Cochlear Implants: Combined Electric and Binaural Acoustic Stimulation

描述(申请人提供)：在人工耳蜗术的最新应用中，患有双侧低频听力的人在一个耳蜗处植入一个短电极阵列，目的是保护该耳的听力。成功的手术结果允许患者结合来自植入耳的电(E)刺激和来自双耳或EAS的声刺激(S)。这项研究的长期目标是量化两只部分听力耳朵和一只部分听力耳朵的声学听力的益处--就像双峰听力的情况一样。之前的研究未能证明，两只部分听力的耳朵与一只部分听力的耳朵相比，对言语感知有显著的好处。然而，用于评估益处的标准临床测量并不是为评估双耳听力而设计的。因此，拟议的研究将测试两组患者，包括(1)EAS接受者，(2)一耳采用传统电极阵列，另一耳采用低频听力(即双模式)的患者。实验将包括复杂的听力环境，这些环境被认为对双耳线索的使用很敏感，包括语音和噪音的空间分离、混响和本地化。这一建议的临床应用是实质性的。听力学家和耳科医生都不确定如何就治疗方案向符合EAS资格的患者提供咨询。该项目将提供必要的信息，以便进行数据驱动的咨询。 公共卫生相关性：电和声刺激(EAS)与短电极阵列相结合，为那些没有从助听器中受益并且可能由于残留的低频听力而不符合人工耳蜗植入资格的个人提供了一种可行的治疗选择。然而，至关重要的是，患者和专业人员都要了解在植入耳中保留听力的好处，以及EAS(人工耳蜗术+双耳听力)与双模式听力(人工耳蜗术+对侧听力)的相对好处。目前的提案旨在开发这一信息，因此，将使适当的知情同意的治疗选择，可能成为努力恢复部分聋人听力的标准外科工具。

DESCRIPTION (provided by applicant): In one of the newest applications of cochlear implants, individuals with bilateral low-frequency hearing receive a short electrode array in one cochlea with the aim of preserving hearing in that ear. A successful surgical outcome allows patients to combine electrical (E) stimulation from the implanted ear and acoustic stimulation (S) from both ears or EAS. The long-term goal of this research is to quantify the benefit of acoustic hearing from two partially hearing ears vs. one partially hearing ear - as in the case of bimodal hearing. Previous research has failed to demonstrate significant benefit to speech perception for EAS with two partially hearing ears vs. one partially hearing ear. The standard clinical measures that have been used to assess benefit, however, have not been designed to assess binaural listening. Thus the proposed research will test two groups of patients including (1) EAS recipients, and (2) patients with a conventional electrode array in one ear and low-frequency hearing in the other ear (i.e., bimodal). Experimentation will include complex listening environments which are thought to be sensitive to the use of binaural cues including the spatial separation of speech and noise, reverberation, and localization. The clinical application of this proposal is substantial. Neither audiologists nor otologists are certain how to counsel EAS-qualifying patients about treatment options. This project will provide the necessary information to allow for data-driven counseling. PUBLIC HEALTH RELEVANCE: Combined electric and acoustic stimulation (EAS) with a short electrode array offers a viable treatment option for individuals who do not receive benefit from hearing aids and may not qualify for a cochlear implant due to residual low-frequency hearing. It is critical, however, that both patients and professionals understand the benefits of preserving hearing in the implanted ear as well as the relative benefits of EAS (cochlear implant + binaural acoustic hearing) vs. bimodal hearing (cochlear implant + contralateral acoustic hearing). The current proposal aims to develop this information and, as a consequence, will enable appropriate informed consent for a treatment option that could become a standard surgical tool in the effort to restore hearing to the partially deaf.