对侧助听器对人工耳蜗使用者言语感知贡献研究

目的探讨讲汉语普通话的人工耳蜗(Cochlear Implantation,以下简称CI)使用者对侧佩戴助听器(Hearing Aid,以下简称HA)的获益。方法:选取对侧使用HA的14名母语为汉语普通话的CI使用者,分别测试其在使用CI和CI+HA(即双模式)两种助听模式下的声调、双音节词、及句子的识别表现,并分析助听器耳残余听力对双模式言语表现的影响。结果:安静环境下使用CI和CI+HA模式下的声调识别率分别为67.6%±10.5%、71.6%±12.5%,双音节词识别率分别为72.3%±21.8%、74.2%±23.3%,句子识别率分别为62.3%±28.3%、61.8%±31.3%,噪声环境句子识别率分别为37.6%±36.5%、42.4%±35.9%。统计分析发现声调识别表现在CI+HA模式下显著优于CI模式(t=-2.285,P=0.04),其余言语识别表现在两种聆听模式下均无显著差异;且1000Hz及以下频率的助听器耳残余听力与CI+HA模式下言语识别表现显著相关。结论::对于"大龄"语前聋患者,一侧人工耳蜗植入联合对侧助听器的双模式应用,需考虑助听器耳的残余听力情况,极重度感音神经性聋助听器辅助效果有限,必要时需考虑双侧人工耳蜗植入。

Contribution of Contralateral Hearing Aid to Speech Recognition in Mandarin-speaking Cochlear Implant Users

Objective To report benefits of bimodal hearing in typical Mandarin-speaking implant users who had poorer residual hearing in the nonimplanted ear.Methods Fourteen Mandarin-speaking cochlear implant users with contralateral hearing aids participated in the study.Sentence recognition in quiet and in noise as well as tone and word recognition in quiet were measured under CI-only and CI+HA conditions.Results Mean recognition performance was67.6%±10.5%under CI-only condition and 71.6%±12.5%under CI+HA condition for tones;72.3%±21.8%and 74.2%±23.3%for disyllable words;62.3%±28.3%and 61.8%±31.3%for sentences in quiet;and 37.6%±36.5%and 42.4%±35.9%for sentence in noise,respectively.There was no significant bimodal gain for word and sentence recognition and only small bimodal gain for tone recognition(4%).Performance under CI+HA condition was correlated with unaided thresholds at frequencies≤1000 Hz.Conclusion Bimodal benefits are limited in CI users with poor residual hearing.These results advocate for a more relaxed implant candidacy criterion to be used in China's Mainland.