语前聋患者人工耳蜗植入后声调识别能力研究

目的分析语前聋患者人工耳蜗植入后声调识别的特点,为编制适用于汉语的人工耳蜗言语编码策略提供参考资料。方法23名语前聋患者,人工耳蜗植入时年龄2～18岁,均使用人工耳蜗1年以上。按人工耳蜗植入时年龄分为6岁以下和6岁以上两组,分别测试患者对一声与二声、一声与三声、一声与四声、二声与三声、二声与四声、三声与四声6种声调组合的识别能力。结果6岁以上组患者一声与二声分辨测试得分最低,与其余5种组合测试得分之间的差异有统计学意义（P〈0.05）;三声与四声分辨的测试得分最高,除二声与四声组合外,与其余4种组合测试得分之间的差异有统计学意义（P〈0.05）。6岁以下组患者一声与二声分辨的测试得分最低,三声与四声分辨的测试得分最高。6种不同声调组合测试得分之间的差异无统计学意义（P〉0.05）。6岁以下组患者6种不同声调组合测试的得分均高于6岁以上组。结论语前聋患者最易区分三声与四声之间的差别,而一声与二声之间的差异最难分辨。语前聋患者植入人工耳蜗越早,使用人工耳蜗时间越长,其声调识别能力越好。     

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.     

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。     

人工耳蜗植入患者术后汉语声韵调识别能力临床分析

目的分析人工耳蜗（CI）植入患者术后普通话单音节声母、韵母、声调的识别能力差异,对比单双侧植入和植入时长对单音节识别的影响。方法选取单侧和双侧CI患者共63例,其中男35例,女28例,平均年龄（23.45±16.30）岁,CI植入时长（2.81±2.41）年。使用信度效度经已认证的单音节识别测试材料进行测试,记录每个患者声母、韵母、声调和总体的识别率得分情况。结果共获得70个测试结果：CI患者对声母、韵母和单音节总识别率均低于声调识别率且差异具有统计学意义（P=0.000 3;P=0.000 3;P=0.030 3）。对单音节总识别率超过50%的CI患者,声调识别率相比声母、韵母、单音节识别率显著性增高（P<0.005）。对于总识别率小于50%的患者,虽然声韵母识别率均低于声调识别率,但仅有韵母和声调之间差异具有统计学意义（P=0.018 9）。单双侧CI患者声调识别率差异无统计学意义(P>0.05),患者佩戴时长与单音节识别的相关性较弱。结论CI患者的声调识别效果较单音节以及声母和韵母更具有优势,声调识别会在使用CI一定时间后趋于较高水平。植入侧别对其影响较小。     

语后聋人工耳蜗植入者言语识别与生活质量评价

目的对语后聋成年人工耳蜗植入者的言语识别能力和术后生活质量进行评估,并探讨二者之间的相关性。方法 12例植入手术半年以上的语后聋人工耳蜗植入者,男性5例,女性7例。应用噪声下普通话言语测试系统(Mandarin Hearing in Noise Test,MHINT)评估植入者在安静条件下和噪声条件下的言语识识别能力,其噪声条件下测试以每一个体在安静条件下所得言语识别率的50%为标准,获得该标准下的信噪比;应用Nijmegen人工耳蜗植入量表(Nijmegen Cochlear Implantation Questionnaire,NCIQ)评价植入者的术后生活质量。结果所有植入者术后言语识别率和生活质量均有明显改善。①安静条件下平均言语识别率为63.5±26.6%;②噪声条件下的平均信噪比为10.3±3.7dB;③NCIQ总分及基本声音感知、高级声音感知、言语功能、自信心、活动能力和交流能力等六个子维度得分均有改善(P<0.05);④NCIQ总分及各子维度得分与言语测试结果间均无显著相关(P>0.05)。结论语后聋成年人工耳蜗植入者术后生活质量获得显著改善,其自我主观评价明显优于言语识别能力评价。     

语后聋Nucleus人工耳蜗使用者的声调识别

目的 评估语后聋Nucleus人工耳蜗使用者的普通话声调识别水平，探讨其影响因素。方法应用(MACC)材科及北京协和医院耳蜗中心自编（声调测试）材科，评估14例语后聋Nucleus人工耳蜗使用者的普通话声调识别能力，其中使用Nucleus24型Sprint产品ACE方案者11例，Nucleus22型MSP产品MPEAK方案者3例。结果所有植入者的普通话声调识别率均高于机会水平，其中2例Nucleus24型Sprint产品使用者可达到100％。结论Nucleus人工耳蜗语后聋使用者可以获得较好的普通话声调识别．Nucleus24型Sprint产品可为部分植入者提供充分的声调信息。     

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。     

植入人工耳蜗与配戴助听器儿童背景噪声下的声调识别

目的 探讨植入人工耳蜗与配戴助听器儿童在声调识别方面是否存在差异,分析背景噪声对听障儿童声调识别的影响.了解在噪声环境中听障儿童声调识别的特点.方法 采用2X4两因素混合实验设计,比较植入人工耳蜗与配戴助听器儿童在不同信噪比条件下(SNR=+12,+6,0 dB)的声调识别能力;采用单因素方差分析,比较不同声调组合识别对听障儿童的难易程度.结果 ①在重建或补偿听阈相似时,植入人工耳蜗与配戴助听器儿童声调识别能力的差异不显著;②在不同信噪比条件下,两组儿童声调识别能力的差异极其显著;③两组儿童均最易分辨一声与四声的差异,最难分辨二声与三声的差异.结论 只要重建或补偿听阈在最适范围,听障儿童便具有一定的声调识别能力,但噪声会对其产生极大的影响.     

婴幼儿期植入人工耳蜗的语前聋儿童单字声调产出特点

目的 探究3岁以内单侧植入人工耳蜗、使用普通话交流且言语康复半年以上的语前聋儿童术后单字声调产出特点和发展规律.方法 以19例3岁以内单侧植入人工耳蜗的语前聋儿童(C I组,生理年龄平均3.79±1.23岁,植入年龄平均1.28±0.55岁)和24例生理年龄与CI组匹配的正常听力儿童(N H组,生理年龄平均3.90±1...     

语前聋儿童人工耳蜗植入效果的评估

目的探索语前聋儿童人工耳蜗植入效果的评估方法.方法受试者为18名接受人工耳蜗植入的语前聋儿童,耳蜗植入时平均年龄6岁.按人工耳蜗使用时间长短分为四个阶段进行评估:第一阶段18名患儿,使用人工耳蜗1～12个月;第二阶段12名,使用人工耳蜗13～24个月;第三阶段8名,使用人工耳蜗25～36个月;第四阶段6名,使用人工耳蜗在36个月以上.描述性分析,以问卷的形式了解儿童在人工耳蜗植入后声音接受、言语表达及行为等方面的变化;言语测试,进行言语识别能力和发声能力测试.结果第一阶段患儿,能够感知和辨别来自家庭和环境中的声音;第二阶段患儿,封闭项词识别率是51%,开放项词识别开始启动;第三阶段患儿,封闭项词识别率达到72%,开放项词识别率是40%,能正确发出的单词数是42%;第四阶段患儿,封闭项词识别率和开放项词识别率分别达到84%和53%,能正确发出的单词数达62%,部分患儿已有自发的口语表达.结论人工耳蜗植入对语前聋患儿的言语发育有帮助,患儿的言语能力随着人工耳蜗使用时间的推移不断进步.     

语前聋患儿6岁前与6岁后植入人工耳蜗效果的比较

目的比较6岁前与6岁后两个年龄组语前聋患儿人工耳蜗植入术后的听觉言语康复的效果. 方法对31例语前聋人工耳蜗植入患儿,术后随访0.5～4年,按手术年龄分成A组(1.0～5.9岁)和B组(6.0～17.9岁),进行术后的听觉和言语识别率的评估. 结果 31例语前聋人工耳蜗植入患儿全部手术成功,全部建立了主观听性反应.A组的纯音听力水平平均为30dBSPL,开放式言语识别率平均为90%.B组的纯音听力水平平均为36dBSPL,开放式言语识别率平均为85%. 结论植入人工耳蜗的语前聋患儿1.0～5.9岁与6.0～17.9岁比较,在术后的言语识别率和语言清晰度两方面的听觉言语康复效果有显著性差异,年龄越小效果越好.因此,为达到满意的听觉言语康复效果,人工耳蜗植入的时机最好在6岁之前.     

Mandarin Chinese speech recognition by pediatric cochlear implant users

Objectives

Because of difficulties associated with pediatric speech testing, most pediatric cochlear implant (CI) speech studies necessarily involve basic and simple perceptual tasks. There are relatively few studies regarding Mandarin-speaking pediatric CI users’ perception of more difficult speech materials (e.g., words and sentences produced by multiple talkers). Difficult speech materials and tests necessarily require older pediatric CI users, who may have different etiologies of hearing loss, duration of deafness, CI experience. The present study investigated how pediatric CI patient demographics influence speech recognition performance with relatively difficult test materials and methods.

Methods

In this study, open-set recognition of multi-talker (two males and two females) Mandarin Chinese disyllables and sentences were measured in 37 Mandarin-speaking pediatric CI users. Subjects were grouped according to etiology of deafness and previous acoustic hearing experience. Group 1 subjects were all congenitally deafened with little-to-no acoustic hearing experience. Group 2 subjects were not congenitally deafened and had substantial acoustic hearing experience prior to implantation. Multiple linear regression analyses were performed within each group using subject demographics such as age at implantation and age at testing.

Results

Pediatric CI performance was generally quite good. For Group 1, mean performance was 82.3% correct for disyllables and 82.8% correct for sentences. For Group 2, mean performance was 76.6% correct for disyllables and 84.4% correct for sentences. For Group 1, multiple linear regression analyses showed that age at implantation predicted disyllable recognition, and that age at implantation and age at testing predicted sentence recognition. For Group 2, neither age at implantation nor age at testing predicted disyllable or sentence recognition. Performance was significantly better with the female than with the male talkers.

Conclusions

Consistent with previous studies’ findings, early implantation provided a significant advantage for profoundly deaf children. Performance for both groups was generally quite good for the relatively difficult materials and tasks, suggesting that open-set word and sentence recognition may be useful in evaluating speech performance with older pediatric CI users. Differences in disyllable recognition between Groups 1 and 2 may reflect differences in adaptation to electric stimulation. The Group 1 subjects developed speech patterns exclusively via electric stimulation, while the Group 2 subjects adapted to electric stimulation relative to previous acoustic patterns.     

母语为汉语患者应用多道人工耳蜗的言语识别

目的　对母语为汉语的多通道人工耳蜗使用者进行言语评估及结果分析。方法　５ 例语后聋成人中,应用ＭＡＣＣ（ 汉语最低听觉功能） 测试材料,分别进行了包括封闭项列（ 机会水平０ ．２５） 和开放项列两大部分的言语识别测试。结果　韵母平均正确识别率５７ ．７１ ％ （２５ ．６９ ％ ～８８ ．１９ ％ ） ;声母７２ ．０４ ％ （４６ ．２３ ％ ～９０ ．４８ ％ ） ;数词８３ ．２６ ％ （４８ ．００ ％ ～１００ ．０ ％ ） ;声调６１ ．６８ ％ （４６ ．４０ ％ ～７１ ．４０ ％ ） ;单字词３８ ．２７ ％ （１ ．７１ ％ ～７９ ．５５ ％ ） ;双字词４４ ．１２ ％ （０ ．００ ％ ～９５ ．９４ ％ ） ;短句中关键字识别率４７ ．８８ ％ （０ ．５３ ％ ～９７ ．３４ ％ ） ;噪声中短句识别全部患者均为０ ％ ;环境声识别率５０ ．５２ ％ （７ ．１４ ％ ～８０ ．９５ ％ ） 。全部患者封闭项列的正确识别率均大于机会水平,而开放项列识别表现不一。结论　国人应用多导人工耳蜗装置后能获得较好的听觉能力和语言交流能力,应用多道人工耳蜗治疗重度和全聋患者具有实用价值     

语前聋成人人工耳蜗植入者嗓音的声学分析

目的观察成人语前聋人工耳蜗植入者嗓音的特点,为这类患者的植入及嗓音矫治提供依据。方法分别对28例语前聋成人人工耳蜗植入者、18例语前聋者和10例正常听力者的元音[a ]3s稳定段进行声学分析,分析内容包括基频、第一、第二共振峰、嗓音声学参数频率微扰商、振幅微扰商、谐噪比。对3组结果进行比较。结果人工耳蜗组的基频为(175 42±25 31)Hz,较耳聋组的(210 84±54 30)Hz有下降(P=0 02)。人工耳蜗组共振峰位置[F2 =(1264 64±152 19)Hz]比耳聋组[F2=(1422 44±232 37)Hz]更接近于正常听力组(P=0 02)。频率微扰商在人工耳蜗组(2 09±1 15)较耳聋组(5 32±4 29)更接近于正常听力组(P=0 006)。人工耳蜗组和耳聋组的嗓音表现出较大的个体差异。结论从嗓音声学特点的角度而言,成人语前聋人工耳蜗植入者可以有限地获益于人工耳蜗植入。由于他们的语言识别能力远远差于儿童和成人语后聋人工耳蜗植入者,其总体效果有限,对这类患者的植入应该慎重开展。     

Deficits in auditory frequency discrimination and speech recognition in cochlear implant users

Abstract

Objectives

Speech recognition varies considerably following cochlear implantation for reasons that are still poorly understood. Considering the role of frequency discrimination in normal speech recognition, the aim of this study was to investigate the association between deficits in auditory frequency discrimination and speech recognition in cochlear implant users.

Methods

Frequency discrimination thresholds and speech recognition were assessed in a group of 20 cochlear implant users and 16 normally hearing controls.

Results

Based on their results on the speech recognition task, the cochlear implant users were categorized either as proficient (n = 10) or non-proficient users (n = 10). The non-proficient cochlear implant users had poorer auditory frequency discrimination compared to the normal hearing participants and proficient cochlear implant users (both P < 0.05). No significant difference was found between the proficient cochlear implant users and the normally hearing group (P > 0.05). Furthermore, a bivariate correlation analysis revealed a relationship between speech recognition and frequency discrimination.

Conclusions

The present findings suggest an association between auditory frequency discrimination and speech recognition proficiency in cochlear implant users. Although no causal link can be drawn from these data, possible reasons for this association are discussed.     

Tone production and perception and intelligibility of produced speech in Mandarin-speaking cochlear implanted children

Objective: This study explored tone production, tone perception and intelligibility of produced speech in Mandarin-speaking prelingually deaf children with at least 5 years of cochlear implant (CI) experience. Another focus was on the predictive value of tone perception and tone production as they relate to speech intelligibility. Design: Cross-sectional research. Study sample: Thirty-three prelingually deafened children aged over eight years with over five years of experience with CI underwent tests for tone perception, tone production, and the Speech Intelligibility Rating (SIR). A Pearson correlation and a stepwise regression analysis were used to estimate the correlations among tone perception, tone production, and SIR scores. Results: The mean scores for tone perception, tone production, and SIR were 76.88%, 90.08%, and 4.08, respectively. Moderately positive Pearson correlations were found between tone perception and production, tone production and SIR, and tone perception and SIR (p?p?p?p?Conclusions: Mandarin-speaking cochlear-implanted children with sufficient duration of CI use produce intelligent speech. Speech intelligibility can be predicted by tone production performance.     

Sensorimotor interaction in deaf children. Relationship between gait performance and hearing input during childhood assessed in pre-lingual cochlear implant users

Abstract

Conclusions: The results suggest that auditory input is not neutral in motor skills and the complex interaction between them is generated in the earlier stages of childhood development.

Objective The assessment of gait performance in pre-lingual deaf children with cochlear implant (CI).

Methods: Gait velocity (GV), using a 10-meter test, was measured by means of three inertial sensors in 10 pre-lingual cochlear implant users (CIU) (10–16 years old) in three sensory conditions: (1) cochlear implant turned on with environmental noise (EN), (2) cochlear implant turned on with EN and with cognitive dual task (DT), and (3) CI turned off (CI-OFF). GV with EN and DT was assessed in a normal hearing control group (CG) (n?=?14). Mann-Whitney and Wilcoxon Signed ranked test were used for significance validation.

Results: (1) GV in CG was lower in DT than with EN (p?=?.019). (2) GV was faster in CG with EN compared with the three conditions in CIU (EN, p?=?.006; DT, p?=?.0001; CI-OFF, p?=?.03). (3) CIU had slower GV walking with EN (p?=?.037) and with DT (p?=?.022). (4) Dividing the CIU sample by age, the acoustic information generates a slower gait for those implanted after 3 years old.     

Outcome analysis of cochlear implant reimplantation in children

OBJECTIVES: We review our experience gained in performing cochlear reimplantation in 25 children who have had multichannel cochlear implant device failure at the Cochlear Implant Center of the Manhattan Eye, Ear and Throat Hospital and Lenox Hill Hospital (New York, NY), to assess the feasibility of cochlear reimplantation in children and the effect of reinsertion on audiological performance. STUDY DESIGN: We retrospectively analyzed the outcome of 27 consecutive multichannel cochlear implant reinsertions performed in 25 children at the Manhattan Eye, Ear and Throat Hospital and Lenox Hill Hospital. These reimplantations were performed between 1990 and 1999, with a minimum follow-up of 6 months for both surgical and audiological performance. METHODS: Charts were reviewed for patient factors, findings at the time of initial operation and repeat operation, and results of audiological testing both before and after reimplantation. RESULTS: Surgical complications of reimplantation included two intraoperative cerebral spinal fluid leaks and two late postoperative flap breakdowns with implant extrusions. For the most part, depth of electrode insertion was unchanged. Open-set speech recognition scores and speech perception abilities remained stable or improved compared with results before reimplantation. CONCLUSION: Our results confirm that cochlear implant reimplantation is technically feasible and allows for continued auditory development for the child who has a cochlear implant device failure.     

不同年龄人工耳蜗置入语前聋儿童元音基频和共振峰变化分析

目的观察不同年龄的语前聋人工耳蜗置入的儿童在置入人工耳蜗后,其元音基频和共振峰的变化规律,为术后语言康复工作提供指导和依据。方法使用澳大利亚Cochlear公司的24M和24Contour置入体、Esprint语言处理器的人工耳蜗置入语前聋儿童19例,分为4岁组和10岁组。采用北京阳宸电子技术公司开发的Vs99嗓音工作站分析软件,对两组患儿[a∶]音3s稳定段进行声学分析,提取基频和共振峰。结果4岁组平均基频与正常组比较无统计学意义;10岁组与正常组比较有统计学意义(P<0.05)。4岁组平均第一共振峰(F1)与正常组比较无统计学意义;10岁组与正常组比较有统计学意义(P<0.01)。4岁组平均第二共振峰(F2)明显高于同年龄性别儿童;10岁组与正常组比较无统计学意义。4岁组平均F1/F2与正常组比较无统计学意义;10岁组与正常组比较有统计学意义(P<0.01)。结论年龄因素对4～10岁年龄段人工耳蜗置入儿童的发声有明显的影响。