Unilateral Hearing Loss: Understanding Speech Recognition and Localization Variability-Implications for Cochlear Implant Candidacy.
Unilateral Hearing Loss: Understanding Speech Recognition and Localization Variability-Implications for Cochlear Implant Candidacy.
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DOI：
10.1097/aud.0000000000000380
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Holden LK
中科院分区：
文献类型：
--
作者：
Firszt JB;Reeder RM;Holden LK
至少，单侧听力损失 (UHL) 会损害声音定位能力和在嘈杂环境中理解语音的能力，特别是当损失严重到极深时。伴随 UHL 的众多负面后果的是其影响程度存在相当大且无法解释的个体差异。识别影响结果并导致 UHL 变异的协变量可以增强咨询、治疗选择和康复。人工耳蜗植入作为 UHL 的治疗方法正在兴起，但对于可能影响表现的因素，或者当一只耳朵的听力接近正常时是否有一个群体面临人工耳蜗植入效果不佳的风险，人们知之甚少。我们研究的总体目标是调查患有严重至极重度 UHL 的个体在噪声和定位中语音识别变异的范围和来源，从而帮助确定与该人群中的人工耳蜗植入决策相关的因素。本研究评估了患有重度至极重度 UHL 的成年人和双侧听力正常的成年人。措施包括餐厅弥漫噪声中的自适应句子理解、定位、流动源语音识别（来自 140° 弧内 15 个说话者中的 1 个的单词）以及具有不同噪声类型和噪声源位置的自适应语音接收阈值心理声学任务。分为三个年龄-性别匹配组：UHL（一只耳朵严重至极重度听力损失，对侧耳朵听力正常）、双侧听力正常和单侧听力正常。尽管双侧听力正常组在所有指标上的得分均明显优于双侧听力组，并且表现变异性较小，但一些 UHL 参与者在所有指标上的得分都在双侧听力正常组的范围内。对于单侧听力正常的参与者来说，对于在阻塞/聋侧而不是开放/听力侧出现的单词，单音节单词理解比 UHL 更好。相比之下，UHL 比正常听力的单侧听者更好地定位开放/听力侧的刺激，而不是阻塞/聋侧的刺激。这表明 UHL 已经学会了改善完整耳朵一侧定位的策略。 UHL 组和单侧正常听力参与者组在噪声中言语测量方面没有显着差异。童年时期而不是近期出现听力损失的 UHL 参与者的定位效果明显更好；然而，这两组在噪声中的语音识别方面没有差异。 UHL 成年人的发病年龄似乎对定位能力的影响与理解噪声中的语音不同。 UHL 参与者的听力阈值与语音识别显着相关，但其他两组则不然。 UHL 的听觉能力差异很大，只能通过听力阈值水平来部分解释。听力损失的发病年龄和持续时间会影响某些指标的表现，但不是所有指标。结果支持需要修订和多样化的临床措施，包括声音定位、在不同环境中理解言语以及仔细考虑功能能力，因为患有严重至极重 UHL 的个体被视为潜在的人工耳蜗植入候选者。
At a minimum, unilateral hearing loss (UHL) impairs sound localization ability and understanding speech in noisy environments, particularly if the loss is severe to profound. Accompanying the numerous negative consequences of UHL is considerable unexplained individual variability in the magnitude of its effects. Identification of co-variables that affect outcome and contribute to variability in UHLs could augment counseling, treatment options, and rehabilitation. Cochlear implantation as a treatment for UHL is on the rise yet little is known about factors that could impact performance or whether there is a group at risk for poor cochlear implant outcomes when hearing is near-normal in one ear. The overall goal of our research is to investigate the range and source of variability in speech recognition in noise and localization among individuals with severe to profound UHL and thereby help determine factors relevant to decisions regarding cochlear implantation in this population. The present study evaluated adults with severe to profound UHL and adults with bilateral normal hearing. Measures included adaptive sentence understanding in diffuse restaurant noise, localization, roving-source speech recognition (words from 1 of 15 speakers in a 140° arc) and an adaptive speech-reception threshold psychoacoustic task with varied noise types and noise-source locations. There were three age-gender-matched groups: UHL (severe to profound hearing loss in one ear and normal hearing in the contralateral ear), normal hearing listening bilaterally, and normal hearing listening unilaterally. Although the normal-hearing-bilateral group scored significantly better and had less performance variability than UHLs on all measures, some UHL participants scored within the range of the normal-hearing-bilateral group on all measures. The normal-hearing participants listening unilaterally had better monosyllabic word understanding than UHLs for words presented on the blocked/deaf side but not the open/hearing side. In contrast, UHLs localized better than the normal hearing unilateral listeners for stimuli on the open/hearing side but not the blocked/deaf side. This suggests that UHLs had learned strategies for improved localization on the side of the intact ear. The UHL and unilateral normal hearing participant groups were not significantly different for speech-in-noise measures. UHL participants with childhood rather than recent hearing loss onset localized significantly better; however, these two groups did not differ for speech recognition in noise. Age at onset in UHL adults appears to affect localization ability differently than understanding speech in noise. Hearing thresholds were significantly correlated with speech recognition for UHL participants but not the other two groups. Auditory abilities of UHLs varied widely and could be explained only in part by hearing threshold levels. Age at onset and length of hearing loss influenced performance on some, but not all measures. Results support the need for a revised and diverse set of clinical measures, including sound localization, understanding speech in varied environments and careful consideration of functional abilities as individuals with severe to profound UHL are being considered potential cochlear implant candidates.