Improving Binaural Hearing in Children with Cochlear Implants

摘要 在单耳植入人工耳蜗(CI)时，儿童在噪音和噪声中会出现听力障碍。 本地化房间内的声音。这并不令人惊讶，因为对正常听力听众的研究已经证明 当人工双耳听力时，在噪声和声音定位中的语音理解可能非常差 打乱了。无法将语音与噪音分开并定位声音可能会对 儿童在教室等环境中学习的能力，在这种环境中，通常会有多种声音到达 每个孩子都面临着将感兴趣的刺激从背景中分离出来的挑战 噪音。临床治疗已经发生了彻底的转变，其中双边顺位已成为标准。 70%的双边传播信息使用者是10岁以下的儿童。绝大多数孩子都会表演 在声音定位和理解方面明显比他们正常的听力差，年龄匹配的同龄人 在嘈杂声中讲话。使用研究处理器同步两个耳朵中的CI，特定的目标将 研究声音局部化机制(目标1)和噪声中语音分离机制(目标2)。此外，我们 将评估神经兴奋传播的外周测量是否可以作为一种有用的工具 预测双耳加工，以便最终开发用于双侧顺式耳机配对的客观临床工具 (目标3)。研究将在先天耳聋和双侧植入的儿童身上进行。 婴儿期和儿童出生时有听力，在儿童早期就有后天耳聋。此外，患有疾病的儿童 将使用双耳CI模拟来研究正常听力，以了解 CI使用者和正常听力儿童之间的差异是由已知的信号退化造成的 发生在顺位词中。CI模拟相对于标准声学提示施加的限制将提供 作为CI人群预期的最佳绩效水平的基准。最终，这项工作将导致 为失聪儿童开发更好的语音处理器，理想情况下他们的能力会有更好的结果 在噪音中听到语音，定位声音，并在复杂的噪音环境中学习。

Abstract When using a cochlear implant (CI) in one ear, children experience difficulties hearing speech in noise and localizing sounds in rooms. This is not surprising, as studies in normal hearing listeners have demonstrated that speech understanding in noise and sound localization can be very poor when binaural hearing is artificially disrupted. Inability to segregate speech from noise and to localize sounds can have a profound impact on the ability of a child to learn in environments such as classrooms, where it is typical to have multiple sounds arrive from various directions, and each child faces the challenge of segregating stimuli of interest from background noise. There has been a sweeping shift in clinical treatment, whereby bilateral CIs have become the standard of care, and 70% of bilateral CI users are children under 10 years of age. The vast majority of children perform significantly worse than their normal hearing, age-matched peers on sound localization and understanding of speech in noise. Using research processors that synchronize the CIs in the two ears, specific aims will investigate mechanisms of sound localization (Aim 1) and speech-in-noise segregation (Aim 2). In addition, we will evaluate whether peripheral measures of neural spread of excitation can serve as a useful tool for predicting binaural processing, in order to ultimately develop objective clinical tools for bilateral fitting of CIs (Aim 3). Studies will be done in implanted children who were congenitally deaf and implanted bilaterally during infancy and children born with hearing and acquired deafness during early childhood. In addition, children with normal hearing will be studied using binaural CI simulations, in order to understand the extent to which differences between CI user and normal hearing children are accounted for by signal degradation that is known to occur with CIs. Limits imposed by the CI simulations relative to standard acoustic cues will provide a benchmark for best performance levels to be expected from the CI populations. Ultimately, the work will lead to development of better speech processors for children who are deaf, and ideally better outcomes in their ability to hear speech in noise, localize sounds, and learn in complex noisy environments.