不同策略的声电双模式助听对事件相关电位的影响

目的 探讨听障儿童单侧耳植入人工耳蜗(cochlear implant,CI)后对侧耳联合使用助听器(hearing aid,HA)的双模式助听策略对事件相关电位P300的影响.方法 研究对象共52人,设实验组(人工耳蜗植入儿童)3组、听力正常对照组1组,每组13人,按实验设计步骤随机测试.按对侧耳配戴HA的不同将人工耳蜗植入儿童分为A(CI+模拟HA)、B(CI+数字HA,未优化)和C(CI+数字HA,优化)3组,评估实验对象术后左右耳的残余听力,分别设置和优化CI及HA的技术参数并在声场中评估其助听后的音频感知情况,测试并比较各组的P300潜伏期及振幅.结果 3组患者术后双耳均有残余听力,助听后组间比较无差别(P>0.05).P300潜伏期比较A组>B组>C组(P<0.05),A、B两组P300潜伏期比对照组延长(P<0.05),C组与对照组比较无差别(P>0.05);P300振幅A组和B组与对照组比较均无意义(P>0.05),C组P300振幅低于对照组(P<0.05).结论 大部分听障儿童一侧耳植入人工耳蜗后对侧耳仍有可利用的残余听力,可以联合配戴适合的全数字编程助听器,大脑听觉中枢可以整合声电双模式助听设备上传的听觉信息.

The Effects of Different Bimodal Hearing Strategies on Event Related Potentials

Objective To study the effects of bimodal hearing strategies on event related potentials P300 in patients with a cochlear implant（CI） in one ear and a hearing aid（HA） in the opposite ear. Methods Fifty-two subjects were enrolled in this study, including 13 normal-hearing people and 39 cochlear implant recipients. The cochlear implant recipients were randomly divided into 3 groups： Group A （CI ＆ analog HA）, Group B （CI ＆ unoptimized digital HA） and Group C （CI ＆ optimized digital HA）. The subjects received the assessment on postoperative residual hearing in both ears. The technical parameters of CI and HA were optimized and the aided hearing of the patients was measured in the sound field. The latencies and amplitudes of P300 were also tested and compared among all the groups. Results The three groups of cochlear implant recipients had bilateral residual hearing after the operation and there was no significant difference among them（P〉0.05）. The P300 latencies of Group A were longer than Group B while Group B longer than Group C（P〈0.05）. The P300 latencies of Groups A and B were longer than those of control group （P〈0.05）,but there was no significant difference between Group C and control group（P〉0.05）. There was no significant difference in P300 amplitudes between Groups A, B and control group（P〉0.05）, but the P300 amplitudes of Group C were lower than those of the control group（P〈0.05）. Conclusion Most hearing-impaired children with a cochlear implant in one ear have useful residual hearing in the contralateral ear and can be fitted with suitable digital hearing aids since the auditory center can integrate the information from acoustic and electric devices.