Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Freiburg, Freiburg, Germany.
Otol Neurotol. 2011 Jan;32(1):39-47. doi: 10.1097/MAO.0b013e3181fcf271.
Up to now, treatment modalities of unilateral deafness consist of no treatment, conventional contralateral routing of signal (CROS), or Bone-Anchored Hearing Aid (BAHA) hearing aid. Cochlear implantation makes a new treatment modality available for patients with single-sided deafness. The aim of this study is to evaluate the use of unilateral electrical stimulation with normal hearing on the contralateral side after a period of 6 months compared with the preoperative unaided situation, conventional CROS, or BAHA hearing aids.
Prospective design.
Tertiary referral center; cochlear implant (CI) program.
Eleven adult subjects with unilateral deafness of various causes were enrolled in the study. Only those patients were included in whom therapy with CROS hearing aid or BAHA was not successful and in whom the auditory nerve was found to be intact and the cochlea patent for cochlear implantation.
All subjects were fitted in random order with a BAHA Intenso mounted on the softband/tension clamp or with a CROS hearing aid. After test periods with both devices, the subjects received a CI.
The Hochmair-Schulz-Moser sentence test and the Oldenburg sentence test were used to test speech comprehension in 3 presentation configurations in the unaided situation, with conventional CROS and BAHA hearing aids before cochlear implantation as well as after 6 months with CI. Localization was assessed using an array of 7 speakers at head level in a frontal semicircle. Subjective improvement in daily life was evaluated using the Speech, Spatial and Qualities of Hearing Scale, the Health Utilities Index 3 and the International Outcome Inventory for Hearing Aids questionnaires. Tinnitus distress was measured with a tinnitus scale before and after CI implantation.
The results show significant improvement in localization ability as well as in speech comprehension in most presentation configurations with the CI. Especially, there is no negative effect on speech comprehension if the noise is presented to the CI ear and speech to the normal hearing ear. With the CI, the summation and squelch effects are not significant, but a significant combined head shadow effect is seen. Speech, Spatial and Qualities of Hearing results show an overall benefit of wearing the CI compared with the other treatment options. The tinnitus scale revealed a positive effect of CI stimulation in cases of preoperative tinnitus.
The results in these patients suggest that cochlear implantation improves hearing abilities in people with single-sided deafness and is superior to the alternative treatment options. The use of the CI does not interfere with speech understanding in the normal hearing ear. Our data suggest that the binaural integration of electric and acoustic stimulation is possible even with unilateral normal hearing.
到目前为止，单侧聋的治疗方法包括不治疗、传统的对侧信号转导（CROS）或骨锚式助听器（BAHA）。人工耳蜗植入为单侧聋患者提供了一种新的治疗方法。本研究的目的是评估单侧电刺激在 6 个月后与术前未助听状态、传统 CROS 或 BAHA 助听器相比的使用情况。
前瞻性设计。
三级转诊中心；人工耳蜗植入（CI）项目。
11 名患有各种原因单侧聋的成年患者入组本研究。仅纳入那些 CROS 助听器或 BAHA 治疗不成功且听神经完整、耳蜗适合人工耳蜗植入的患者。
所有患者均随机佩戴软带/张力夹上的 BAHA Intenso 或 CROS 助听器。在两种设备的测试期后，患者接受 CI。
在未助听状态、植入 CI 前的传统 CROS 和 BAHA 助听器以及植入 CI 后 6 个月，使用 Hochmair-Schulz-Moser 句子测试和奥登堡句子测试在 3 种呈现配置下测试言语理解能力。使用头部水平的 7 个扬声器阵列评估定位。使用言语、空间和听力质量量表、健康效用指数 3 和听力辅助国际结果清单问卷评估日常生活中的主观改善。使用耳鸣量表在 CI 植入前后评估耳鸣困扰。
结果显示，CI 可显著改善定位能力和大多数呈现配置下的言语理解能力。特别是，如果将噪声传递到 CI 耳，而将言语传递到正常听力耳，不会对言语理解产生负面影响。CI 没有明显的总和和抑制效应，但有显著的综合头影效应。言语、空间和听力质量结果显示，与其他治疗选择相比，佩戴 CI 具有整体优势。耳鸣量表显示，对于术前有耳鸣的患者，CI 刺激有积极的效果。
这些患者的结果表明，人工耳蜗植入可改善单侧聋患者的听力能力，优于其他治疗选择。CI 的使用不会干扰正常听力耳的言语理解。我们的数据表明，即使单侧正常听力，电刺激和声学刺激的双耳整合也是可能的。
