Clinical Application of Spectral Envelope Perception: Cochlear Implant Evaluation

描述（由申请人提供）：大多数现代人工耳蜗（CI）候选人在一只或两只耳朵中都有残余的听觉。一些研究表明，当与双模听力配置的CI配对时，这种残余听力提供了显著的好处。然而，与声学相关的双峰获益程度在不同的耳朵上是不同的，与听力阈值、病因、年龄或术前语音识别无关。在术前听力锐度没有明显差异的情况下，双耳听力残余的患者通常被告知，当与CI配对时，任何一只耳朵都可以提供益处。目前还没有临床指标为选择植入耳蜗提供预测效用，这是一个关键的考虑因素，特别是在双侧耳蜗植入可能受到限制的情况下（即保险限制）。本应用程序建议开发和实现这样一个临床工具。光谱调制检测（SMD）的临床测试是一个改进版本的有效的心理物理程序评估光谱分辨率。在这个任务中，听众被要求区分频谱平坦噪声和频谱调制噪声。该临床程序的试点工作表明，当与双模听力CI配对时，非植入耳中的SMD是声学效益的极好预测因子（r = 0.89）。因为这项任务对比噪音刺激，它不需要言语理解，并且可以由残听很少的候选人完成——这两种情况都是术前评估的个体所期望的。我们最新的临床试验每只耳朵需要5到6分钟，在安静和噪音中与声学效益高度相关，并以正确率报告得分。该工具有潜力满足听力学和耳科领域的强烈需求，并显著影响手术决策和患者预后。

DESCRIPTION (provided by applicant): 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 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 er to be implanted-a critical consideration particularly in cases for which bilateral cochlear implantation may be restricted (i.e. insurance restrictions). 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 to6 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.