Bimodal Hearing or Bilateral Cochlear Implants? Ask the Patient.
Bimodal Hearing or Bilateral Cochlear Implants? Ask the Patient.
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DOI：
10.1097/aud.0000000000000657
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发表时间：
2019
期刊：
影响因子：
3.7
通讯作者：
Dorman MF
中科院分区：
文献类型：
--
作者：
Gifford RH;Dorman MF
本研究的目的是评估言语理解的各种措施在区分成人双峰和双侧人工耳蜗植入（CI）受体之间的性能差异的有效性，并提供一个初步的循证工具，指导临床决策有关的双边CI候选人。本研究采用多基线、横断面设计，调查85名有经验的成年CI接受者（49名双峰，36名双侧）的语音识别性能。在标准临床测试环境中使用单个扬声器使用成人CI接受者的最小语音测试组合以及R-SPACE™ 8扬声器声音模拟系统评估语音识别。所有参与者都在三种听力条件下进行了测试，包括每只耳朵单独以及双侧/双峰条件。此外，我们要求每位双峰听众对“您认为需要第二个CI吗？”的问题提供是/否的答案。这项研究产生了三个主要结果：1）在语音识别的临床测量上，双峰和双侧CI表现或双耳总和之间没有显著差异，2）R-SPACE™系统中的自适应语音识别任务揭示了双峰和双侧CI用户之间的表现和双耳总和的显著差异，其中双侧CI用户实现了显著更好的表现和更大的总和，以及3）患者对问题的回答，“你认为你需要第二个CI吗？”保持用于识别可能的双侧CI候选者的高灵敏度（100%命中率）和用于正确识别最适合于双峰听力配置的收听者的中等高特异性（77%正确拒绝率）。临床不能依赖于目前的临床措施的语音理解，一个单一的扬声器，以确定双边CI候选人的成年双峰听众，也不能准确地记录双边利益相对于以前的双峰听力配置。复杂收听环境中的语音识别（诸如R-SPACE™）是用于确定双侧CI候选资格的敏感且适当的测量，并且还可能用于记录相对于先前双峰配置的双侧益处。在没有可用的R-SPACE™系统的情况下，询问患者是否认为她/他需要第二个CI是一种高度敏感的措施，可以证明在临床上有用。
The objectives of this study were to assess the effectiveness of various measures of speech understanding in distinguishing performance differences between adult bimodal and bilateral cochlear implant (CI) recipients and to provide a preliminary evidence-based tool guiding clinical decisions regarding bilateral CI candidacy. This study used a multiple-baseline, cross-sectional design investigating speech recognition performance for 85 experienced adult CI recipients (49 bimodal, 36 bilateral). Speech recognition was assessed in a standard clinical test environment with a single loudspeaker using the minimum speech test battery for adult CI recipients as well as with an R-SPACE™ 8-loudspeaker, sound-simulation system. All participants were tested in three listening conditions for each measure including each ear alone as well as in the bilateral/bimodal condition. In addition, we asked each bimodal listener to provide a yes/no answer to the question, “Do you think you need a second CI?” This study yielded three primary findings: 1) there were no significant differences between bimodal and bilateral CI performance or binaural summation on clinical measures of speech recognition, 2) an adaptive speech recognition task in the R-SPACE™ system revealed significant differences in performance and binaural summation between bimodal and bilateral CI users, with bilateral CI users achieving significantly better performance and greater summation, and 3) the patient’s answer to the question, “Do you think you need a second CI?” held high sensitivity (100% hit rate) for identifying likely bilateral CI candidates and moderately high specificity (77% correct rejection rate) for correctly identifying listeners best suited with a bimodal hearing configuration. Clinics cannot rely on current clinical measures of speech understanding, with a single loudspeaker, to determine bilateral CI candidacy for adult bimodal listeners nor to accurately document bilateral benefit relative to a previous bimodal hearing configuration. Speech recognition in a complex listening environment, such as R-SPACE™, is a sensitive and appropriate measure for determining bilateral CI candidacy and also likely for documenting bilateral benefit relative to a previous bimodal configuration. In the absence of an available R-SPACE™ system, asking the patient whether or not s/he thinks s/he needs a second CI is a highly sensitive measure which may prove clinically useful.