Strategies to Optimize Benefit with a Cochlear Implant

该项目的长期目标是为个别患者优化人工耳蜗术的益处。 最近的研究表明了个性化选择语音编码策略、刺激的重要性 速率，以及语音处理器中每个电极上的最小和最大刺激电平，以优化 日常生活中的语音识别和偏好。还需要进一步的研究来确定新药物的疗效 用于个性化试衣的输入和输出语音处理。虽然电复合动作电位 阈值(使用神经反应遥测[NRT]获得)与行为反应相结合 事实证明，对于选择每个电极上的MAP最低和最高水平很有价值，目前尚不清楚NRT如何 可以使用幅度增长、不稳定恢复和跨通道前向屏蔽功能来选择MAP 参数与个体的电听觉最匹配。临床上迫切需要确定 如何将这些NRT/NRI(神经反应成像)测量与行为测量相结合 对植入参数进行拟合，以更高效和有效地优化成人和 孩子们。 在所提出的研究中，电刺激被分为两个领域：输入信号处理 和输出信号处理。特定目标1评估将输入信号的处理改变为 语音处理器用于日常生活中的语音识别和偏好(例如，强调瞬时语音 声音，为电极分配频率边界的标准)。具体目标2评估以下项目的效果 改变对日常生活中的语音识别和偏好的输出信号的处理(例如，顺序 每个周期所有电极的刺激与选定电极的漫游刺激、脉冲持续时间和 电极上的单极与三极刺激)。具体目标3评估NRT/NRI的使用和行为 成人和儿童种植体参数个体化适配措施。特定目标4评估 各种因素的影响(例如，电极在耳蜗中的位置，对NRT/NRI措施的反应，认知 功能、言语能力、病因和传记因素)对成年人的单词识别。这样做的结果是 研究有望显著改善人工耳蜗术后患者的临床护理。

The long-term objective of this project is to optimize benefit from a cochlear implant for individual patients. Recent research has shown the importance of individualized selection of speech coding strategy, stimulation rate, and minimum and maximum stimulation levels on each electrode in the speech processor map to optimize speech recognition and preference in everyday life. Further research is needed to determine the efficacy of new input and output speech processing for individualized fitting. Although electrical compound action potential thresholds (obtained with Neural Response Telemetry [NRT]) combined with behavioral responses have proved valuable for selecting map minimum and maximum levels on each electrode, it is unknown how NRT amplitude growth, refractory recovery, and cross-channel forward masking functions can be used to select map parameters best matched to an individual's electrical hearing. There is an urgent clinical need to determine how these NRT/NRI (Neural Response imaging) measures can be combined with behavioral measures in the fitting of implant parameters to optimize speech recognition more efficiently and effectively in adults and children. For the proposed research, electrical stimulation has been divided into two domains: input signal processing and output signal processing. Specific Aim 1 evaluates effects of changing processing of the input signal to the speech processor on speech recognition and preference in everyday life (e.g., emphasizing transient speech sounds, criteria for assigning frequency boundaries to electrodes). Specific Aim 2 evaluates effects of changing processing of the output signal on speech recognition and preference in everyday life (e.g., sequential stimulation of all electrodes vs roving stimulation of selected electrodes each cycle, effect of pulse duration and monopolar vs tripolar stimulation on electrodes). Specific Aim 3 evaluates use of NRT/NRI and behavioral measures for individualized fitting of implant parameters in adults and children. Specific Aim 4 evaluates the effect of various factors (e.g., position of electrodes in the cochlea, response to NRT/NRI measures, cognitive function, verbal abilities, etiology, and biographical factors) on word recognition in adults. Outcome of this research holds promise for marked improvement in clinical care of cochlear implant recipients.