Cochlear implantation with hearing preservation yields significant benefit for speech recognition in complex listening environments.
Cochlear implantation with hearing preservation yields significant benefit for speech recognition in complex listening environments.
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DOI：
10.1097/aud.0b013e31827e8163
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发表时间：
2013-07
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：
Gifford RH;Dorman MF;Skarzynski H;Lorens A;Polak M;Driscoll CL;Roland P;Buchman CA
本研究的目的是评估在复杂的听力环境中保留植入耳的声学听力对语音识别的好处。目前的研究包括一个内部受试者，重复测量设计，包括21名说英语和17名说波兰语的人工耳蜗受者，在植入的耳朵中保留了听觉。患者被植入电极，电极的插入深度从10到31毫米不等。对于英语和波兰语参与者，植入耳的平均术前低频阈值（平均125、250和500 Hz）分别为39.3和23.4 dB HL。在一种情况下，在一个8个扬声器的环境中评估语音感知，其中语音信号来自一个扬声器，餐厅噪音来自所有扬声器。在另一种情况下，信号在混响时间为0.6秒的模拟混响环境中呈现。响应测量包括语音接收阈值（srt）和句子理解正确率两种测试条件：人工耳蜗（CI）加对侧耳低频听力（双峰条件）和人工耳蜗加双耳低频听力（最佳辅助条件）。另外，研究人员还对6名英语听众进行了250赫兹信号的耳间时差阈值测试。与双峰条件相比，最佳辅助条件下的性能改善较小，但显著（1.7 - 2.1 dB和6 - 10个百分点）。植入耳的术后阈值与扩散噪声下语音识别的EAS获益程度相关。植入耳的听力学阈值测量和手术后阈值的升高与混响语音理解的改善之间没有可靠的关系。自适应SRT的250 Hz过渡段阈值与eass相关效益之间存在显著相关。我们的研究结果表明：(i)保留低频听力可以提高CI接受者的言语理解能力；（ii）在复杂的听力环境中进行测试，在这种环境中，双耳对信号和噪声的时间线索不同，可能最能证明拥有双耳低频声学听力的价值；（iii）保留双耳时间线索，尽管比正常听力的个体观察到的要差。在保留听力的单侧人工耳蜗植入后是可能的，并且与EAS益处相关。我们的研究结果证明了人工耳蜗在听力保护方面的显著交流益处，并为扩大人工耳蜗标准提供了支持，以包括低频阈值在正常到接近正常范围内的个体。
The aim of this study was to assess the benefit of having preserved acoustic hearing in the implanted ear for speech recognition in complex listening environments. The current study included a within subjects, repeated-measures design including 21 English speaking and 17 Polish speaking cochlear implant recipients with preserved acoustic hearing in the implanted ear. The patients were implanted with electrodes that varied in insertion depth from 10 to 31 mm. Mean preoperative low-frequency thresholds (average of 125, 250 and 500 Hz) in the implanted ear were 39.3 and 23.4 dB HL for the English- and Polish-speaking participants, respectively. In one condition, speech perception was assessed in an 8-loudspeaker environment in which the speech signals were presented from one loudspeaker and restaurant noise was presented from all loudspeakers. In another condition, the signals were presented in a simulation of a reverberant environment with a reverberation time of 0.6 sec. The response measures included speech reception thresholds (SRTs) and percent correct sentence understanding for two test conditions: cochlear implant (CI) plus low-frequency hearing in the contralateral ear (bimodal condition) and CI plus low-frequency hearing in both ears (best aided condition). A subset of 6 English-speaking listeners were also assessed on measures of interaural time difference (ITD) thresholds for a 250-Hz signal. Small, but significant, improvements in performance (1.7 – 2.1 dB and 6 – 10 percentage points) were found for the best-aided condition vs. the bimodal condition. Postoperative thresholds in the implanted ear were correlated with the degree of EAS benefit for speech recognition in diffuse noise. There was no reliable relationship among measures of audiometric threshold in the implanted ear nor elevation in threshold following surgery and improvement in speech understanding in reverberation. There was a significant correlation between ITD threshold at 250 Hz and EAS-related benefit for the adaptive SRT. Our results suggest that (i) preserved low-frequency hearing improves speech understanding for CI recipients (ii) testing in complex listening environments, in which binaural timing cues differ for signal and noise, may best demonstrate the value of having two ears with low-frequency acoustic hearing and (iii) preservation of binaural timing cues, albeit poorer than observed for individuals with normal hearing, is possible following unilateral cochlear implantation with hearing preservation and is associated with EAS benefit. Our results demonstrate significant communicative benefit for hearing preservation in the implanted ear and provide support for the expansion of cochlear implant criteria to include individuals with low-frequency thresholds in even the normal to near-normal range.