双侧人工耳蜗植入者在噪声环境下的言语辨别能力

目的 探讨双侧人工耳蜗植入患者的言语辨别能力。方法 用2例双侧人工耳蜗植入者比较双侧与单侧人工耳蜗在不同信噪比下对广东话声调的辨别能力。结果 在 15, 10和 5的信噪比下,双侧人工耳蜗的平均能力为96%,92%和88%,而左耳及右耳单侧人工耳蜗的平均成绩为86%,83和74%。在0,-5,-10及-15的信噪比下,单侧人工耳蜗的平均能力近于0%,而双侧人工耳蜗的平均成绩为80%,72%,68%和54%。结论 在不同信噪比下,双侧人工耳蜗植入更有助于提高对广东话声调的辨别能力。进一步证明了双侧人工耳蜗植入患者运用双耳听力的优势。     

同期双侧人工耳蜗植入者言语识别长期效果研究

目的 通过比较同期双侧人工耳蜗植入者和单侧人工耳蜗植入者术后远期听觉言语识别得分,探讨同期双侧植入人工耳蜗对听觉及言语识别能力发展的影响。 方法 选取2007年在北京协和医院接受同期双侧人工耳蜗植入的患者9例(双侧组),并根据年龄、性别、耳聋时间等因素配对选取单侧人工耳蜗植入者9例(单侧组),收集术前听力学资料,随访术后人工耳蜗使用情况。测试两组受试者在安静环境下佩戴人工耳蜗的助听听阈,测试在安静环境和噪声环境下的单音节词、双音节词和短句识别率;设置三种不同声源位置的噪声环境模式(分别模拟头影效应、双侧抑噪效应和中枢冗余效应),测试不同噪声模式及不同信噪比下的短句识别率。使用SPSS 19.0软件进行统计学分析。 结果 安静环境下,相比于单侧人工耳蜗植入组,双侧人工耳蜗植组的平均助听听阈下降(7.2±3.0)dB,差异具有统计学意义( P<0.05)。安静环境下两组单音节词、双音节词和短句的识别率接近,差异无统计学意义( P值均>0.05);噪声环境下,双侧植入者的言语识别率明显好于单侧植入者,差异具有统计学意义( P值均<0.05)。同一信噪比(＋8 dB)噪声环境下短句测试：头影效应模式,双侧组的识别率明显好于单侧组,差异有统计学意义( P<0.01);中枢冗余模式,双侧组的识别率明显好于单侧组,差异具有统计学意义( P<0.01);双侧抑噪模式,双侧组的识别率与单侧组相比,差异无统计学意义( P>0.05)。不同信噪比(＋8 dB、＋4 dB)噪声环境下短句测试,三种噪声给声模式均表现为信噪比越高,言语识别率越高( P值均<0.01)。对比三种噪声给声模式下短句识别率的变化值,头影效应较双侧抑噪和中枢冗余模式受信噪比变化的影响更大,差异有统计学意义( F值分别为3.399和3.875, P值均<0.05);中枢冗余和双侧抑噪效应受信噪比变化的影响相近,差异无统计学意义( F＝0.371, P＝0.549)。 结论 同期双侧植入人工耳蜗与单侧植入相比,可以更好地改善助听听阈,显著提高噪声环境下的单音节词、双音节词及短句的识别率。双耳聆听的三种效应在言语识别能力的发展中起到不同的作用,共同促进噪声环境下言语识别率的提高。     

耳蜗植入可提高言语的识别能力

耳蜗植入可提高言语的识别能力ＢＳＷｉｌｓｏｎ，ＣＣＦｉｎｌｅｙ，ＤＴＬａｗｓｏｎ，ＲＤＷｏｌｆｏｒｔＤＫＥｄｄｉｎｇ，ＷＭＲａｂｉｎｏｗｉｔｚ采用具有最新声信息处理方案的多电极人工耳蜗可获得高水平的言语识别率。人工耳蜗植入系统由一个或多个植入电极组成...     

双侧人工耳蜗植入患者早期言语识别率的特点

目的 通过对两例双侧人工耳蜗植入患者早期言语识别率的分析,探讨双侧人工耳蜗植入对言语识别率的影响及中枢对双侧信号的处理机制。方法 2例先天性聋的双恻人工耳蜗植入的患儿参与测试。第二次植入术后一个月开机时,分别测定双耳、左耳、右耳对数字、单宇词、双字词的言语识别率。结果 新近植入侧单独开机时,各种方法下的言语识别率均为零。分别采用数字,单字词、双字词测试获得的言语识别率各不相同,其差异有显著性(P<0.01)。双侧同时开机可以明显提高患儿对双字词的的识别率,但对数字和单字词的影响不大。在对1例患儿不同时期的言语识别率的观察中,随着双侧人工耳蜗使用时间的延长,无论先植入耳、后植入耳及双耳的言语识别率均有所提高。结论 对数字、单字词、双字词的中枢识别机制有所不同,每一种单独方法都不能完整反映受试者的实际言语听觉能力。证实了双侧人工耳蜗植入术可以明显提高患者的言语识别率;接受双侧人工耳蜗植入术的患者双耳听力效应的重建需要一个重新学习和适应的过程。而耳蜗植入后听力训练则在其中起着极为重要的作用。     

儿童人工耳蜗植入者的言语识别

1　引言在过去的 30年中 ,人工耳蜗 ( cochlearimplant,CI)已从早期的临床试用阶段发展到今天国际上作为重度耳聋的常规治疗方法。美国洛杉矶House耳研所在早期单通道装置的研制和应用方面做了大量的工作 ,他们的 3M/House单道装置于1 984年得到美国食品药品管理局 ( FDA)批准 ,使CI首次作为一种治疗方法正式应用于临床。近 1 0多年来随着微电子学、计算机科学等高新科技的发展 ,多通道 CI在提高使用者的语音识别方面取得了重大突破。1 990年以墨尔本大学 Clark研究中心为代表的多道装置又被 FDA批准应用于临床〔1〕。多通道 CI在重…     

人工耳蜗使用者噪声环境下言语识别能力研究

目的:评估人工耳蜗(CI)植入者在噪声环境下的言语识别能力。方法:利用普通话版噪声下言语测试(MHINT)为言语测试工具,选取22例CI受试者,按照MHINT适应性得分规则,首先确定受试者在噪声下识别50%～74%的句子内容(评分规则3),达到该水平则继续进行75%以上难度内容(评分规则2或规则1),否则停止。获得受试个体在噪声下言语识别能力的语句接受阈、言语识别率和PI function曲线。结果:22例受试者中,5例在噪声下识别能力达80%～90%,3例可达60%～70%,7例达到50%,7例未能达到MHINT评分规则3测试。获得15例受试者的PI function并与听力正常人进行比较。结论:MHINT适应性得分规则测试法,可有效地获得CI植入者在噪声下的言语识别能力。与听力正常者相比,CI植入者的PI function显示右移10dB以上,在噪声环境下仍需要更好的信噪比。     

人工耳蜗植入的言语评估

人工耳蜗作为使深度听障者复聪的主要方法近年来日益得到重视，我国的人工耳蜗从植入数量、科研水平上均与10年前不可同日而语。耳蜗植入的最终目的是使用者能够自如地与他人进行言语交流，其康复成功的第一个标志应该是听懂言语。与国外术前、术后言语评估大量的报告相比．我国的研究相对较少。这不仅影响了国人术后效果与全球各地的比较，而且难以解释现有的多道装置和编码策略对汉     

104例人工耳蜗植入儿童在噪声环境中选择性听取能力的研究

目的 通过对104例6以下植入人工耳蜗的听力障碍儿童在噪声环境中言语识别能力的评估,探讨其在术后不同康复阶段选择性听取能力的发展及其影响因素.方法 采用模拟城市噪声和双音节词识别词表,对人工耳蜗植入儿童分别进行噪声环境下及安静环境下的言语识别能力评估.结果 噪声环境下与安静环境下的言语识别有相似的发展趋势,但得分有显著性差异(P<0.05);术后第1年内不同康复阶段的选择性听取能力差异非常显著(P<0.001).结论 噪声环境下较安静环境下的言语识别难度大,儿童的选择性听取能力在人工耳蜗植入后1年一直有较大幅度的提高,可见术后第1年内是听觉言语康复强化训练的关键期,这一时期对听力障碍儿童的选择性听取能力的发展有显著的促进作用.     

电子耳蜗再植入是否影响言语识别能力

对于语后聋的成人和语前聋的儿童来说,耳蜗植入术已被证明是十分有效的康复方法。但是,人工耳蜗做为一种电子装置,由于技术更新、电极错位、局部感染、操作失误等原因,偶尔仍会受损或失效,此时有必     

人工耳蜗植入患者听觉言语康复及其影响因素研究进展

人工耳蜗是用于重建听觉的植入式电子装置。目前研究主要从言语识别与理解能力及言语产出能力对人工耳蜗植入术后患者的听觉言语康复进行探讨,同时涉及内耳畸形、术前平均残余听力、助听时间、手术年龄、术后康复模式及时间等因素对听觉言语康复的影响。本文对人工耳蜗植入患者的听觉言语康复及其影响因素进行综述。     

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。     

共同腔畸形人工耳蜗手术适应证及手术方法的探讨

目的：探讨共同腔畸形人工耳蜗手术适应证以及人工耳蜗电极植入人路的选择。方法：在对重度或全聋患者进行人工耳蜗植入术前影像掌检查中,发现了6例耳蜗、前庭、外半规管呈共同腔畸形,其中5例有残留听力,1例未查到残留听力。结果：6例影像学检查呈共同腔畸形患者中,对5例有残留听力患者进行了人工耳蜗植入,其中3例选择了常规入路植入电极,2例选择了经乳突侧入路植入电极,术后均建立了人工耳蜗的听觉反应。1例因未查到残留听力,放弃了人工耳蜗手术治疗。结论：有残留听力的共同腔畸形患者,如果能够接受术后听觉言语识别效果差的事实,可以进行人工耳蜗手术。无残留听力或无法了解到有听觉反应的共同腔畸形患者,在现有技术条件下应放弃人工耳蜗植入手术。     

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。     

Correlative studies of cochlear neuronal loss with speech discrimination and pure-tone thresholds

Summary Correlations were made between speech discrimination scores, pure-tone thresholds, and neuronal populations in 28 cochleae which were removed postmortem from elderly patients who had known premortem audiometric records. The predominant pathology present was loss of cochlear neurons. The capability for speech discrimination correlated directly with the innervation density of the 15- to 22-mm region (segment III) of the cochlea. Speech discrimination scores showed an inverse relationship to pure-tone thresholds in the middle frequency range of 1 kHz to 2 kHz.Supported by the National Institute of Neurlogical and Communicative Disorders and Stroke, grant no. 5 ROI NS05881     

Speech perception with a cochlear implant used in conjunction with a hearing aid in the opposite ear

The aim of this study was to determine the improvement in speech recognition provided by a cochlear implant (CI) in conjunction with a hearing aid (HA) in the opposite ear. The study was a retrospective cohort study in the context of a university teaching hospital CI programme. Seven CI patients who still use their HA in the opposite ear were tested. The scores with the CI alone and the CI in conjunction with an HA were evaluated by using three speech perception tests in quiet (Freiburger Numbers, Freiburger Monosyllables, and Innsbrucker Sentence Test). In the majority of tests and subjects, the CI alone performed better than the HA alone, and the bimodal (CI+HA) condition was superior to the CI alone. On the sentence test, the patients as a group improved from 47-96% (mean: 79%; CI alone) to 50-100% (mean: 88.1%; CI+HA, pv<0.05). With the more difficult monosyllable test, the scores improved from 15-52% (mean: 37.2%; CI alone) to 15-82% (mean: 48.7%; CI+ HA, p<0.05). On the numbers test, scores increased from 65-98% (mean: 83%; CI alone) to 75-98% (mean: 88.7%; CI+ HA, p<0.05). All patients in this study were implanted in the poorer ear. The results of the present study suggest the advantage of CI usage in conjunction with an HA in the opposite ear.     

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.     

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。     

Comparison of bilateral and unilateral cochlear implants in children with sequential surgery

Objective

The objective of this study was to evaluate the effect of bilateral versus unilateral cochlear implants and the importance of the inter-implant interval.

Methods

Seventy-three prelingually deaf children received sequential bilateral cochlear implants. Speech recognition in quiet with the first, second and with both implants simultaneously was evaluated at the time of the second implantation and after 12 and 24 months.

Results

Mean bilateral speech recognition 12 and 24 months after the second implantation was significantly higher than that obtained with either the first or the second implant. The addition of a second implant was demonstrated to have a beneficial effect after both 12 and 24 months. Speech recognition with the second implant increased significantly during the first year. A small, non-significant improvement was observed during the second year. The inter-implant interval significantly influenced speech recognition with the second cochlear implant both at 12 and 24 months, and bilateral speech recognition at 12 months, but not at 24 months.

Conclusions

A small, but statistically significant improvement in speech recognition was found with bilateral cochlear implants compared with a unilateral implant. A major increase in speech recognition occurred with the second cochlear implant during the first year. A shorter time interval between the two implantations resulted in better speech recognition with the second implant. However, no definitive time-point was found for when the second implant could no longer add a positive effect.