The effects of early acoustic hearing for pediatric cochlear implant recipients

临床医生现在关注的是，在每只耳朵上，哪种设备最能提供感知敏锐度，从而使年龄- 适当的口语发展。建议年轻人尽快进行双侧CI（BCI） 听力损失最严重的儿童（HLs）。然而，临床医生不太确定， 对于患有从严重到严重不等的HL的幼儿的建议。虽然长期 这些设备决定的后果是未知的，期望是早期的感知能力提供了 功能性沟通和同伴互动的基础，对于学术和社会导航至关重要 在听觉世界中。一般来说，助听器的建议是基于听力阈值 和语音感知分数，通常是分段语音分数（例如，理解的话）。然而 超音段感知（对语调、重音和节奏的感知），这对 口语和词汇的发展，在很大程度上被忽视了。重要的是， 具有超分割知觉的CI和HA的传输效果并不相同; CI通常更 有效地传达分段线索，而取决于听者的残余听力， 有效地传达超音段线索。我们确定了以下三种情况下使用HA的关键持续时间： HL严重程度范围（纯音平均值[PTA]为72、92和110 dB HL）， 超节段知觉两者都有助于接受性语言，超音段仍然是重要的 早期阅读技能。我们的研究结果表明，一个患有严重HL（~72 dB HL）的儿童在早期接受脑机接口， 年龄，因此没有经历早期延长使用HA，可能会被拒绝良好 超音段感知和更典型的语言基础。然而，早期的长期利益 HA使用（由PTA调节）对口语技能，阅读和其他感知能力的影响仍然存在 未知我们现在建议确定早期使用HA是否有助于或减损感知技能 隐含在“真实的世界”通信中，即视听（AV）语音感知和双耳收听。早期 听觉补充了视觉语音信息，并且可以为AV感知提供很大的益处。 或者，为了发展双耳听力技能，早期的BCI，由于它们的对称刺激， 可能比双模态设备更好，对于双模态设备，存在隐含的延长的声学听觉时间段， 不对称刺激我们将在这两种感知能力成熟的年龄， 被认为是充分发展的，可以可靠地评估。目标1a：确定早期听觉是否 有助于AV感知和双耳听力技能。目标1b：确定AV的独特贡献 感知和双耳听力技能，口语，听力质量和社会功能。目标二： 确定早期超音段知觉对接受性语言的贡献是否会延伸到成年 语言技能、阅读理解能力、自我和同伴评定的听力和社交技能。

Clinicians are now focused on which device, at each ear, best provides the perceptual acuity such that age- appropriate spoken language develops. Bilateral CIs (BCIs) are recommended as soon as possible for young children with the most profound hearing losses (HLs). Clinicians are less certain, however, about recommendations for young children with HL varying from severe to profound. Although the long-term consequences of these device decisions are unknown, the expectation is that early perceptual abilities provide a foundation for functional communication and peer interactions critical for navigating academic and social situations in a hearing world. Generally, hearing-device recommendations are based on audiometric thresholds and speech perception scores, usually segmental speech scores (e.g., words understood). Yet suprasegmental perception (perception of intonation, stress, and rhythm), which is also extremely important for spoken language and lexical development, has been largely ignored. Importantly, the acoustic cues associated with suprasegmental perception are not transmitted equally well with CIs and HAs; CIs are typically more effective for conveying segmental cues while HAs, depending on a listener's residual hearing, are more effective for conveying suprasegmental cues. We identified a critical duration of HA use for each of three ranges of HL severity (pure-tone-averages [PTAs] of 72, 92 &110 dB HL) that maximizes both segmental and suprasegmental perception. Both contribute to receptive language, and suprasegmental remains significant for early reading skills. Our results suggest that a child with severe HL (~72 dB HL) who receives BCIs at an early age, and consequently does not experience early extended use of a HA, could be denied good suprasegmental perception and a more-typical language foundation. The long-term benefits, however, of early HA use (moderated by PTA) to spoken language skills, reading, and other perceptual abilities remain unknown. We now propose to establish whether early HA use contributes to, or detracts from, perception skills implicit in “real world” communication, namely audiovisual (AV) speech perception and binaural listening. Early acoustic hearing complements visual speech information and may provide large benefits for AV perception. Alternatively, for developing binaural listening skills, early BCIs, with their somewhat symmetrical stimulation, may be better than bimodal devices for which there is an implicit extended period of acoustic hearing and asymmetrical stimulation. We will examine these two types of perceptual abilities at ages when these skills are thought to be fully-developed and can be reliably assessed. Aim 1a: Determine whether early acoustic hearing contributes to AV perception and binaural listening skills. Aim 1b: Determine the unique contributions of AV perception and binaural listening skills to spoken language, quality of hearing, and social functioning. Aim 2: Determine if contributions of early suprasegmental perception to receptive language extend to adolescent-age verbal skills, reading comprehension and self- and peer-rated hearing and social skills.