人工耳蜗电极植入部位对人工耳蜗使用者言语理解影响的研究

目的:探讨人工耳蜗电极覆盖耳蜗基膜范围对汉语普通话人工耳蜗使用者的言语识别能力,特别是声调识别能力的影响.方法:使用人工耳蜗调试软件通过开启(关闭)不同电极通道设置7种测试条件,以模拟人工耳蜗电极覆盖耳蜗基膜范围的不同状态.并对各测试条件下人工耳蜗使用者元音、辅音、声调识别能力进行测试.结果:不同测试条件下元音识别平均得分56%～91%(P<0.05);辅音识别平均得分72%～85%(P<0.05);声调识别平均得分68%～81%(P>0.05).但随着人工耳蜗电极覆盖基底膜范围的扩大,人工耳蜗使用者元音、辅音成绩呈现显著性改善,声调识别成绩亦有所提高.结论:增加人工耳蜗电极覆盖基膜的范围、积极利用耳蜗各个区域有利于改善人工耳蜗使用者的言语识别能力,进而对提高人工耳蜗使用者言语交流和社会交往能力是非常重要的.     

方向性麦克风对语后聋人工耳蜗使用者言语识别能力的影响

目的 探讨方向性麦克风系统对人工耳蜗使用者言语识别能力的影响，以期为解决人工耳蜗使用者噪声下言语识别困难提供参考。方法 采用普通话噪声下言语识别测试以及自行编制的聆听感受自评问卷，对14例母语为汉语普通话的成人语后聋人工耳蜗植入者进行不同麦克风系统和拾音模式下的单音节词分辨能力、短句识别能力以及聆听感受评估，采用SPSS 26.0统计软件对结果进行统计分析。结果 (1)言语识别能力：麦克风拾音模式对人工耳蜗使用者噪声条件下言语识别率得分有显著影响，SONNET/自适应模式得分最高，SONNET/全向模式、SONNET/定向模式和OPUS/全向模式的得分相当；麦克风拾音模式对人工耳蜗使用者安静条件下言语识别率得分无显著影响：SONNET/全向模式与OPUS/全向模式得分相当。(2)聆听感受自评：麦克风拾音模式对人工耳蜗使用者噪声条件下问卷得分有显著影响，SONNET/自适应模式得分最高，SONNET/定向模式得分次之，SONNET/全向模式和OPUS/全向模式的得分相当。麦克风拾音模式对人工耳蜗使用者安静条件下问卷得分无显著差异，SONNET/定向模式与OPUS/全向模式得分相当。(3)...     

人工耳蜗植入者使用精细结构编码策略的音高和言语感知相关研究

目的:通过评估MED-EL人工耳蜗植入者使用FS4编码策略和HDCIS编码策略时的音乐音高和言语感知能力,探索提供精细结构信息的编码策略对人工耳蜗使用效果的影响。方法:12例植入MED-EL人工耳蜗的语后聋患者分别在FS4和HDCIS编码策略下编程调试,并进行音高差阈、音高方向和言语感知测试,比较2种编码策略下各项测试的结果,并进行统计学分析。结果:在FS4编码策略下的音高差阈和音高方向测试结果均显著优于HDCIS编码策略下的测试结果,测试得分差异有统计学意义(P<0.05)。2种编码策略下的汉语声调、声母和韵母识别得分均差异无统计学意义(P>0.05)。结论:FS4编码策略对人工耳蜗植入者的音乐音高感知有较大帮助。在汉语声调、声母和韵母识别方面,FS4和HDCIS编码策略的使用效果差异不大。     

多通道人工耳蜗在语前聋儿童及青少年中的应用

目的 通过对植入人工耳蜗的语前聋儿童和青少年的听力和语言能力的评估,探讨我国儿童在使用人工耳蜗后的听力和言语能力发展规律及影响因素。方法 ２５例行人工耳蜗植入的语前聋儿童及青少年患者参与本组测试。选用《聋儿听觉言语康复评估方法》作为测试材料,分别进行声音,言语声和环境声的辨别,数词,单字词,双字词,３字词,韵母,声母,声调,封闭项列短句的识别,开放项列字词和开放项列短句识别,语言清晰度,模仿句长,     

双侧人工耳蜗植入术后言语识别效果的评估

目的评估双侧人工耳蜗植入者汉语普通话短句、双音节词单音节词及汉语声调的识别效果,探索双侧人工耳蜗植入者双耳听觉产生的机制及对言语识别率的影响。方法选取双侧人工耳蜗植入患者6人,自制问卷收集受试者的基本信息并评估他们的主观听觉状况。首先测试受试者在使用双侧人工耳蜗（BCI）、单独使用一侧人工耳蜗（RCI/LCI）的听阈,随后测试他们在BCI和RCI/LCI两种听觉模式下的七音节短句、双音节词、声调、韵母、声母识别率,测试背景环境包括安静环境和嘈杂语噪声环境,言语信号强度为65dB SPL,固定信噪比为+10 dB SPL。随后将BCI和RCI/LCI两种听觉模式下的识别效果进行比较。结果除噪声状态下韵母识别测试中其余测试结果均为BCI言语识别率得分高于RCI/LCI。结论对于符合双侧人工耳蜗植入术适应证标准的患者而言,双侧植入人工耳蜗可以在不同程度上提高安静和噪声环境下的短句、双字词、声母、韵母及声调的识别率,降低其声场听阈。     

多通道人工耳蜗在语前聋儿童及青少年中的应用

目的　通过对植入人工耳蜗的语前聋儿童和青少年的听力和语言能力的评估 ,探讨我国儿童在使用人工耳蜗后的听力和言语能力发展规律及影响因素。方法　 2 5例行人工耳蜗植入的语前聋儿童及青少年患者参与本组测试。选用《聋儿听觉言语康复评估方法》作为测试材料 ,分别进行声音、言语声和环境声的辨别 ,数词、单字词、双字词、3字词、韵母、声母、声调、封闭项列短句的识别 ,开放项列字词和开放项列短句识别 ,语言清晰度 ,模仿句长 ,听话识图和看图说话等方面测试。结果　受试者术后均能感知到声音 ,辨别不同类别的声音。封闭项列测试结果全部大于机会水平 ,正确识别率随人工耳蜗使用时间而不断增加 ,随植入时年龄的增长而呈下降趋势。术后约半年显现开放项列识别能力 ,使用人工耳蜗后对患儿的言语发育具有较大帮助。结论　尽早对语前聋患儿植入人工耳蜗及进行术后康复 ,以达改善听力 ,提高语言能力 ,促进身心全面发展的目的。     

人工耳蜗植入和助听器配戴儿童声调识别的对比实验研究

目的探讨人工耳蜗植入儿童和助昕器配戴儿童在声调识别方面是否存在差异；考查人工耳蜗开机时间、入园康复时间，儿童的年龄、性别等因素对声调识别是否有影响。方法采用《言语听觉反应评估》（evaluation of auditory responses to speech，EARS）中的“封闭式声调测试”作为测试材料．对61名3～6岁聋儿（其中人工耳蜗植入儿童31名，助昕器配戴儿童30名）进行声调识别的测试，利用SPSS软件对结果进行统计分析。结果助昕器配戴儿童在声调识别的精确性上优于人工耳蜗植入聋儿；人工耳蜗开机时间对声调测试成绩没有明显的影响；康复时间、聋儿的年龄和声调测试成绩呈正比；聋儿的性别和声调测试成绩无关。结论助昕设备类型、康复时间、年龄等对声调识别的成绩有一定影响，这些因素之间可能存在相互作用，有待进一步探讨。     

言语、空间和音质听觉量表评估双侧人工耳蜗与双模式干预效果研究

目的　用言语、空间和音质听觉量表（speech，spatial and qualities of hearing scale，SSQ）对双侧人工耳蜗植入者和双耳双模式使用者进行评估，探讨不同干预模式的重度听力损失患者在言语理解、声音定位和声音质量方面的异同。方法　选取双侧人工耳蜗植入2年以上、双耳双模式干预2年以上患者各20例，分为双侧人工耳蜗组和双模式干预组，使用SSQ量表评估对比两组受试者在言语理解能力、空间定位能力和声音聆听质量方面的异同。结果  在言语理解、声音定位方面，两组得分无明显差异，两组在声音聆听质量上存在显著性差异，双耳双模式组表现更优。结论　双侧人工耳蜗植入者与双耳双模干预者在言语理解、声音定位两个方面无显著性差异，双耳双模干预者声音聆听质量优于双侧耳蜗植入者。     

多通道人工耳蜗使用者电刺激速率辨别与声调识别的关系

目的用心理物理学的方法探讨多通道人工耳蜗使用者单个电极速率识别与声调及言语识别的关系，为国人使用多通道人工耳蜗效果的评估及汉语语音编码方案的设计提供依据。方法４例语后聋成人人工耳蜗使用者参与测试。以４个标准频率５０、１００、２００和４００Ｈｚ为基线，对４个电极对（Ｅ１，Ｅ３），（Ｅ７，Ｅ９），（Ｅ１４，Ｅ１６）和（Ｅ２０，Ｅ２２）分别用不同频率与４个基线间进行刺激率辨别测试。用２５组４个声调共计１００汉字进行声调识别测试。计算正确识别率，分析正确和错误识别的混淆矩阵，对测试材料进行基频分析。结果速率辨别阈（７５．０％正确率时）个体差异很大，从数Ｈｚ到上百Ｈｚ。统计学分析显示标准频率、电极位置和患者间差异具有显著性。声调识别正确率为４０％～８０％，阴平和上声较阳平和去声容易识别。相关分析显示在速率辨别与声调识别间表现出高度相关性。结论人工耳蜗使用者的声调识别依赖于其良好的电极速率辨别。     

汉语普通话人工耳蜗使用者对声调识别的分析研究

目的 初步确定人工耳蜗使用者声调感知的特点,并进行分析研究.方法 利用自主开发的噪声下声调识别测试材料(tone identification in noise test,TINT)在Speech Performance测试平台的控制下对20例母语为汉语普通话人工耳蜗使用者声调识别能力进行评估,获得各声调识别成绩以及声调识别混淆矩阵.采用χ2检验(chi-square test)对本组人工耳蜗使用者汉语声调识别成绩差异进行统计学分析.结果 ①本组人工耳蜗使用者的汉语普通话声调识别总成绩(百分制得分)分布48.75%~98.75%,平均成绩(76.38±17.29)%;②各声识别成绩平均值差异显著(χ2=2358.357,P<0.01),由高到低分别为T3(85.75%)>T4(85.25%)>T1(69.75%)>T2(64.75%),即本组人工耳蜗植入者感知T3、T4较为容易、感知T1、T2较为困难;③声调识别混淆矩阵提示T2(35.35%)、T1(30.25%)混淆度明显高于T4(14.75%)、T3(14.25%),并且各个声调之间的混淆趋势不同,T1易被混淆为T2(18.25%)、T2易被混淆为T3(24.00%).结论 时域特性明显的声调更易被人工耳蜗群体识别,因此应根据声调感知难易程度制定针对性的声调康复训练方案,综合利用听觉信息和视觉信息改善声调,特别是一声、二声的识别能力.     

Speech recognition outcomes in Mandarin-speaking cochlear implant users with fine structure processing

Conclusion: Mandarin-speaking adults can use the Fine Structure Processing (FSP) coding strategy as well as the Continuous Interleaved Sampling (CIS+) coding strategy. No loss in performance was observed after switch-over. Tone identification improves over time with the FSP coding strategy, which is of benefit to tonal-language users. After some time, fine structure was preferred.

Objective: This study aimed to determine speech perception, tone perception, and the subjective preferences of Mandarin-speaking adults who received the FSP coding strategy, at upgrade from the CIS?+?coding strategy.

Methods: Thirteen Mandarin-speaking subjects were tested at switch-over from CIS?+?to the FSP coding strategy ～1-month after switch-over, 2-months after switch-over, and 3-months after switch-over with the Mandarin Hearing in Noise Test (M-HINT), the Mandarin Tone Identification in Noise Test (M-TINT), and a visual analogue scale assessing Sound and Speech Assessment (SSA).

Results: There were no significant differences in the M-HINT between presentation levels (62?dB SPL vs 65?dB SPL), over time, nor when compared to the CIS?+?coding strategy. Tone perception improved significantly over time with the FSP coding strategy. Subjects rated the FSP coding strategy with the OPUS 2 as significantly more ‘full’ and ‘rich’ than with the CIS?+?coding strategy after 3-months.     

Speech and music perception with the new fine structure speech coding strategy: preliminary results

CONCLUSIONS: Taking into account the excellent results with significant improvements in the speech tests and the very high satisfaction of the patients using the new strategy, this first implementation of a fine structure strategy could offer a new quality of hearing with cochlear implants (CIs). OBJECTIVE: This study consisted of an intra-individual comparison of speech recognition, music perception and patient preference when subjects used two different speech coding strategies with a MedEl Pulsar CI: continuous interleaved sampling (CIS) and the new fine structure processing (FSP) strategy. In contrast to envelope-based strategies, the FSP strategy also delivers subtle pitch and timing differences of sound to the user and is thereby supposed to enhance speech perception in noise and increase the quality of music perception. PATIENTS AND METHODS: This was a prospective study assessing performance with two different speech coding strategies. The setting was a CI programme at an academic tertiary referral centre. Fourteen post-lingually deaf patients using a MedEl Pulsar CI with a mean CI experience of 0.98 years were supplied with the new FSP speech coding strategy. Subjects consecutively used the two different speech coding strategies. Speech and music tests were performed with the previously fitted CIS strategy, immediately after fitting with the new FSP strategy and 4, 8 and 12 weeks later. The main outcome measures were individual performance and subjective assessment of two different speech processors. RESULTS: Speech and music test scores improved statistically significantly after conversion from CIS to FSP strategy. Twelve of 14 patients preferred the new FSP speech processing strategy over the CIS strategy.     

Speech and music perception with the new fine structure speech coding strategy: preliminary results

Conclusions. Taking into account the excellent results with significant improvements in the speech tests and the very high satisfaction of the patients using the new strategy, this first implementation of a fine structure strategy could offer a new quality of hearing with cochlear implants (CIs). Objective. This study consisted of an intra-individual comparison of speech recognition, music perception and patient preference when subjects used two different speech coding strategies with a MedEl Pulsar CI: continuous interleaved sampling (CIS) and the new fine structure processing (FSP) strategy. In contrast to envelope-based strategies, the FSP strategy also delivers subtle pitch and timing differences of sound to the user and is thereby supposed to enhance speech perception in noise and increase the quality of music perception. Patients and methods. This was a prospective study assessing performance with two different speech coding strategies. The setting was a CI programme at an academic tertiary referral centre. Fourteen post-lingually deaf patients using a MedEl Pulsar CI with a mean CI experience of 0.98 years were supplied with the new FSP speech coding strategy. Subjects consecutively used the two different speech coding strategies. Speech and music tests were performed with the previously fitted CIS strategy, immediately after fitting with the new FSP strategy and 4, 8 and 12 weeks later. The main outcome measures were individual performance and subjective assessment of two different speech processors. Results. Speech and music test scores improved statistically significantly after conversion from CIS to FSP strategy. Twelve of 14 patients preferred the new FSP speech processing strategy over the CIS strategy.     

Short-term study of the effect of speech coding strategy on the auditory performance of pre- and post-lingually deafened adults implanted with the Clarion CII

OBJECTIVE: The auditory performance of cochlear implantees is linked to numerous variables, such as audiological characteristics, age and type of speech coding strategy. In recent years, many different ways of processing sounds have been developed, with possible implications for auditory performance. The purpose of this study was to evaluate the intra-individual differences of patients for speech perception tasks in quiet and in noise as a result of switching from a standard strategy [Continuous Interleaved Sampling (CIS)/Simultaneous Analog Strategy (SAS)] to Hi-Resolution (HiRes). MATERIAL AND METHODS:A total of 14 post-lingual adults implanted with the Clarion CII were selected for trials. At switch-on, six patients chose a CIS strategy and eight an SAS strategy. After an average period of 9.3 months, all patients were switched over to HiRes. All patients were tested (open-set mode) with bisyllabic words and sentences, in both quiet and noise [speech/noise ratio (SNR) = +10]. Testing was carried out after an initial period with the CIS/SAS strategy and 3 months after switching over to HiRes. RESULTS: After switch-over a significant improvement was seen for both speech in quiet (words +25.2%, sentences +10.8%) and speech in noise (words 44.8%, sentences 45.4%). CONCLUSION: Despite individual differences, all patients improved their performance with HiRes use, the greatest improvements being seen under unfavourable listening conditions (SNR = +10). Subjective improvements in speech discrimination and overall sound quality perception were reported even after the first week of HiRes use.     

Clinical Trial Results with the MED-EL Fine Structure Processing Coding Strategy in Experienced Cochlear Implant Users

Objectives: To assess the subjective and objective performance of the new fine structure processing strategy (FSP) compared to the previous generation coding strategies CIS+ and HDCIS. Methods: Forty-six adults with a minimum of 6 months of cochlear implant experience were included. CIS+, HDCIS and FSP were compared in speech perception tests in noise, pitch scaling and questionnaires. The randomized tests were performed acutely (interval 1) and again after 3 months of FSP experience (interval 3). The subjective evaluation included questionnaire 1 at intervals 1 and 3, and questionnaire 2 at interval 2, 1 month after interval 1. Results: Comparison between FSP and CIS+ showed that FSP performed at least as well as CIS+ in all speech perception tests, and outperformed CIS+ in vowel and monosyllabic word discrimination. Comparison between FSP and HDCIS showed that both performed equally well in all speech perception tests. Pitch scaling showed that FSP performed at least as well as HDCIS. With FSP, sound quality was at least as good and often better than with HDCIS. Conclusions: Results indicate that FSP performs better than CIS+ in vowel and monosyllabic word understanding. Subjective evaluation demonstrates strong user preferences for FSP when listening to speech and music.     

Fine Structure Processing improves speech perception as well as objective and subjective benefits in pediatric MED-EL COMBI 40+ users

Objectives

Presently, there are only few studies examining the benefits of fine structure information in coding strategies. Against this background, this study aims to assess the objective and subjective performance of children experienced with the C40+ cochlear implant using the CIS+ coding strategy who were upgraded to the OPUS 2 processor using FSP and HDCIS.

Methods

In this prospective study, 60 children with more than 3.5 years of experience with the C40+ cochlear implant were upgraded to the OPUS 2 processor and fit and tested with HDCIS (Interval I). After 3 months of experience with HDCIS, they were fit with the FSP coding strategy (Interval II) and tested with all strategies (FSP, HDCIS, CIS+). After an additional 3-4 months, they were assessed on all three strategies and asked to choose their take-home strategy (Interval III). The children were tested using the Adaptive Auditory Speech Test which measures speech reception threshold (SRT) in quiet and noise at each test interval. The children were also asked to rate on a Visual Analogue Scale their satisfaction and coding strategy preference when listening to speech and a pop song. However, since not all tests could be performed at one single visit, some children were not able complete all tests at all intervals.

Results

At the study endpoint, speech in quiet showed a significant difference in SRT of 1.0 dB between FSP and HDCIS, with FSP performing better. FSP proved a better strategy compared with CIS+, showing lower SRT results of 5.2 dB. Speech in noise tests showed FSP to be significantly better than CIS+ by 0.7 dB, and HDCIS to be significantly better than CIS+ by 0.8 dB. Both satisfaction and coding strategy preference ratings also revealed that FSP and HDCIS strategies were better than CIS+ strategy when listening to speech and music. FSP was better than HDCIS when listening to speech.

Conclusions

This study demonstrates that long-term pediatric users of the COMBI 40+ are able to upgrade to a newer processor and coding strategy without compromising their listening performance and even improving their performance with FSP after a short time of experience.     

Short-term study of the effect of speech coding strategy on the auditory performance of pre- and post-lingually deafened adults implanted with the Clarion CII®

Objective The auditory performance of cochlear implantees is linked to numerous variables, such as audiological characteristics, age and type of speech coding strategy. In recent years, many different ways of processing sounds have been developed, with possible implications for auditory performance. The purpose of this study was to evaluate the intra-individual differences of patients for speech perception tasks in quiet and in noise as a result of switching from a standard strategy [Continuous Interleaved Sampling (CIS)/Simultaneous Analog Strategy (SAS)] to Hi-Resolution (HiRes).

Material and Methods A total of 14 post-lingual adults implanted with the Clarion CII® were selected for trials. At switch-on, six patients chose a CIS strategy and eight an SAS strategy. After an average period of 9.3 months, all patients were switched over to HiRes. All patients were tested (open-set mode) with bisyllabic words and sentences, in both quiet and noise [speech/noise ratio (SNR)=+10]. Testing was carried out after an initial period with the CIS/SAS strategy and 3 months after switching over to HiRes.

Results After switch-over a significant improvement was seen for both speech in quiet (words +25.2%, sentences +10.8%) and speech in noise (words 44.8%, sentences 45.4%).

Conclusion Despite individual differences, all patients improved their performance with HiRes use, the greatest improvements being seen under unfavourable listening conditions (SNR=+10). Subjective improvements in speech discrimination and overall sound quality perception were reported even after the first week of HiRes use.     

Comparison of two cochlear implant coding strategies on speech perception

Objective: Assess whether differences in speech perception are observed after exclusive listening experience with high-definition continuous interleaved sampling (HDCIS) versus fine structure processing (FSP) coding strategies.

Methods: Subjects were randomly assigned at initial activation of the external speech processor to receive the HDCIS or FSP coding strategy. Frequency filter assignments were consistent across subjects. The speech perception test battery included CNC words in quiet, HINT sentences in quiet and steady noise (+10?dB SNR), AzBio sentences in quiet and a 10-talker babble (+10?dB SNR), and BKB-SIN. Assessment intervals included 1, 3, and 6 months post-activation.

Results: Data from 22 subjects (11 with HDCIS and 11 with FSP) were assessed over time. Speech perception performance was not significantly different between groups.

Discussion: Speech perception performance was not significantly different after 6 months of listening experience with the HDCIS or FSP coding strategy.     

Comparison of the TEMPO+ ear-level speech processor and the cis pro+ body-worn processor in adult MED-EL cochlear implant users

A study was conducted to compare the new MED-EL TEMPO+ ear-level speech processor with the CIS PRO+ body-worn processor in the COMBI 40/COMBI 40+ implant system. Speech tests were performed in 46 experienced subjects in two test sessions approximately 4 weeks apart. Subjects were switched over from the CIS PRO+ to the TEMPO+ in the first session and used only the TEMPO+ in the time between the two sessions. Speech tests included monosyllabic word tests and sentence tests via the telephone. An adaptive noise method was used to adjust each subject's scores to approximately 50%. Additionally, subjects had to complete a questionnaire based on their 4 weeks of experience with the TEMPO+. The speech test results showed a statistically significant improvement in the monosyllabic word scores with the TEMPO+. In addition, in the second session, subjects showed a significant improvement when using the telephone with the TEMPO+, indicating some learning in this task. In the questionnaire, the vast majority of subjects found that the TEMPO+ allows equal or better speech understanding and rated the sound quality of the TEMPO+ higher. All these objective and subjective results indicate the superiority of the TEMPO+ and are mainly attributed to a new coding strategy called CIS+ and its implementation in the TEMPO+. In other words, based on the results of this study, it appears that after switching over from the CIS PRO+ to the TEMPO+, subjects are able to maintain or even improve their own speech understanding capability.     

New cochlear implant coding strategy for tonal language speakers

Accurate pitch perception on the basis of fundamental frequency patterns is essential for the processing of lexical tones in tonal languages such as Cantonese. Speech intelligibility in Cantonese-speaking CI recipients was compared using current signal processing strategies, which typically result in poor pitch perception, and a new strategy, known as the multi-channel envelope modulation (MEM) strategy, was designed to enhance temporal periodicity cues to the fundamental frequency. Performance of nine postlingually hearing-impaired adult cochlear implant users was measured twice using each strategy, initially after a four week trial, and again after two weeks of use with each strategy. Speech intelligibility in speech-spectrum shaped noise was measured using the Cantonese hearing in noise test. A fixed noise level of 65 dB A was used and the signal-to-noise ratios were fixed at either +10, +15, or +20 dB, depending on the baseline performance of individual subjects using the clinical processor. Self-reported benefit in 18 listening situations and overall preference for strategies were obtained at the end of these trial periods. Results showed poorer speech intelligibility with CIS while results obtained using ACE and MEM were comparable. Unfamiliar place coding might have contributed to poorer performance using CIS. Self-reported benefit across strategies did not differ in most listening situations. Participants preferred ACE for listening overall in daily situations, and a few preferred MEM in noise. Whilst the results did not demonstrate any advantages for speech recognition in noise when using MEM compared to ACE, no degradation in performance was observed. This implies that the form of processing employed by MEM retains similar segmental information to that provided by ACE and that potentially, future variations/optimizations of MEM may lead to some improvement in tone perception.