Towards the development of a prognostic tool for cochlear implant outcome using functional near-infrared spectroscopy (fNIRS).

背景：在英国，每天有四个婴儿出生时就是聋人。与听力正常的儿童相比，听力损失的儿童不仅言语和语言发育迟缓，而且教育成绩也较低。人工耳蜗是一种可以恢复先天或失聪儿童听力的装置。所有新生儿现在都要接受听力损失测试。随后，可以在生命的最初几天或几个月内识别出适合植入人工耳蜗的儿童。总体而言，植入人工耳蜗后，儿童的言语理解能力有所改善。然而，一些孩子的言语和语言能力比我们预期的要差得多，我们也不完全理解为什么会发生这种情况。目前评估听力和语言理解水平的测试对非常年幼的儿童来说是不可靠的。由于先天失聪的儿童通常在出生后的第一年或两年内接受人工耳蜗植入，父母和医疗保健专业人员往往要过几年才能意识到糟糕的言语和语言技能。目前，很难区分接受人工耳蜗术的幼儿表现良好和表现不佳。我们想知道为什么一些孩子植入人工耳蜗可以听得很好，而另一些孩子则不能。我们还希望尽早预测和识别那些植入人工耳蜗的儿童，他们的言语理解能力很差。这项研究的目的：在诺丁汉听力生物医学研究中心，我们建议使用一种名为功能性近红外光谱(简称fNIRS)的非侵入性脑扫描方法来测量聋儿在接受人工耳蜗植入之前和之后的大脑活动。我们想知道，这种大脑扫描技术是否可以用来测试孩子听和理解语言的能力，而不是依赖只适用于年龄较大的儿童的现有听力测试。尽管我们考虑了其他测量大脑活动的方法，但这些方法要么对植入人工耳蜗术的患者不安全，要么与潜在的有害影响有关。FNIRS对儿童在人工耳蜗植入前后都是完全安全的，没有任何副作用或对健康的风险。这项研究的预期好处：如果我们能够评估儿童使用fNIRS的听力有多好，临床专业人员可以测量比目前可能的年龄小得多的儿童的言语能力。随后，我们将能够在最小的年龄识别和治疗听力不佳的儿童。在这样做的过程中，我们将识别那些植入人工耳蜗的儿童，他们的听力有困难，需要额外的言语和语言支持。目前，在不了解植入人工耳蜗的年幼儿童能力的情况下，NHS为每一名儿童提供了宝贵的言语和语言支持资源，使一些儿童得到的支持可能超过他们的需要，而另一些儿童得到的支持则太少。FNIRS可能会帮助我们量身定做，更恰当地直接向那些最需要的儿童提供言语和语言支持。我们还将能够向父母提供更准确的解释，说明他们的孩子植入人工耳蜗后改善的可能性有多大。人工耳蜗还需要定期进行“微调”或编程，以提供尽可能好的听力，以满足个人的需求。FNIRS有可能指导和改进这一编程过程。这是因为，在孩子长到告诉我们的年龄之前，它可能能够告诉我们大脑对语言和声音的理解程度，并使我们能够对他们的人工耳蜗进行适当的调整。我们相信，fNIRS有可能让每一个植入人工耳蜗的儿童都能得到最好的治疗，以满足他们的个人需求。

Background: In the UK, four babies are born deaf each day. Children with hearing loss not only have delayed speech and language development, but also have lower educational achievements compared with children who have normal hearing. A cochlear implant is a device that can restore a sensation of hearing to children who are born or become deaf. All newborns are now tested for a hearing loss. Subsequently, children who are suitable for a cochlear implant can be identified in the first few days or months of life. Overall, speech understanding in children improves after cochlear implantation. However, some children's speech and language abilities are much worse than we would otherwise expect and we don't fully understand why this happens. The current tests for assessing levels of hearing and speech understanding are unreliable in very young children. Since children that are born deaf often receive their cochlear implants within the first year or two of life, years can often pass before parents and healthcare professionals become aware of poor speech and language skills. Currently, it is extremely difficult to distinguish between very young children with cochlear implants who are performing well and those who are performing not so well. We want to understand why some children can hear well with a cochlear implant and others cannot. We would also like to predict and identify at the earliest possible stage those children with a cochlear implant who have poor speech understanding. Aims of this research: At the Nottingham Hearing Biomedical Research Centre, we propose to use a non-invasive brain scanning method called functional near-infrared spectroscopy, or fNIRS for short, to measure brain activity in deaf children before and immediately after they receive a cochlear implant. We want to know if this brain scanning technique can be used to test how well a child can hear and understand speech instead of having to rely on existing hearing tests that are only suitable for older children. Although we have considered other methods for measuring brain activity, they are either not safe for use in patients with a cochlear implant or are associated with potential harmful effects. fNIRS is completely safe for children both before and after cochlear implantation and does not have any side effects or risks to health.Expected benefits of this research: If we are able to assess how well a child can hear using fNIRS, clinical professionals could measure speech abilities in much younger children than is presently possible. Subsequently, we will be able to identify and treat children who are not hearing so well at the earliest age. In so doing, we will identify those children with a cochlear implant who struggle with their hearing and need extra speech and language support. At present, without any idea of the abilities of our very young children with cochlear implants, valuable NHS resources for speech and language support are provided to every single child, so that some children may receive more support than they require, whilst others receive too little. fNIRS may help us to tailor and more appropriately direct speech and language support to those children who need it the most. We would also be able to give parents a more accurate explanation of how likely their child is to improve with their cochlear implant. Cochlear implants also need to be 'fine tuned' or programmed regularly so that they provide the best possible level of hearing to meet the needs of an individual. fNIRS has the potential to guide and improve this programming process. This is because it may be able to inform us on how well speech and sound is understood by the brain, years before a child is old enough to tell us, and enable us to make the appropriate adjustments to their cochlear implant. We believe that fNIRS has the potential to allow every child with a cochlear implant to have the best possible treatment that is tailored to their individual needs.