Effects of Training on Adult Cochlear Implant Users

描述（由申请人提供）：尽管双耳听力有优势，但对于使用双耳人工耳蜗（CIs）或人工耳蜗与助听器结合使用的患者来说，语音和噪音的定位和空间隔离仍然很困难。这些困难可能是由于：1)较差的频谱和/或时间处理，2)扭曲的外围模式，和/或3)较差的双耳外围模式整合。听觉训练可以减轻这些缺陷。我们的长期目标是开发提高CI患者双耳感知的训练方法。目前尚不清楚训练是否应该针对单侧外周信号处理或双侧外周信号整合，或两者兼而有之。我们假设必须减少双耳单侧表现的差异（“不对称”），以最大限度地提高双耳的效益。用较差的耳朵进行单侧训练，然后进行双侧训练，效果最好

DESCRIPTION (provided by applicant): Despite the advantages of listening with two ears, localization and spatial segregation of speech and noise remain difficult for patients who use two cochlear implants (CIs) or a CI in combination with a hearing aid. These difficulties may be due to: 1) poor spectral and/or temporal processing, 2) distorted peripheral patterns, and/or 3) poor binaural integration of peripheral patterns. Auditory training may mitigate these deficits. Our long-term goal is to develop training methods that improve CI patients' binaural perception. It is as yet unclear whether training should target unilateral peripheral processing or bilateral integration of peripheral signals or both. We hypothesize that the difference in unilateral performance across ears ("asymmetry") must be reduced to maximize the binaural benefit. Unilateral training with the poorer ear alone, followed by bilateral training will provide the best training outcome. For spatial binaural perception (localization and squelch), we further hypothesize that localization requires greater spatial precision than segregation of speech and noise; improving localization will improve spatial segregation. Localization training, followed by spatial segregation training will provide the best outcomes for spatial hearing. In all three Aims, we will use a crossover experimental design to see whether the training sequence affects outcomes. Auditory training has not been extensively studied in bilateral CI or bimodal listeners, and there are few (if any) targeted rehabilitation programs for these patient groups. By addressing these deficits in research and rehabilitation, the proposed research offer novel approaches to increasingly commonplace difficulties for CI patients. The research seeks to identify the best training approach for bilateral CI and bimodal patients, as well as understand how differences in the peripheral input may influence binaural perception as well as the training outcomes. The conceptual framework addresses different factors that may limit performance: auditory resolution, peripheral representation and/or integration of peripheral inputs. Experiments 1 and 2 address whether unilateral psychophysical or speech training is more effective. Experiments 3 and 4 address a fundamental question facing all bilateral CI and bimodal patients: Is it better to train with one ear or two? Experiments 5 and 6 addresses whether spatial training is task-specific (localization vs. spatial segregation). The proposal is o great clinical significance, as the research will guide efficient training methods to maximize CI users' binaural perception. The research is also of great theoretical significance, as it seeks to better understand connections between psychophysical and speech measures, binaural benefits and unilateral performance, as well as localization and spatial segregation in electric hearing. As advances in CI technology seem to be reaching a point of diminishing returns, auditory training may provide the most cost-effective approach to maximize the benefit of cochlear implantation.