Moberly Aaron C, Bates Chelsea, Harris Michael S, Pisoni David B
*Department of Otolaryngology, The Ohio State University Wexner Medical Center, Ohio†Department of Psychological and Brain Sciences, Indiana University, Indiana.
Otol Neurotol. 2016 Dec;37(10):1522-1528. doi: 10.1097/MAO.0000000000001211.
Considerable unexplained variability and large individual differences exist in speech recognition outcomes for postlingually deaf adults who use cochlear implants (CIs), and a sizeable fraction of CI users can be considered "poor performers." This article summarizes our current knowledge of poor CI performance, and provides suggestions to clinicians managing these patients.
Studies are reviewed pertaining to speech recognition variability in adults with hearing loss. Findings are augmented by recent studies in our laboratories examining outcomes in postlingually deaf adults with CIs.
In addition to conventional clinical predictors of CI performance (e.g., amount of residual hearing, duration of deafness), factors pertaining to both "bottom-up" auditory sensitivity to the spectro-temporal details of speech, and "top-down" linguistic knowledge and neurocognitive functions contribute to CI outcomes.
The broad array of factors that contribute to speech recognition performance in adult CI users suggests the potential both for novel diagnostic assessment batteries to explain poor performance, and also new rehabilitation strategies for patients who exhibit poor outcomes. Moreover, this broad array of factors determining outcome performance suggests the need to treat individual CI patients using a personalized rehabilitation approach.
对于使用人工耳蜗（CI）的语后聋成年人，言语识别结果存在大量无法解释的变异性和较大的个体差异，相当一部分CI使用者可被视为“表现不佳者”。本文总结了我们目前对CI表现不佳的认识，并为管理这些患者的临床医生提供建议。
回顾了有关听力损失成年人言语识别变异性的研究。我们实验室最近对语后聋成年CI使用者的研究结果进一步补充了这些发现。
除了CI表现的传统临床预测因素（如残余听力量、耳聋持续时间）外，与对语音频谱-时间细节的“自下而上”听觉敏感性以及“自上而下”语言知识和神经认知功能相关的因素也会影响CI结果。
导致成年CI使用者言语识别表现的因素众多，这表明新型诊断评估组合有可能解释表现不佳的原因，也为表现不佳的患者提供了新的康复策略。此外，众多决定结果表现的因素表明，需要采用个性化康复方法来治疗个体CI患者。
