听障儿童双耳双模式配戴的声源定位能力初探*

目的探讨双耳双模式配戴能否帮助听障儿童改善声源定位能力以及哪些因素可能影响双耳双模式声源定位优势的发挥。方法采用强迫二选一任务,比较16名听障儿童在不同助听模式及不同声源角度下的声源定位能力。结果声源位于90°/270°时,38%的被试体现出双耳双模式的声源定位优势;位于45°/315°时,优势比例下降到25%。进一步分析表明,人工耳蜗麦克风的位置以及术前双耳配戴助听器的经验与双耳双模式声源定位优势的发挥密切相关。结论声源定位能力是听障儿童日常生活中的难点,即使双耳双模式配戴,也仅在声源位于左右方时,比单侧耳蜗状态体现出一定优势,随着声源角度的减小,双耳强度差和时间差线索减弱,双耳双模式的声源定位优势也随之减小。人工耳蜗的麦克风须放置在正确位置,否则会影响声源定位能力。此外,术前助听器配戴经验可能会影响听障儿童利用双耳线索的能力。     

双耳双模式助听患者的声调识别和音乐感知

双耳双模式是指一侧植入人工耳蜗,对侧佩戴助听器的助听方式,已帮助许多听力损失患者重新回到有声世界。本文就双耳双模式对助听患者的声调识别与音乐感知能力的效果进行综述,以期挖掘患者更多的听力潜能,使患者获得更好的生活。     

双耳双模式助听患者汉语普通话声调识别特征

目的 比较双耳双模式助听患者在安静环境和不同背景噪声下的声调识别率,探讨不同信噪比和不同基频噪声下的双模式优势.方法 12例一侧植入人工耳蜗、对侧佩戴助听器[双模式(CIHA)]的汉语普通话患者参加本研究,所有患者双模式使用时间均为半年以上.使用天使语训i-CAST测试软件的人工耳蜗科研项目模块,采用闭合式测试方法,分别测试受试者在安静环境和不同背景噪声环璋下单独使用人工耳蜗(CI)、单独使用助听器(HA)和双模式下(CIHA)的声调识别率,测试环境包括安静环境、男信号男背景、男信号女背景三种,每种背景噪声包含10、5和0 dB三种信噪比(以下将6种背景噪声简称为男男10、男男5、男男0、男女10、男女5和男女0),即每位患者进行21组测试;每组分别测试/Ba/、/Bi/、/Bo/、/Bu/4个音的一、二、三、四4个声调;测试声通过扬声器发出,强度为65 dB SPL;记录患者上述三种模式下的助听听阈及助听侧裸耳听阈.结果 患者在CIHA与CI模式下的助听听阈差异无统计学意义(P>0.05),但均与HA模式和非植入侧的裸耳听阈差异有统计学意义(P<0.05).声调识别率受背景环境的显著影响(F=24.77,P<0.001),安静环境、男男5和男男0背景噪声环境下双模式无明显优势(P>0.05),在男男10、男女10、男女5和男女0背景噪声环境下双模式均有显著优势(P值分别为0.010,0.012,0.015和0.001).结论 本组患者在安静环境下的声调识别双模式无显著优势,信号声与背景噪声基频不同时,双模式优势显著.     

双耳双模式调试策略研究进展

和单侧人工耳蜗相比,双耳双模式助听优势已被广泛认可,但是如何调试能够使得双耳双模式优势最大化还未达成共识,因此本文通过梳理国外相关文献,结合我国国情,分别从频率响应(全频段放大、高频增益限制、移频)和响度平衡两方面探讨对于双耳双模式配戴的调试策略,并介绍了助听器和人工耳蜗联动技术进展,旨在为临床调试提供参考,促进相关研究的开展。     

听障儿童双耳双模式配戴的机制及应用研究进展

经过30年的发展,现代多通道人工耳蜗植入术已被证明是最有效的听力重建手段。人工耳蜗植入使全世界重度和极重度听障儿童在很多方面受益,尤其是为他们提供了良好的安静环境下的言语识别能力。     

学龄前听障儿童与健听儿童不同语句的语调声学特点比较

目的：探讨学龄前听障儿童不同语句语调的声学特点,为其语调训练提供参考。方法选取4～5岁听障儿童和健听儿童各20例,以自编陈述和疑问语句为测试材料,获得两组儿童边界调的起点值、终点值和频率值,分析不同语调类型和儿童类型之间的差异及相互影响。结果两类学龄前儿童疑问句边界调的起点值、终点值和斜率值均大于陈述语句;与健听儿童相比,听障儿童陈述语调的第一声边界调斜率值偏低即音高下倾趋势过多,第四声边界调起点值、终点值均偏低即音高曲线整体下降过多;听障儿童疑问语调的第一、二、三声边界调斜率值偏小,即音高上扬趋势不足,第一、四声边界调起点值、终点值都偏低,即音高曲线整体提高不够。结论学龄前听障儿童陈述语调比疑问语调掌握好,在疑问语调训练时,可以依据其边界调音高曲线的起点、终点和走势特征进行针对性训练。     

听障儿童疑问语调发音异常干预的个案研究

目的：探讨听障儿童疑问语调发音异常的矫治方法。方法对1例5岁4个月配戴助听器的疑问语调发音异常听障儿童实施针对性训练,采用单一被试研究方法,对比个案干预前后疑问语调边界调的终点基频值和基频斜率值。结果干预前后被试基线期和处理期的终点基频值（P=0.0156<0.05）和基频斜率值（P=0.0011<0.05）数据呈显著性差异。结论本研究设计的综合性康复训练方案使听障儿童疑问语调发音异常得到有效改善,可为临床康复提供理论与实践依据。     

听障儿童电声双模式助听的应用效果

目的 研究调查听障儿童一侧耳植入人工耳蜗后对侧耳配戴助听器,这种电声双模式同时刺激的应用效果.方法 随机测试78名儿童人工耳蜗植入者在使用人工耳蜗和助听器(CI+HA)及单独使用人工耳蜗(CI)时听觉事件相关电位MMN和P300潜伏期及波幅的变化,比较同一患者在三种环境下(安静、S/N-0dB,S/N-15dB)的听觉言语识别率,并进行家长问卷调查.结果 患者使用CI+HA与CI的MMN 引出率分别是 80%和75%,P300引出率分别是93.1%和89%;CI+HA组与CI组MMN和P300潜伏期以及CI+HA组与正常组P300波幅的比较有显著差异(P<0,05);在S/N-0dB时CI+HA组单音节、双音节和声调的识别率均高于CI组(P<0.05),而安静环境下和S/N-15dB时组内比较无统计学意义;开放式问卷调查结果 显示60.26%的患者认为使用CI+HA模式能获得更多不同的听觉帮助.闭合式问卷结果 显示使用CI+HA和单用CI的聆听效果有差别.结论 本文大多数听障儿童使用电声同时刺激的助听模式.大脑中枢处理系统并不拮抗,能发挥协同作用,尤其在改善噪声环境下的言语识别和声调感知.以及声源定位和声信息的利用等方面具有优势.     

双模式助听儿童的皮层听觉诱发电位特征研究北大核心CSCD

目的探讨人工耳蜗及助听器(hearing aids,HA)双模式助听与单独人工耳蜗植入(cochlear implant,CI)患者皮层听觉诱发电位(cortical auditory evoked potential,CAEP)中P1及失匹配负波(mismatch negativity,MMN)的分化特征,对双模式助听效果进行客观评价。方法双模式助听儿童7例(双模式使用时长均不少于6个月),在CI与助听器达到最佳助听模式后,分别在双模式及单侧CI两种助听模式下,以/ba1/、/ba4/(即/ba/一声和四声)作为标准刺激与偏差刺激声进行声场下CAEP测试,分析两种模式下P1波和MMN的潜伏期与幅值的差异。结果双模式助听下CAEP的P1的潜伏期、幅值以及MMN的潜伏期、幅值分别为159.29±31.80 ms、1.86±3.12μV、245.29±58.82 ms、-2.16±1.34μV;单侧CI助听时分别为172.00±43.84 ms、1.26±2.85μV、288.29±54.00 ms、-1.63±1.19μV。双模式助听下P1及MMN潜伏期较单侧助听CI时显著缩短(P<0.05),P1及MMN幅值较单侧CI时呈现增大趋势,但差异无统计学意义(P>0.05)。结论CI及助听器双模式助听下CAEP的P1及MMN潜伏期较单侧CI助听时显著缩短,提示双模式助听下患者听觉辨别能力提高。     

学业不良儿童声调双耳分听能力的特征研究

目的探讨学业不良儿童声调双耳分听能力的特征。方法采用自编材料对小学三年级学业优良和学业不良儿童声调双耳分听能力进行比较分析。结果①学业不良儿童双耳声调分听能力显著低于学业优良儿童;②在声调分听材料中,有意义材料的分听具有右耳、左脑效应,而无意义材料则没有明显的半球优势;③学业不良儿童双耳分听无意义材料时,四声最容易,一声、二声其次,三声最难;而分听有意义材料时,则一、三、四声较容易,二声最难。结论教师应采用恰当的训练措施帮助学业不良儿童提高双耳分听能力,增强其听处理能力,最终提高其学业成绩。     

A Clinical Test for the Assessment of Binaural Speech Perception in Noise

The present paper describes a clinical test for the assessment of speech perception in noise. The test was designed to separate the effects of several relevant monaural and binaural cues. Results show that the performance of individual hearing-impaired listeners deviates significantly from normal for at least 2 of the following aspects: (1) perception of speech in steady-state noise; (2) relative binaural advantage due to directional cues; (3) relative advantage due to masker fluctuations. In contrast, both the hearing loss for reverberated speech and the relative binaural advantage due to interaural signal decorrelation, caused by reverberation, were essentially normal for almost all hearing impaired.     

语前聋儿童佩戴助听器后塞音发音特点

目的分析听力障碍患儿佩戴助听器后塞音的发音特点。方法以佩戴助听器的语前聋患儿30例(助听器组)和健听儿童30例(健听组)为研究对象,年龄3~6岁(分为3~、4~、5~6岁组,每组2类儿童各10例),日常均使用汉语普通话交流,具备一定的发音能力。以塞音词表进行测试,分析两组儿童塞音(/b/、/d/、/g/、/p/、/t/、/k/)的发音正确率和错误类型,分析不同生理年龄、助听时间与发音正确率的关系。结果助听器组儿童塞音发音的正确率从高到低为/b/>/d/>/g/>/k/>/t/>/p/,健听组儿童塞音发音的正确率从高到低依次为/b/>/g/>/k/>/p/>/d/>/t/;健听组儿童塞音/b/、/g/、/k/、/t/、/p/的正确率显著高于助听器组儿童(P<0.05)。助听组儿童发音错误规律包括:①发音方法相同的音互相替代,如不送气塞音的互相替代和送气塞音的互相替代;②发音部位相同的音互相替代;③发音方法和发音部位不同的替代,如:塞音擦音化,塞音塞擦音化,不送气化。4~、5~6岁组听障儿童塞音/g/、/p/、/k/发音的正确率明显高于3~岁组(P<0.05),助听器佩戴时间大于2年的听障儿童塞音/p/、/t/发音的正确率明显高于小于2年的儿童(P<0.05)。结论听障儿童塞音发音清晰度落后于健听组儿童,生理年龄、听觉干预的时间对听障儿童部分塞音发音的正确率有影响,需进行积极的干预和有针对性的康复训练。     

Advantages of Binaural Amplification to Acceptable Noise Level of Directional Hearing Aid Users

Objectives

The goal of the present study was to examine whether Acceptable Noise Levels (ANLs) would be lower (greater acceptance of noise) in binaural listening than in monaural listening condition and also whether meaningfulness of background speech noise would affect ANLs for directional microphone hearing aid users. In addition, any relationships between the individual binaural benefits on ANLs and the individuals'' demographic information were investigated.

Methods

Fourteen hearing aid users (mean age, 64 years) participated for experimental testing. For the ANL calculation, listeners'' most comfortable listening levels and background noise level were measured. Using Korean ANL material, ANLs of all participants were evaluated under monaural and binaural amplification with a counterbalanced order. The ANLs were also compared across five types of competing speech noises, consisting of 1- through 8-talker background speech maskers. Seven young normal-hearing listeners (mean age, 27 years) participated for the same measurements as a pilot testing.

Results

The results demonstrated that directional hearing aid users accepted more noise (lower ANLs) with binaural amplification than with monaural amplification, regardless of the type of competing speech. When the background speech noise became more meaningful, hearing-impaired listeners accepted less amount of noise (higher ANLs), revealing that ANL is dependent on the intelligibility of the competing speech. The individuals'' binaural advantages in ANLs were significantly greater for the listeners with longer experience of hearing aids, yet not related to their age or hearing thresholds.

Conclusion

Binaural directional microphone processing allowed hearing aid users to accept a greater amount of background noise, which may in turn improve listeners'' hearing aid success. Informational masking substantially influenced background noise acceptance. Given a significant association between ANLs and duration of hearing aid usage, ANL measurement can be useful for clinical counseling of binaural hearing aid candidates or unsuccessful users.     

听障儿童声母音位对听说对比特征研究

目的 本研究以音位对为载体,从听说两方面探讨听障儿童的听觉识别和构音语音特征,从而为听障儿童声母构音语音异常矫治提供指导.方法 对60名听障儿童声母音位对的听觉识别能力与构音语音能力进行分析,分别从听、说和听说对比3个维度对汉语普通话中的9项23对声母音位对的听觉识别和构音语音得分进行统计比较.结果 [1]9项声母音位对在听和说两方面难度分布相似,塞音与鼻音音位对、送气塞音与不送气塞音音位对的难度都较低,舌尖前音和舌尖后音音位对的难度较高;[2]23对声母音位对的听觉识别难度低于构音语音难度,被试的听觉识别平均分高于构音语音平均分;[3]听障儿童的听觉识别平均分和构音语音平均分具有显著的正相关,听觉识别能力越高,构音语音能力也相对较高.结论 听障儿童的构音语音能力落后于听觉识别能力.对听障儿童进行构音语音异常矫治时,要充分利用其听觉辨识能力,进行听说对比训练,用听带动说,以增强其构音语音康复训练的效果,提高言语听觉能力.     

Tracking of Complex Binaural Images

Subjects were presented with an initially stationary binaural image formed by the fusion of two identical pulses, without interaural time difference (ITD), at the two ears. The image was then made to traverse the subject's auditory perceptual space by introducing ITD, varying linearly with time, under computer control. The direction of movement, i.e. towards the right or left ear, could be reversed by the listener, by pressing a button. Subjects were requested to keep the image central, by pressing the button when they judged that deviation from subjective centre had occurred.

Experiments of this type can be considered as analogous to Békésy audiometry, where the subject automatically traces his threshold of hearing, in that here the listener traces out his auditory perceptual centre as it varies with time. Hence, equivalent analyses to those employed for Békésy audiometry are possible.

Subsequent to the initial part of the experiment, an additional pulse was added to one channel, preceding the original pulse, to form a pulse pair. The monaural masking of the original pulse by this additional pulse thus acts to shift the pre-existing binaural image. The effect of varying the amplitude and onset time of the masking pulse, relative to the original pulse, on the Békésy-type trace was examined.     

23例听力障碍儿童助听效果评估的探讨

目的 探讨用不同的方法评价助听效果的相关性.方法 对23例4～6岁听障儿童分别采用问卷调查、助听听阈、听觉功能测试等方法进行评估、分析.结果 家长问卷、助听听阈及听觉功能测试3种评估方法的相关系数为0.23～0.51,呈正相关,其相关系数处于低、中相关程度之间.结论 各项评估方法从不同的角度反映患者配戴助听器后的实际效果,相互之间不能替代但又可以互补,临床运用时不能依靠单—评估方法评价判断助听效果.     

Impaired Binaural Hearing in Children Produced by a Threshold Level of Middle Ear Disease

Otitis media with effusion (OME), a form of middle ear disease, is the most common reason for young children both to visit their family doctor and to have surgery. Almost all children have at least a single episode of OME before their first birthday and annual incidence rates exceed 50% in each of the first five years. For most children, OME occurs infrequently, but about 10–15% of children have OME during more than half of their first six years. Middle ear effusions attenuate and delay sound, causing conductive sound distortion during the crucial years for language acquisition. The many studies of OME effects on language and other indices of development have produced mixed results. However, a consensus is emerging of mild language impairment in the preschool years, with subsequent performance, emotional, and behavioral difficulties. In addition to the peripheral hearing loss produced directly by the disease, binaural and other central auditory deficits can outlive the OME. It has been unclear which children are at risk of central impairment following OME, since the children studied have generally been recruited from otolaryngology clinics. Consequently, a detailed prospective history of the middle ear status of participants has not been available. By studying six-year-old children with a lifetime known history of OME, we show in this study that only those children with a cumulative OME experience of more than about half the time during the first five years consistently have residual impaired binaural hearing.     

读写技能训练对学龄期听障儿童学业成绩的影响

目的分析读写技能训练对学龄期听障儿童学业成绩的影响。方法选取2007~2012年在特殊教育学校学习的7~12岁有读写障碍的重度感音神经性听障儿童101名,按年龄分为7~8岁组(n=37)、9~10岁组(n=39)、11~12岁组(n=25),分别在读写技能训练前后采用《儿童汉语阅读障碍量表》(dyslexia cheeklist for Chinese children,DCCC)对儿童进行评估,采用学习成绩等级评价反映儿童的学业成绩。结果训练后不同年龄组儿童的DCCC总分均较训练前不同程度下降,7~8岁组、9~10岁组训练前后的DCCC总分无显著差异(P>0.05),而11~12岁组训练前后的DCCC总分有显著差异(P<0.05)。训练后不同年龄组的学业成绩均较训练前有不同程度提高,7~8岁组、11~12岁组训练前后的学业成绩无显著差异(P>0.05),而9~10岁组训练前后的学业成绩有显著差异(P<0.05)。结论读写技能训练对提升学龄期听障儿童的学业成绩有积极作用,尤其对学龄晚期儿童的效果更佳。