Acoustically evoked auditory change complex in children with auditory neuropathy spectrum disorder: a potential objective tool for identifying cochlear implant candidates.
Acoustically evoked auditory change complex in children with auditory neuropathy spectrum disorder: a potential objective tool for identifying cochlear implant candidates.
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DOI：
10.1097/aud.0000000000000119
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发表时间：
2015-05
期刊：
影响因子：
3.7
通讯作者：
Buchman CA
中科院分区：
文献类型：
--
作者：
He S;Grose JH;Teagle HF;Woodard J;Park LR;Hatch DR;Roush P;Buchman CA
该研究的总体目的是评估使用听觉变化复合体（ACC）的电生理测量来确定听力神经病变谱系障碍（ANSD）儿童人工耳蜗植入候选人的可行性。为了实现这一总体目标，本研究(1)评估了在一组跨年龄范围的ANSD儿童中测量时间间隔诱发的ACC的可行性；2)研究了由ACC记录测量的间隙检测阈值（GDTs）与开放集语音感知表现之间的关系。本研究共纳入19例双侧ANSD患儿，年龄1.9 ~ 14.9岁，平均7.8岁。所有被试都完成了听觉事件相关电位（ERP）的电生理记录，包括开始的ERP反应和ACC，并对16个被试的开放集语音感知进行了评估。对于ERP记录，刺激是通过ER-3A插入式耳机呈现给测试耳的高斯噪声。采用了两种刺激条件。在“控制条件”中，刺激是一个800毫秒的高斯噪声。在“间隙条件”中，刺激是两个噪声段，每个噪声段的持续时间为400毫秒，由5个间隙（即5、10、20、50或100毫秒）中的一个隔开。刺激间隔为1200 ms。使用语音平衡幼儿园（PBK）单词表，在60 dB SPL的声压下使用录音测试材料评估辅助开放集语音感知能力。对于言语感知测试，受试者按照临床听力学家推荐的设置佩戴助听器。对于一个由五名受试者组成的亚组，心理物理间隙检测阈值对高斯噪声也使用三间隔，三种选择的强制选择程序进行评估。本研究记录了所有被试在所有刺激条件下由高斯噪声触发引起的反应（即触发反应）。出现/不存在，峰值潜伏期和振幅，以及开始反应的反应宽度与辅助PBK单词得分无关。17例受试者的ACC记录测量的客观GDTs范围为10 ~ 100 ms。在本研究中，没有记录两个受试者的任何间隔时间。客观GDTs和辅助PBK单词评分之间存在显著的负相关。总的来说，客观GDTs延长的受试者显示出较低的辅助PBK单词得分。使用前扣带电生理记录测量的GDTs与使用心理物理方法测量的GDTs在使用两种方法评估的五名受试者中有四名具有良好的相关性。起病反应在预测开放性言语知觉能力方面的临床应用相对有限。ACC记录可用于客观评价无严重合并症且年龄大于1.9岁的ANSD儿童的时间分辨能力。ACC可以作为一种客观的工具，通过适当的放大来识别表现不佳的ANSD儿童，从而确定谁是人工耳蜗的候选人。
The overall aim of the study was to evaluate the feasibility of using electrophysiological measures of the auditory change complex (ACC) to identify candidates for cochlear implantation in children with auditory neuropathy spectrum disorder (ANSD). In order to achieve this overall aim, this study 1) assessed the feasibility of measuring the ACC evoked by temporal gaps in a group of children with ANSD across a wide age range; and 2) investigated the association between gap detection thresholds (GDTs) measured by the ACC recordings and open-set speech-perception performance in these subjects. Nineteen children with bilateral ANSD ranging in age between 1.9 to 14.9 yrs (mean: 7.8 yrs) participated in this study. Electrophysiological recordings of the auditory event-related potential (ERP), including the onset ERP response and the ACC, were completed in all subjects and open-set speech perception was evaluated for a subgroup of sixteen subjects. For the ERP recordings, the stimulus was a Gaussian noise presented through ER-3A insert earphones to the test ear. Two stimulation conditions were used. In the “control condition,” the stimulus was an 800-ms Gaussian noise. In the “gapped condition”, the stimuli were two noise segments, each being 400 ms in duration, separated by one of five gaps (i.e. 5, 10, 20, 50, or 100 ms). The inter-stimulation interval was 1200 ms. The aided open-set speech perception ability was assessed using the Phonetically Balanced Kindergarten (PBK) word lists presented at 60 dB SPL using recorded testing material in a sound booth. For speech perception tests, subjects wore their hearing aids at the settings recommended by their clinical audiologists. For a subgroup of five subjects, psychophysical gap detection thresholds for the Gaussian noise were also assessed using a three-interval, three-alternative forced-choice procedure. Responses evoked by the onset of the Gaussian noise (i.e. onset responses) were recorded in all stimulation conditions from all subjects tested in this study. The presence/absence, peak latency and amplitude, and response width of the onset response did not correlate with aided PBK word scores. The objective GDTs measured with the ACC recordings from seventeen subjects ranged from 10 to 100 ms. The ACC was not recorded from two subjects for any gap durations tested in this study. There was a robust negative correlation between objective GDTs and aided PBK word scores. In general, subjects with prolonged objective GDTs showed low aided PBK word scores. GDTs measured using electrophysiological recordings of the ACC correlated well with those measured using psychophysical procedures in four of five subjects who were evaluated using both procedures. The clinical application of the onset response in predicting open-set speech-perception ability is relatively limited in children with ANSD. The ACC recordings can be used to objectively evaluate temporal resolution abilities in children with ANSD having no severe comorbidities, and who are older than 1.9 years. The ACC can potentially be used as an objective tool to identify poor performers among children with ANSD using properly fit amplification, and who are thus, cochlear implant candidates.