Neural Predictors of Speech Perception Outcomes in Adults with Cochlear Implants

项目摘要/摘要 全球超过324,200名聋人或重度聋人接受了人工耳蜗植入物(CI)。 自1984年以来一直在听证。虽然cis可以显著改善听觉言语感知，导致更好的 生活质量对于重度到深度聋人来说，成功率和言语知觉是高度可变的 结果(SPO)在不同CI用户之间差别很大。造成这种巨大差异的因素有很多，比如年龄。 植入时间、耳聋持续时间、术前可用剩余听力水平、CI前助听器使用情况以及 CI电极的设计。然而，这些因素只解释了大约10%-20%的差异。因此，a 术后SPO的很大一部分差异仍然不清楚和不可预测，导致极大的困难 在确定谁将从CI中受益方面。这个项目的目标是确定基于大脑的因素， 确定战略目标的可变性，以确定导致战略目标成功的因素。功能性 将使用磁共振成像(FMRI)和功能近红外光谱(FNIRS)来测量 脑活动，弥散加权成像(DWI)将用于测量脑白质完整性之前 这些措施将与一组正常的听力控制组进行对比。植入后，仅 FNIRS(与CI完全兼容)将用于测量活动的变化以及 CI激活后三个月和六个月随访时的言语知觉。核心假设是， 基于大脑预测能力的有前景的措施，是手术前的神经标记物 预测植入后的SPOS。如果这一假设是正确的，手术前的脑成像扫描可能是 在CI候选资格的评估过程中引入。长期目标是实现成像制导的 确定手术前CI候选资格和协助手术后听力康复的过程。具体目标 目的是：1)确定有舌后感觉神经病的成年人在活动度和白质完整性方面的差异 听力损失(SNHL)和年龄和性别匹配的正常听力控制；2)确定 预测SPO；以及3)确定大脑活动的变化，特别是语言后的跨模式重组 SNHL组，植入后。通过实现这些目标，国际和平研究所将收集制定一项 治疗方案，涉及脑成像数据，以最好地指导成人和儿童的临床实践，这 将在随后的R01中提出。最终，这项研究的结果将揭示这些神经因素 对预测CI使用者更好的SPOS具有重要意义，并将导致改善预后。从以下方面获得的知识 这项工作还将阐明解释两者之间关系的对立理论框架 CI用户的功能变化和SPO。根据本奖项建立的基础信息将提供 未来研究计划的框架，旨在收集临床上所有年龄段的CI候选患者的影像数据 练习。这项研究直接涉及最新的听力和平衡研究中的优先领域2和3 NIDCD战略计划。

PROJECT SUMMARY/ABSTRACT Cochlear implants (CIs) have benefited more than 324,200 individuals worldwide who are deaf or severely hard of hearing since 1984. Although CIs can significantly improve auditory speech perception, leading to better quality of life for severe-to-profoundly deaf individuals, the success rate is highly variable and speech perception outcomes (SPOs) differ widely across CI users. Many factors can contribute to this wide variability, such as age of implantation, duration of deafness, level of preoperative usable residual hearing, pre-CI hearing aid use, and the design of CI electrodes. However, these factors explain only about 10-20% of the variance. Therefore, a large portion of the variance in post-surgical SPOs remains unclear and unpredictable, leading to great difficulty in determining who will benefit from a CI. The goal of this project is to identify the brain-based factors that determine the variability in SPOs in order to characterize the factors leading to successful SPOs. Functional magnetic resonance imaging (fMRI) and functional near-infrared spectroscopy (fNIRS) will be used to measure brain activity, and diffusion weighted imaging (DWI) will be used to measure white matter integrity prior to implantation; these measures will be contrasted with a group of normal hearing controls. After implantation, only fNIRS (which is fully compatible with a CI) will be used to measure changes in activity together with changes in speech perception at three- and six-month follow-up visits after the activation of the CI. The central hypothesis, formulated on the promising predictive powers of brain-based measures, is that pre-surgical neural markers predict SPOs following implantation. If this hypothesis is correct, pre-surgical brain imaging scans might be introduced in the evaluation process of CI candidacy. The long-term goal is to implement an imaging-guided process to determine pre-surgical CI candidacy and assist in post-surgical aural rehabilitation. The specific aims are to: 1) identify differences in activity and white matter integrity between adults with post-lingual sensorineural hearing loss (SNHL) and age- and gender-matched normal hearing controls; 2) determine neural markers that predict SPOs; and 3) identify changes in brain activity, specifically cross-modal reorganization in the post-lingual SNHL group, following implantation. By achieving these aims, the PI will gather data essential to developing a treatment protocol that involves brain imaging data to best guide clinical practices in adults and children, which will be proposed in a subsequent R01. Ultimately, the results of this research will reveal those neural factors important in predicting better SPOs in CI users and will lead to improved prognosis. The knowledge gained from this work will also shed light on opposing theoretical frameworks that account for the relationship between functional changes and SPOs in CI users. The foundational information established under this award will provide the framework for future research proposals aiming to collect imaging data in CI candidates for all ages in clinical practices. This study directly addresses Priority Areas 2 and 3 in Hearing and Balance Research of the latest NIDCD Strategic Plan.