Clinical Application of Spectral Envelope Perception: Cochlear Implant Evaluation

9.项目总结/摘要 大多数现代人工耳蜗（CI）候选人在一个或两个中具有残余声学听力 耳朵几项研究表明，当与CI配对时，这种残余听力提供了显着的益处 在双模态收听配置中。然而，声学相关的双峰益处的程度在不同的环境中不同。 与听力阈值、病因、年龄或术前言语识别无关。在 术前听力敏锐度无明显差异，患者在两种情况下均存在残余听力 耳朵通常被告知，当与CI配对时，任何一只耳朵都可以提供益处。没有临床 一种为选择要进行听力检查的耳朵提供预测效用的措施-一个关键的考虑因素 特别是在双侧耳蜗植入可能受到限制的情况下（即 如医疗保险和医疗补助所遇到的）。本申请提出开发和实现这样的 临床工具光谱调制检测（SMD）的临床测试是经过验证的 心理物理程序评估光谱分辨率。在这个任务中，听者被要求区分 频谱平坦噪声与频谱调制噪声。该临床程序的试点工作表明，SMD 非植入耳是一个很好的预测声学效益（r = 0.89），当配对的CI为双峰 听证会因为这项任务对比噪声刺激，它不需要语音理解，可以 由候选人完成，很少有剩余听力-这两种情况都是对个人的预期， 术前评估。我们最新的临床任务迭代的试点工作每次需要5到6分钟， 耳朵，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。 该工具有潜力满足听力学和耳科领域的强烈需求， 影响手术决策和患者结果。在这项研究的结论，我们将提供临床医生 通过植入前和植入后的听觉完整性测试，将测试分数转化为有意义的 预测每只耳朵在特定治疗条件下的潜在益处，以及数据驱动的指南， 耳朵选择因此，这项研究有可能帮助我们在医学上实现循证医学目标。 植入耳选择、期望管理和模态选择（双峰听力或双侧 植入）。

9. PROJECT SUMMARY/ABSTRACT 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 in 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 ear to be implanted-a critical consideration particularly in cases for which bilateral cochlear implantation may be restricted (i.e. insurance restrictions such as encountered with Medicare and Medicaid). 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 to 6 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. At the conclusion of this study, we will provide clinicians with a pre- and post-implant test of auditory integrity, the supporting tools to translate test scores to meaningful predictions about the potential benefit of each ear in specific treatment conditions, and a data-driven guide to ear selection. Thus, the study has the potential to help us meet the evidence-based objective in medicine in the areas of implant ear selection, expectations management, and modality selection (bimodal hearing or bilateral implantation).