Residual Cochlear Function in Adults and Children Receiving Cochlear Implants: Correlations With Speech Perception Outcomes
Residual Cochlear Function in Adults and Children Receiving Cochlear Implants: Correlations With Speech Perception Outcomes
复制标题
DOI：
10.1097/aud.0000000000000630
复制
发表时间：
2019-05-01
期刊：
影响因子：
3.7
通讯作者：
Fitzpatrick, Douglas C.
中科院分区：
文献类型：
--
作者：
Fontenot, Tatyana Elizabeth;Giardina, Christopher Kenneth;Fitzpatrick, Douglas C.
目的：人工耳蜗植入后言语感知结果的变异性在很大程度上仍然无法解释。最近，耳蜗电描记术，或测量耳蜗电位对声音的反应，已被用于评估植入时的残余耳蜗功能。我们的目标是表征所有年龄段受试者植入前记录的电位，并评估反应（包括神经活动的主观估计）与言语感知结果之间的关系。设计图：在北卡罗来纳州大学的一个前瞻性队列中记录了284名人工耳蜗植入候选人（10个月至88岁）的耳蜗电图。对每个受试者获得被称为“总响应”（TR）的残余耳蜗功能的测量，该总响应是响应于不同刺激频率的音调的频谱分量的幅度的总和。TR，然后与相应年龄的单音节词得分测试的结果在安静。除TR外，还评估了耳蜗电图结果的复合动作电位和听神经音形式的神经活动。结果如下：TR的幅度范围从几乎检测不到的约0.02 μ V到超过100 μ V。在成年人（18至79岁）中，TR占线性回归的语音感知结果变异性的46%（r（2）= 0.46; p < 0.001）。在6 ~ 17岁儿童中，变异占36%（p < 0.001）。在年龄较小的儿童中，TR占变异性的15%（p = 0.012）。在6个月的测试间隔，80岁以上的受试者在给定TR方面的表现往往比年轻成人差。与单独的TR相比，主观评估的神经活动并没有增加信息，TR主要由毛细胞产生的耳蜗颤噪音组成。结论：听觉外周的状态，特别是毛细胞而不是神经活动的状态，占成人和年龄较大儿童言语感知结果变异性的很大一部分。在年龄较小的儿童中，这种关系较弱，老年人与其他成年人不同。这种简单的测量可以以高通量应用，使得可以评估外周状态以帮助管理患者期望，创建个性化定制的治疗计划，并基于残余耳蜗功能识别表现低于期望的受试者。
Objectives: Variability in speech perception outcomes with cochlear implants remains largely unexplained. Recently, electrocochleography, or measurements of cochlear potentials in response to sound, has been used to assess residual cochlear function at the time of implantation. Our objective was to characterize the potentials recorded preimplantation in subjects of all ages, and evaluate the relationship between the responses, including a subjective estimate of neural activity, and speech perception outcomes. Design: Electrocochleography was recorded in a prospective cohort of 284 candidates for cochlear implant at University of North Carolina (10 months to 88 years of ages). Measurement of residual cochlear function called the "total response" (TR), which is the sum of magnitudes of spectral components in response to tones of different stimulus frequencies, was obtained for each subject. The TR was then related to results on age-appropriate monosyllabic word score tests presented in quiet. In addition to the TR, the electrocochleography results were also assessed for neural activity in the forms of the compound action potential and auditory nerve neurophonic. Results: The TR magnitude ranged from a barely detectable response of about 0.02 mu V to more than 100 mu V. In adults (18 to 79 years old), the TR accounted for 46% of variability in speech perception outcome by linear regression (r(2) = 0.46; p < 0.001). In children between 6 and 17 years old, the variability accounted for was 36% (p < 0.001). In younger children, the TR accounted for less of the variability, 15% (p = 0.012). Subjects over 80 years old tended to perform worse for a given TR than younger adults at the 6-month testing interval. The subjectively assessed neural activity did not increase the information compared with the TR alone, which is primarily composed of the cochlear microphonic produced by hair cells. Conclusions: The status of the auditory periphery, particularly of hair cells rather than neural activity, accounts for a large fraction of variability in speech perception outcomes in adults and older children. In younger children, the relationship is weaker, and the elderly differ from other adults. This simple measurement can be applied with high throughput so that peripheral status can be assessed to help manage patient expectations, create individually-tailored treatment plans, and identify subjects performing below expectations based on residual cochlear function.