Effects of Training on Adult Cochlear Implant Users

描述(申请人提供)：尽管双耳听具有优势，但对于使用两个人工耳蜗(CI)或CI与助听器相结合的患者来说，语音和噪声的定位和空间分离仍然困难。这些困难可能是由于：1)糟糕的频谱和/或时间处理，2)扭曲的外围图案，和/或3)糟糕的外围图案的双耳集成。听觉训练可能会缓解这些缺陷。我们的长期目标是开发提高脑梗塞患者双耳知觉的训练方法。目前尚不清楚训练是否应该针对单侧外周加工或双侧外周信号整合，或者两者兼而有之。我们假设，必须减小耳朵间单侧表现的差异(“不对称性”)，以使双耳受益最大化。单侧训练与较差的耳朵单独，其次是双侧训练将提供最好的 培训结果。对于空间双耳感知(定位和静噪)，我们进一步假设定位比语音和噪声分离需要更高的空间精度；改进定位将改善空间分离。局部化训练后的空间分离训练将为空间听力提供最好的效果。在所有三个目标中， 我们将使用交叉实验设计来看看训练序列是否会影响结果。听觉训练在双侧CI或双峰听者中尚未得到广泛研究，而且针对这些患者群体的针对性康复计划也很少(如果有的话)。通过解决研究和康复方面的这些缺陷，拟议的研究为CI患者提供了越来越常见的困难的新方法。本研究旨在确定双侧CI和双峰患者的最佳训练方法，并了解外周输入的差异如何影响双耳知觉以及训练结果。概念框架解决了可能限制性能的不同因素：听觉分辨率、外围设备表示和/或外围设备输入的整合。实验1和实验2讨论了单边心理物理训练和言语训练中哪一个更有效。实验3和实验4解决了所有双侧脑梗塞和双峰型患者面临的一个基本问题：用一只耳朵训练还是用两只耳朵训练更好？实验5和实验6讨论了空间训练是否具有任务特异性(本地化与空间隔离)。这一建议具有重要的临床意义，因为该研究将指导有效的训练方法，以最大限度地提高CI用户的双耳感知。这项研究也具有重要的理论意义，因为它试图更好地理解心理物理和言语测量之间的联系，双耳收益和单边表现之间的联系，以及电听力中的局部化和空间隔离。随着CI技术的进步似乎达到了回报递减的地步，听觉训练可能提供了最具成本效益的方法，以最大限度地发挥人工耳蜗术的好处。

DESCRIPTION (provided by applicant): Despite the advantages of listening with two ears, localization and spatial segregation of speech and noise remain difficult for patients who use two cochlear implants (CIs) or a CI in combination with a hearing aid. These difficulties may be due to: 1) poor spectral and/or temporal processing, 2) distorted peripheral patterns, and/or 3) poor binaural integration of peripheral patterns. Auditory training may mitigate these deficits. Our long-term goal is to develop training methods that improve CI patients' binaural perception. It is as yet unclear whether training should target unilateral peripheral processing or bilateral integration of peripheral signals or both. We hypothesize that the difference in unilateral performance across ears ("asymmetry") must be reduced to maximize the binaural benefit. Unilateral training with the poorer ear alone, followed by bilateral training will provide the best training outcome. For spatial binaural perception (localization and squelch), we further hypothesize that localization requires greater spatial precision than segregation of speech and noise; improving localization will improve spatial segregation. Localization training, followed by spatial segregation training will provide the best outcomes for spatial hearing. In all three Aims, we will use a crossover experimental design to see whether the training sequence affects outcomes. Auditory training has not been extensively studied in bilateral CI or bimodal listeners, and there are few (if any) targeted rehabilitation programs for these patient groups. By addressing these deficits in research and rehabilitation, the proposed research offer novel approaches to increasingly commonplace difficulties for CI patients. The research seeks to identify the best training approach for bilateral CI and bimodal patients, as well as understand how differences in the peripheral input may influence binaural perception as well as the training outcomes. The conceptual framework addresses different factors that may limit performance: auditory resolution, peripheral representation and/or integration of peripheral inputs. Experiments 1 and 2 address whether unilateral psychophysical or speech training is more effective. Experiments 3 and 4 address a fundamental question facing all bilateral CI and bimodal patients: Is it better to train with one ear or two? Experiments 5 and 6 addresses whether spatial training is task-specific (localization vs. spatial segregation). The proposal is o great clinical significance, as the research will guide efficient training methods to maximize CI users' binaural perception. The research is also of great theoretical significance, as it seeks to better understand connections between psychophysical and speech measures, binaural benefits and unilateral performance, as well as localization and spatial segregation in electric hearing. As advances in CI technology seem to be reaching a point of diminishing returns, auditory training may provide the most cost-effective approach to maximize the benefit of cochlear implantation.