-ended questionnaire results indicated a significant difference between CI＆HA mode and CI alone. Conclusion The results clearly show that binaural advantages in noisy conditions can be obtained from using a cochlear implant in one ear with a hearing aid in the opposite such as the improvement of speech and tone recognition, sound location and sound information utilization. No antagonistic reaction between the electronic and acoustic signals is observed in this study.