Clinical Application of Spectral Envelope Perception: Cochlear Implant Evaluation

描述(由申请人提供)：大多数现代人工耳蜗术(CI)患者的一只或两只耳朵都有残留的声学听力。一些研究表明，当与CI配对时，这种残留听力提供了显着的好处，即双模式听力配置。然而，声学相关的双峰受益程度因耳朵而异，与听力阈值、病因、年龄或术前语音识别无关。在术前听力没有明显差异的情况下，出现双耳听力残留的患者通常被告知，当配对CI时，其中一只耳朵可以提供益处。对于选择植入的内耳，没有临床措施提供预测性效用--这是一个关键的考虑因素，特别是在双边人工耳蜗术可能受到限制的情况下(即保险限制)。本申请提出了开发和实施这样的临床工具。光谱调制检测(SMD)的临床测试是一种经过验证的评估光谱分辨率的心理物理程序的修改版本。在这个任务中，听者被要求区分频谱平坦的噪声和频谱调制的噪声。这项临床试验工作表明，当与双峰听力的CI配对时，非植入耳的SMD是一个很好的声学效益预测指标(r=0.89)。因为这项任务对比的是噪音刺激，所以它不需要语音理解，并且可以由只有很少剩余听力的应试者完成-这两项都是对接受手术前评估的人所期望的。我们最新迭代的临床任务的试点工作每只耳朵需要5到6分钟，与安静和噪音中的声学益处高度相关，并以百分比正确分数报告。这一工具有可能满足听力学和耳科领域的强烈需求，并显著影响手术决定和患者预后。

DESCRIPTION (provided by applicant): Most modern day cochlear implant (CI) candidates have residual acoustic hearing in one or both ears. Several studies have shown that this residual hearing provides significant benefit when paired with a CI a bimodal listening configuration. The degree of acoustic-related, bimodal benefit however, varies across ears and is not correlated with audiometric threshold, etiology, age or preoperative speech recognition. In the absence of gross differences in preoperative hearing acuity, patients presenting with residual hearing in both ears are commonly told that either ear could provide benefit when paired with a CI. There is no clinical measure that provides predictive utility for selecting the er to be implanted-a critical consideration particularly in cases for which bilateral cochlear implantation may be restricted (i.e. insurance restrictions). This application proposes to develop and implement such a clinical tool. The clinical test of spectral modulation detection (SMD) is a modified version of a validated psychophysical procedure assessing spectral resolution. In this task, the listener is asked to discriminate spectrally-flat noise from spectrally-modulated noise. Pilot work on this clinical procedure has shown SMD in the non-implanted ear is an excellent predictor of acoustic benefit (r = 0.89) when paired with a CI for bimodal hearing. Because this task contrasts noise stimuli, it does not require speech understanding and can be completed by candidates with very little residual hearing-both of which are expected for individuals being evaluated preoperatively. Pilot work with our most recent iteration of the clinical task takes 5 to6 minutes per ear, is highly correlated with acoustic benefit in quiet and noise, and is reported as a percent correct score. This tool has the potential to satisfy a strong need in the fields of audiology and otology as well as significantly influence surgical decisions and patient outcomes.