Integration of acoustic and electric hearing within or across ears

摘要：越来越多的人工耳蜗(CI)患者能够结合残余声学 同一耳朵内的听力(AH)和电听力(EH)(电声刺激，或EAS)，跨耳朵 (双峰)，或两者兼而有之(双峰)。声电听力(AEH)的好处是多种多样的；一些CI用户甚至 体验声刺激和电刺激模式之间的干扰。在诊所里，几乎没有什么努力 为了优化关于组合的声学和电学听力的CI和/或助听器信号处理， 目前尚不清楚声学和电学模式是在耳朵内部还是在耳朵之间进行不同的组合。EAS BEAS患者可能会经历EH电流传播和BEAS之间的能量干扰 来自AH的激励传播(SOE)。Bimodal、EAS和BiEAS患者也可能体验到信息 干扰，因为相同的声学输入可能被传递到不同的耳蜗处(音调 不匹配)耳朵内和/或耳朵之间。为了减轻这些不利影响，对CI和/或 AEH的助听器可能与EH和/或AH的助听器有很大不同。 这项建议的长期目标是了解整合 声学和电学听力，可用于提高CI用户的AEH效益。我们假设 声音和电刺激模式在耳朵内和耳朵之间以不同的方式整合。具体来说，我们 假设EAS听众的整合受到能量和信息干扰的限制； 减少AH和EH之间的电流分布/SOE并减少音调失配可能会有所改善 整合。我们还假设双峰收听者的整合受到信息干扰的限制， 由于声调不匹配和耳朵之间的音质差异；改善EH的音质 (例如，聚焦刺激)，同时减少AH和EH之间的音调失配可能会改善 整合。声电整合将以正常听力的平行实验配对进行评估。 (NH)受试者收听AEH的模拟以及真实EAS、双峰和BiEAS CI收听者。演讲 测量(安静和噪声中的元音和句子识别，声音情感识别)和频率 将使用AH、EH和AEH收集解析，并根据整体AEH性能、AEH进行评估 收益(AEH和AH或EH之间的性能差异)和集成效率( 观察和预测AEH性能)。目标1将主要探索影响电听力的各个方面 声电一体化而AIM 2则将重点放在影响声电的声学听力方面 整合。这项拟议的研究具有很大的理论意义，因为它将为 AEH的声电一体化。这项拟议的研究也具有很大的临床价值，因为结果 可为优化AEH的CI信号处理提供更好的指导。

SUMMARY: Increasing numbers of cochlear implant (CI) patients are able to combine residual acoustic hearing (AH) with electric hearing (EH) in the same ear (electric-acoustic stimulation, or EAS), across ears (bimodal), or both (biEAS). The benefits of acoustic-electric hearing (AEH) are variable; some CI users even experience interference between acoustic and electric stimulation patterns. In the clinic, there is little effort to optimize CI and/or hearing aid signal processing with regard to combined acoustic and electric hearing, and it is unclear whether acoustic and electric patterns are combined differently within or across ears. EAS and biEAS patients may experience energetic interference between the current spread from EH and the spread of excitation (SOE) from AH. Bimodal, EAS, and biEAS patients may also experience informational interference because the same acoustic input may be delivered to different cochlear places (tonotopic mismatch) within and/or across ears. To mitigate these adverse effects, the optimal fitting for CI and/or hearing aid devices might be quite different for AEH than for EH and/or AH. The long-term goals of this proposal are to understand the mechanisms that underlie integration of acoustic and electric hearing, which can be used to improve AEH benefits for CI users. We hypothesize that acoustic and electric stimulation patterns are integrated differently within and across ears. Specifically, we hypothesize that integration for EAS listeners is limited by both energetic and informational interference; reducing the current spread/SOE between AH and EH and reducing tonotopic mismatch may improve integration. We also hypothesize that integration for bimodal listeners is limited by informational interference, due to tonotopic mismatch and sound quality differences across ears; improving the sound quality of EH (e.g., focused stimulation) while reducing the tonotopic mismatch between AH and EH may improve integration. Acoustic-electric integration will be evaluated in pairs of parallel experiments with normal-hearing (NH) subjects listening to simulations of AEH and in real EAS, bimodal, and biEAS CI listeners. Speech measures (vowel and sentence recognition in quiet and in noise, vocal emotion recognition) and frequency resolution will be collected with AH, EH, and AEH, and evaluated in terms of overall AEH performance, AEH benefit (performance difference between AEH and AH or EH), and integration efficiency (the ratio between observed and predicted AEH performance). Aim 1 will primarily explore aspects of electric hearing that affect acoustic-electric integration while Aim 2 will focus on aspects of acoustic hearing that affect acoustic-electric integration. The proposed research is of great theoretical interest, as it will provide greater insight into acoustic-electric integration for AEH. The proposed research is also of great clinical value, as the results may provide better guidance for optimizing CI signal processing for AEH.