Clinical Application of Spectral Envelope Perception: Cochlear Implant Evaluation

9.项目摘要/摘要 大多数现代人工耳蜗术后患者只有一个或两个都有残留的听力。 耳朵。几项研究表明，当与CI配对时，这种残留听力会提供显著的好处 在双峰监听配置中。然而，声学相关的双峰受益程度因不同而异 与听力阈值、病因、年龄或术前语音识别无关。在 术前听力无明显差异，患者出现双侧残余听力 耳朵通常被告知，当与CI配对时，任何一只耳朵都可以提供好处。没有临床上的 为选择要植入的耳朵提供预测性实用工具的措施-关键考虑因素 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 就像在医疗保险和医疗补助中遇到的那样)。本应用程序提出了开发和实现这样一个 临床工具。光谱调制检测(SMD)的临床测试是经过验证的 评估光谱分辨率的心理物理程序。在这项任务中，听者被要求辨别 频谱平坦噪声来自频谱调制噪声。这一临床程序的试点工作已经显示SMD在 当与双峰CI配对时，未植入的耳朵是声学益处的极好预测因子(r=0.89 听证。因为这项任务对比噪声刺激，所以它不需要语音理解，并且可以 由几乎没有剩余听证的候选人完成-这两种情况都适用于以下个人 术前评估。我们的最新临床任务迭代的试点工作每次需要5到6分钟 耳朵，与安静和噪音中的声学益处高度相关，并报告为正确分数的百分比。 该工具有可能满足听力学和耳科学领域的强烈需求，并显著 影响手术决定和患者预后。在这项研究结束时，我们将为临床医生提供 通过植入前后的听力完整性测试，支持工具将测试分数转换为有意义的 对每个耳朵在特定治疗条件下的潜在益处的预测，以及数据驱动的指南 耳朵选择。因此，这项研究有可能帮助我们达到循证医学的目标 植入耳选择、期望管理和模式选择(双模式或双侧)的领域 植入)。

9. PROJECT SUMMARY/ABSTRACT 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 in 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 ear to be implanted-a critical consideration particularly in cases for which bilateral cochlear implantation may be restricted (i.e. insurance restrictions such as encountered with Medicare and Medicaid). 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 to 6 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. At the conclusion of this study, we will provide clinicians with a pre- and post-implant test of auditory integrity, the supporting tools to translate test scores to meaningful predictions about the potential benefit of each ear in specific treatment conditions, and a data-driven guide to ear selection. Thus, the study has the potential to help us meet the evidence-based objective in medicine in the areas of implant ear selection, expectations management, and modality selection (bimodal hearing or bilateral implantation).