Davidson Lisa S
Central Institute for the Deaf, Washington University, St. Louis, Missouri 63110, USA.
Ear Hear. 2006 Oct;27(5):493-507. doi: 10.1097/01.aud.0000234635.48564.ce.
The present investigation was designed to provide information to facilitate the decision of whether a child should continue using digital signal processing (DSP) hearing aids with wide dynamic range compression (WDRC) or be recommended for a cochlear implant, based on the unaided pure-tone average (PTA at 500, 1000, and 2000 Hz).
Fifty-two children (ages 5 to 15 yr) with unaided PTAs in the moderately severe to profound range, wearing (DSP) hearing aids with (WDRC) or a Nucleus 24, Clarion 1.2, or CII cochlear implant system, participated: 26 with unaided PTAs from 60 to 98 dB HL using DSP hearing aids and 26 with pre-implant unaided PTAs from 93 to 120 dB HL, using cochlear implants. An open-set speech perception test, the Lexical Neighborhood Test (LNT; ), was administered at intensity levels representative of raised (70 dB SPL) and soft (50 dB SPL) speech at two different times approximately 1 mo apart. Minimum audibility of soft sounds was determined for the children with implants and with DSP hearing aids using warble-tone thresholds at octave intervals between 250 and 4000 Hz.
Regression analyses and significance testing were used to determine the unaided PTA values at which the performance of the DSP Hearing Aid group (DSP HA group) and Cochlear Implant group on the LNT test were statistically different at the 0.05 significance level. For the 70 dB SPL presentation level, the statistically different PTAs were 113 and 97 dB HL at Time 1 and Time 2, respectively, and 96 and 88 dB HL at 50 dB SPL for Time 1 and Time 2, respectively.
The Unaided PTA at which children in the cochlear implant group would be expected to score significantly better than the children in the DSP HA group was lowest (96 and 88 dB HL) for the lower signal level (50 dB SPL). Assuming that LNT scores at 50 dB SPL are representative of long-term hearing of soft incidental speech that is essential for language learning and fluent communication, the children with PTA values greater than the range from 88 to 96 dB HL would be expected to have significantly better LNT scores with a cochlear implant. These results should be further examined with research efforts focusing on early intervention with optimally fitted DSP hearing aids and cochlear implants.
本研究旨在提供信息，以便基于未助听纯音平均听阈（500、1000和2000赫兹处的PTA），辅助决定儿童应继续使用具有宽动态范围压缩（WDRC）功能的数字信号处理（DSP）助听器，还是被推荐使用人工耳蜗。
52名年龄在5至15岁之间、未助听PTA处于中度重度至极重度范围的儿童参与了研究，他们佩戴（DSP）助听器并带有（WDRC）功能，或使用Nucleus 24、Clarion 1.2或CII人工耳蜗植入系统：26名未助听PTA在60至98分贝听力级（dB HL）之间的儿童使用DSP助听器，26名植入前未助听PTA在93至120分贝听力级之间的儿童使用人工耳蜗。进行了一项开放式言语感知测试，即词汇邻域测试（LNT），在大约相隔1个月的两个不同时间，以代表提高的（70分贝声压级）和柔和的（50分贝声压级）言语的强度水平进行测试。使用250至4000赫兹倍频程间隔的啭音阈值，确定了植入人工耳蜗和使用DSP助听器的儿童的柔和声音的最小可听度。
使用回归分析和显著性检验来确定未助听PTA值，在该值时，DSP助听器组（DSP HA组）和人工耳蜗植入组在LNT测试中的表现，在0.05显著性水平上具有统计学差异。对于70分贝声压级的呈现水平，在第1次和第2次测试时，具有统计学差异的PTA分别为113和97分贝听力级，在50分贝声压级时，第1次和第2次测试的PTA分别为96和88分贝听力级。
对于较低信号水平（50分贝声压级），人工耳蜗植入组儿童预计得分显著高于DSP HA组儿童的未助听PTA最低（96和88分贝听力级）。假设50分贝声压级的LNT得分代表对语言学习和流畅交流至关重要的柔和偶然言语的长期听力，那么预计PTA值大于88至96分贝听力级范围的儿童使用人工耳蜗时LNT得分会显著更好。这些结果应通过聚焦于最佳适配的DSP助听器和人工耳蜗早期干预的研究工作进一步检验。
