Improving Binaural Hearing in Children with Cochlear Implants

摘要 当在一只耳朵中使用人工耳蜗（CI）时，儿童在噪音中难以听到语音， 在房间中定位声音。这并不奇怪，因为对正常听力的听众的研究表明， 当双耳听觉被人工地 被打乱了无法将语音与噪音分离以及无法定位声音会对语音产生深远的影响。 儿童在教室等环境中学习的能力，通常有多种声音到达 每个孩子都面临着将感兴趣的刺激与背景分离的挑战 噪声临床治疗发生了彻底的转变，双侧CI已成为标准 70%的双侧CI使用者是10岁以下的儿童。绝大多数的孩子 在声音定位和理解方面， 噪音中的言语使用研究处理器同步两个耳朵中的CI，特定目标将 研究声音定位（目标1）和噪声中语音分离（目标2）的机制。另外我们 将评估是否周边措施的神经传播的兴奋可以作为一个有用的工具， 预测双耳处理，以便最终开发用于CI双侧拟合的客观临床工具 (Aim 3）。研究将在先天性耳聋和双侧植入的植入儿童中进行， 婴儿期和儿童出生时有听力和在幼儿期获得性耳聋。此外， 正常听力将使用双耳CI模拟进行研究，以了解 CI用户和正常听力儿童之间的差异由已知的信号退化来解释 发生在CI身上。由CI模拟相对于标准声学线索施加的限制将提供 预期CI人群的最佳绩效水平的基准。最终，这项工作将导致 为失聪儿童开发更好的语音处理器，理想情况下， 在噪音中听语音，定位声音，并在复杂的嘈杂环境中学习。

Abstract When using a cochlear implant (CI) in one ear, children experience difficulties hearing speech in noise and localizing sounds in rooms. This is not surprising, as studies in normal hearing listeners have demonstrated that speech understanding in noise and sound localization can be very poor when binaural hearing is artificially disrupted. Inability to segregate speech from noise and to localize sounds can have a profound impact on the ability of a child to learn in environments such as classrooms, where it is typical to have multiple sounds arrive from various directions, and each child faces the challenge of segregating stimuli of interest from background noise. There has been a sweeping shift in clinical treatment, whereby bilateral CIs have become the standard of care, and 70% of bilateral CI users are children under 10 years of age. The vast majority of children perform significantly worse than their normal hearing, age-matched peers on sound localization and understanding of speech in noise. Using research processors that synchronize the CIs in the two ears, specific aims will investigate mechanisms of sound localization (Aim 1) and speech-in-noise segregation (Aim 2). In addition, we will evaluate whether peripheral measures of neural spread of excitation can serve as a useful tool for predicting binaural processing, in order to ultimately develop objective clinical tools for bilateral fitting of CIs (Aim 3). Studies will be done in implanted children who were congenitally deaf and implanted bilaterally during infancy and children born with hearing and acquired deafness during early childhood. In addition, children with normal hearing will be studied using binaural CI simulations, in order to understand the extent to which differences between CI user and normal hearing children are accounted for by signal degradation that is known to occur with CIs. Limits imposed by the CI simulations relative to standard acoustic cues will provide a benchmark for best performance levels to be expected from the CI populations. Ultimately, the work will lead to development of better speech processors for children who are deaf, and ideally better outcomes in their ability to hear speech in noise, localize sounds, and learn in complex noisy environments.