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具有残余听觉。几项研究表明，这种残余听力在与CI（双峰听力配置）配对时提供了显著的益处。然而，声学相关的双峰益处的程度因耳而异，并且与听力阈值、病因、年龄或术前语音识别无关。在术前听力敏锐度没有明显差异的情况下，双耳存在残余听力的患者通常被告知，当与CI配对时，任何一只耳朵都可以提供益处。目前还没有临床测量方法能为选择要植入的耳道提供预测性效用，这是一个关键的考虑因素，特别是在双侧人工耳蜗植入可能受到限制的情况下（即保险限制）。本申请提出开发和实施这样的临床工具。光谱调制检测（SMD）的临床测试是评估光谱分辨率的经验证的心理物理程序的修改版本。在这个任务中，要求听者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，非植入耳中的SMD与双模态听力的CI配对时，是声学益处的极好预测因子（r = 0.89）。因为这项任务对比噪声刺激，它不需要语音理解，可以完成的候选人很少的残余听力，这两个都是预期的个人正在术前评估。我们最近一次临床任务的试点工作每只耳朵需要5到6分钟，与安静和噪音中的声学益处高度相关，并报告为正确分数百分比。该工具有可能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结局。

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.