THE EFFECTS OF EARLY ACOUSTIC HEARING FOR PEDIATRIC COCHLEAR IMPLANT RECIPIENTS

描述(申请人提供)：目前，儿科患者从双耳装置[对侧耳植入人工耳蜗(CI)+助听器(HA)]转向双侧CI的决定是在缺乏经验指导的情况下做出的。通过这些研究，我们将通过检查使用双模装置和两个顺式助听器的儿童来检查剩余听力水平和助听器使用时间的连续体。对重音、音高和韵律(超段线索)的感知是使正常听力(NH)婴儿能够识别音素并最终感知单词的早期先兆。尽管顺式听力支持单词识别所必需的高水平的音素辨别，但超段听力对正常听力儿童语言发展的贡献可能是缺乏的，部分原因是当前顺式听力的频谱分辨率降低。我们试图通过研究100名儿童的纵向队列来阐明早期使用HA对言语感知和语言技能的好处，这些儿童在5岁到8岁时接受测试，两年后在7岁到10岁时重新测试。具有不同程度残余听力(辅助阈值)和不同使用HA时间的儿童将代表早期声音体验的连续体。一些儿童将是双模使用者，因此使用HA的时间更长，可能会有更好的声学听力；其他儿童将同时或在第一次CI后的不同时间间隔收到第二次CI(2CI)，并具有一定的声学听力经验。我们假设，早期的HA声学经验为非常年轻的CI用户提供了超段线索，从而导致对节段线索的感知(目标1)。听觉对语言的影响将通过言语感知、语音加工、单词学习和记忆来实现(目标2)。最后，我们寻求确定对语言水平最优的HA使用时间和辅助听力程度(目标3)。这些研究最终将指导临床医生就早期双峰(HA/CI)的使用和潜在的双侧人工耳蜗术的时机提出明智的建议。

DESCRIPTION (provided by applicant): Currently the decision to proceed from bimodal devices [cochlear implant (CI) plus hearing aid (HA) in the opposite ear] to bilateral CIs for pediatric patients is made in the absence of empirically driven guidelines. Through these research studies we will examine a continuum of residual hearing levels and length of hearing aid use by examining children with bimodal devices and two CIs. Perception of stress, pitch and prosody (suprasegmental cues) are early precursors that enable normal hearing (NH) infants to discern phonemes and ultimately perceive words. Although CIs support high levels of phoneme discrimination necessary for word recognition, the contribution of suprasegmental listening that bootstraps language development in normal hearing children may be lacking, partly due to reduced spectral resolution of current CIs. We seek to elucidate the reported benefits of early HA use for speech perception and language skills by examining a longitudinal cohort of 100 children tested when they are between 5 and 8 years and retested two years later when they are between 7 and 10 years. A continuum of early acoustic experience will be represented by children with varying degrees of residual hearing (aided thresholds) and varying durations of HA use. Some children will be bimodal users and thus have longer periods of HA use and presumably better acoustic hearing; others will have received their second CI (2CIs) either simultaneously or at varying time intervals since their first CI, and had some prior acoustic hearing experience. We hypothesize that early acoustic experience with a HA provides the very young CI user with suprasegmental cues that lead to perception of segmental cues (Aim 1). The effects of acoustic hearing on language will be mediated by speech perception, phonological processing, word learning and memory (Aim 2). Finally we seek to determine the duration of HA use and degree of aided hearing that are optimal for language level (Aim 3). These studies will eventually guide clinicians in making informed recommendations regarding early bimodal (HA/CI) use and the timing of potential bilateral cochlear implantation.