植入耳丧失可用听觉的成年人工耳蜗植入受者的临床结局。

Plant Kerrie L, van Hoesel Richard J M, McDermott Hugh J, Dawson Pamela W, Cowan Robert S

1The HEARing CRC, University of Melbourne, Victoria, Australia; 2Cochlear Limited, Macquarie University, Sydney, New South Wales, Australia; 3Department of Audiology and Speech Pathology, The University of Melbourne, Victoria, Australia; 4Bionics Institute, East Melbourne, Victoria, Australia; 5Faculty of Human Sciences, Macquarie University, Sydney, NSW, Australia.

Ear Hear. 2015 May-Jun;36(3):338-56. doi: 10.1097/AUD.0000000000000122.

OBJECTIVES

The first aim of the study was to quantify the change in clinical performance after cochlear implantation for adults who had pre-operative levels of acoustic hearing in each ear of greater than or equal to 46% phoneme score on an open-set monosyllabic word test, and who subsequently experienced loss of useable acoustic hearing in the implanted ear. Pre- and postoperative spatial hearing abilities were assessed, because a clinical consideration for candidates with bilateral acoustic hearing is the potential for post-operative reduction in spatial hearing ability. Second, it was of interest to examine whether preoperative localization ability, as an indicator of access to interaural timing and level cues preoperatively, might be correlated with post-operative change in spatial hearing abilities.

DESIGN

Clinical performance measures in the binaural condition were obtained preoperatively and at 12 months postoperatively in 19 postlinguistically hearing-impaired adult subjects. Preoperative localization ability was investigated as a potential correlate with post-operative change in spatial hearing abilities.

RESULTS

Significant postoperative group mean improvement in speech perception was observed on measures of open-set monosyllabic word perception in quiet and on an adaptive sentence test presented in coincident 4-talker babble. Observed benefit was greater for a lower presentation level of 55 dB SPL as compared with a conversational speech level of 65 dB SPL. Self-reported ratings of benefit also improved for all questionnaires administered. Objective assessment of localization ability revealed poorer localization postoperatively, although subjective ratings of post-operative change in localization ability in real-world environments were more variable. Postoperative spatial release from masking was not different to that measured preoperatively for the configuration where the side of the head with the hearing aid was advantaged, but improved postoperatively for the configuration that advantaged the implanted side. Preoperative binaural localization ability was not correlated with postoperative spatial hearing abilities.

CONCLUSIONS

The findings from this study support cochlear implantation for candidates with pre-operative levels of binaural acoustic hearing within the range examined within the present study. This includes subjects with preoperative open-set monosyllabic word scores ranging from 11 to 62% in the implanted ear, and from 16 to 75% on the contralateral side. Post-operative improvement would be expected for those subjects on a range of clinical measures, even when acoustic hearing was lost in the implanted ear after implantation.

目的

本研究的首要目的是量化人工耳蜗植入术后，术前每侧耳朵在开放式单音节词测试中语音听力水平大于或等于46%音素得分、且随后植入耳丧失可用听觉的成年人的临床表现变化。评估术前和术后的空间听力能力，因为双侧听觉候选人的一个临床考量因素是术后空间听力能力可能下降。其次，研究术前定位能力作为术前获取双耳时间和强度线索指标，是否可能与术后空间听力能力变化相关也很有意义。

设计

对19名语后聋成年受试者在术前和术后12个月获取双耳条件下的临床表现测量结果。研究术前定位能力作为与术后空间听力能力变化的潜在关联因素。

结果

在安静环境下的开放式单音节词感知测量以及在4人同时说话的嘈杂环境中进行的自适应句子测试中，术后组平均言语感知有显著改善。与65 dB SPL的对话语音水平相比，55 dB SPL的较低呈现水平观察到的益处更大。所有问卷的自我报告受益评分也有所改善。定位能力的客观评估显示术后定位较差，尽管在现实环境中对术后定位能力变化的主观评分更具变异性。对于助听器所在侧头部占优势的配置，术后掩蔽下的空间解脱与术前测量结果无差异，但对于植入侧占优势的配置，术后有所改善。术前双耳定位能力与术后空间听力能力无相关性。