Binaural cue sensitivity in children and adults with combined electric and acoustic stimulation

项目总结 采用微创手术技术和无创电极阵列的人工耳蜗术已导致 成人和儿童人工耳蜗(CI)接受者中有联合植入潜力的患病率不断上升 电刺激和双耳刺激(EAS)。许多研究表明，成年EAS用户 在噪声和空间听力任务中始终显示出对语音理解的显著好处 与仅与对侧HA配对的CI相比。我们还展示了对耳间声音的敏感性 时差(ITD)和耳间水平差(ILD)提示与EAS对语言后的益处相关 耳聋的成年听众。尽管有这一活跃的发现阶段，但仍有惊人的缺乏对 儿童CI使用者的EAS结果，EAS匹配后的预期受益轨迹，以及 推动EAS在所有人群中受益(或缺乏)的潜在机制。两者之间有一种脱节 EAS在所有CI接受者中的可用性和EAS利用率以及EAS的当前听力学管理 候选人并不是由数据驱动的。考虑到双耳系统的长期成熟，这是有问题的 事实上，我们不知道感觉神经性听力损失和合并的EAS可能会有什么额外的影响 发展中的双耳系统。拟议的研究活动将描述 双耳发育使用行为和客观反应的耳间差异的时间(阶段)和 水平以及允许临床干预的自然因素调查，EAS Fitment On说 发展。在临床试验的背景下，我们将比较急性和慢性EAS的结果 语音识别和空间听力与双耳线索敏感度、线索权重和潜在线索有关 神经同步性对于ITD的解决是必要的。我们已经为两位成人提出了一项单组作业 和儿科EAS用户，还将包括按时间顺序和听力年龄匹配的听者，其正常 听证(NH)。针对EAS和NH听众的受试者内加速纵向设计将提供 深入了解儿童NH双耳系统的发展轨迹，并将提供一个基准 为了解释感音神经性听力损失的影响，由耳蜗所引起的听觉不对称 植入，并在所述弹道上使用EAS。我们提议的研究活动将有助于缩小 EAS技术在技术上是可行的，耳科医生和 研究双耳敏感度和空间听力发展的听觉学家。生成的数据 将包括对双耳行为和电生理测量的第一次全面描述 在患有NH和EAS的成人和儿童中进行听证，并将揭示我们EAS临床的信息 在设备配件以及听力学和耳科领域具有较高临床应用潜力的人群 关于人工耳蜗术的临床建议。

PROJECT SUMMARY Cochlear implantation with minimally traumatic surgical techniques and atraumatic electrode arrays has led to an increasing prevalence of adult and pediatric cochlear implant (CI) recipients with the potential for combined Electric and binaural Acoustic Stimulation (EAS). Many studies have demonstrated that adult EAS users consistently exhibit significant benefits for speech understanding in noise and spatial hearing tasks as compared to a CI paired only with a contralateral HA. We have also demonstrated that sensitivity to interaural time difference (ITD) and interaural level difference (ILD) cues is correlated with EAS benefit for postlingually deafened adult listeners. Despite this active phase of discovery, there is still a striking paucity of research on EAS outcomes in pediatric CI users, the expected trajectory of benefit following EAS fitting, as well as underlying mechanisms driving EAS benefit (or lack thereof) in all populations. There is a disconnect between EAS availability and EAS utilization in all CI recipients and current audiological management of EAS candidates is not data driven. This is problematic given the protracted maturation of the binaural system and the fact that we do not understand what additional effects sensorineural hearing loss and combined EAS may have on the developing binaural system. The proposed research activities will describe the time course of binaural development using behavioral and objective responses to interaural differences in timing (phase) and level as well as allow for a natural factor investigation of a clinical intervention, the EAS fitting, on said development. Within the context of a clinical trial, we will compare acute and chronic EAS outcomes for speech recognition and spatial hearing as related to binaural cue sensitivity, cue weighting, and underlying neural synchrony necessary for ITD resolution. We have proposed a single-group assignment for both adult and pediatric EAS users and will also include chronological- and hearing-age-matched listeners with normal hearing (NH). A within-subjects, accelerated longitudinal design for both EAS and NH listeners will provide insight into the developmental trajectory of the binaural system for children NH and will provide a benchmark for interpreting effects of sensorineural hearing loss, asymmetry in audibility resulting from cochlear implantation, and EAS use on said trajectory. Our proposed research activities will help close the gap between what is technologically possible with EAS technology and what is clinically implemented by otologists and audiologists investigating development of binaural sensitivity and spatial hearing abilities. The resultant data will comprise the first comprehensive description of behavioral and electrophysiologic measures of binaural hearing in adults and children both with NH and EAS and will uncover information about our EAS clinical populations holding high potential for clinical application in device fittings as well as audiologic and otologic clinical recommendations regarding cochlear implantation.