THE EFFECTS OF EARLY ACOUSTIC HEARING FOR PEDIATRIC COCHLEAR IMPLANT RECIPIENTS

描述（由申请人提供）：目前，在缺乏经验驱动的指南的情况下，儿科患者决定从双模装置[对耳人工耳蜗（CI）加助听器（HA）]转向双侧CIs。通过这些研究，我们将通过检查使用双峰式助听器和两个ci的儿童来检查残余听力水平和助听器使用时间的连续性。对压力、音高和韵律的感知（超片段线索）是正常听力（NH）婴儿辨别音素并最终感知单词的早期前兆。虽然ci支持单词识别所必需的高水平的音素辨别，但在正常听力儿童中引导语言发展的超分段听力的贡献可能缺乏，部分原因是当前ci的频谱分辨率降低。我们试图通过对100名5至8岁儿童的纵向队列进行测试，并在两年后的7至10岁期间重新测试，来阐明早期使用HA对言语感知和语言技能的益处。具有不同程度残余听力（辅助阈值）和不同HA使用时间的儿童将代表连续的早期声学体验。有些儿童将是双峰使用者，因此使用HA的时间更长，可能会有更好的听觉；另一些人则在第一次CI后同时或在不同的时间间隔接受了第二次CI (2ci)，并且有一些先前的声学听力经验。我们假设早期HA的声学经验为非常年轻的CI用户提供了超片段线索，从而导致对片段线索的感知（目的1）。听觉对语言的影响将通过言语感知、语音加工、单词学习和记忆来调节（目的2）。最后，我们试图确定HA使用的持续时间和辅助听力的程度是语言水平的最佳选择（目标3）。这些研究最终将指导临床医生对早期双模（HA/CI）使用和潜在双侧人工耳蜗植入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.