1Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 2Department of Speech and Language Pathology, Myongji University Graduate School, Seoul, Korea; 3Department of Speech Pathology and Audiology, University of Iowa, Iowa City, Iowa, USA; and 4Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Ear Hear. 2017 Jul/Aug;38(4):426-440. doi: 10.1097/AUD.0000000000000401.
The aim of this study was to compare binaural performance of auditory localization task and speech perception in babble measure between children who use a cochlear implant (CI) in one ear and a hearing aid (HA) in the other (bimodal fitting) and those who use bilateral CIs.
Thirteen children (mean age ± SD = 10 ± 2.9 years) with bilateral CIs and 19 children with bimodal fitting were recruited to participate. Sound localization was assessed using a 13-loudspeaker array in a quiet sound-treated booth. Speakers were placed in an arc from -90° azimuth to +90° azimuth (15° interval) in horizontal plane. To assess the accuracy of sound location identification, we calculated the absolute error in degrees between the target speaker and the response speaker during each trial. The mean absolute error was computed by dividing the sum of absolute errors by the total number of trials. We also calculated the hemifield identification score to reflect the accuracy of right/left discrimination. Speech-in-babble perception was also measured in the sound field using target speech presented from the front speaker. Eight-talker babble was presented in the following four different listening conditions: from the front speaker (0°), from one of the two side speakers (+90° or -90°), from both side speakers (±90°). Speech, spatial, and quality questionnaire was administered.
When the two groups of children were directly compared with each other, there was no significant difference in localization accuracy ability or hemifield identification score under binaural condition. Performance in speech perception test was also similar to each other under most babble conditions. However, when the babble was from the first device side (CI side for children with bimodal stimulation or first CI side for children with bilateral CIs), speech understanding in babble by bilateral CI users was significantly better than that by bimodal listeners. Speech, spatial, and quality scores were comparable with each other between the two groups.
Overall, the binaural performance was similar to each other between children who are fit with two CIs (CI + CI) and those who use bimodal stimulation (HA + CI) in most conditions. However, the bilateral CI group showed better speech perception than the bimodal CI group when babble was from the first device side (first CI side for bilateral CI users or CI side for bimodal listeners). Therefore, if bimodal performance is significantly below the mean bilateral CI performance on speech perception in babble, these results suggest that a child should be considered to transit from bimodal stimulation to bilateral CIs.
本研究旨在比较双耳聆听对侧有助（一侧使用人工耳蜗，另一侧使用助听器）和双侧人工耳蜗植入儿童的听觉定位任务和背景噪声下言语感知能力。
招募了 13 名（平均年龄±标准差=10±2.9 岁）双侧人工耳蜗植入儿童和 19 名双耳聆听对侧有助儿童。声音定位通过在安静的隔音室内使用 13 个扬声器阵列进行评估。扬声器以 15°的间隔从-90°方位角到+90°方位角（水平平面）放置在一个弧形中。为了评估声音位置识别的准确性，我们计算了每次试验中目标扬声器和响应扬声器之间的绝对误差。通过将绝对误差之和除以试验总数，计算平均绝对误差。我们还计算了半视野识别得分，以反映右/左辨别能力的准确性。我们还使用来自前扬声器的目标语音在声场中测量背景噪声下的言语感知能力。在以下四种不同的聆听条件下，从前扬声器（0°）、两个侧扬声器（+90°或-90°）中的一个、两个侧扬声器（±90°）呈现 8 人噪声言语。言语、空间和质量问卷进行了管理。
当直接比较两组儿童时，在双耳条件下，定位准确性或半视野识别得分无显著差异。在大多数背景噪声条件下，言语感知测试的表现也相似。然而，当背景噪声来自第一个设备侧（对双耳聆听对侧有助的儿童来说是人工耳蜗侧，对双侧人工耳蜗植入儿童来说是第一个人工耳蜗侧）时，双侧人工耳蜗使用者在背景噪声下的言语理解能力明显优于双耳聆听对侧有助者。两组之间的言语、空间和质量评分相似。
总体而言，在大多数情况下，双耳聆听对侧有助（一侧使用人工耳蜗，另一侧使用助听器）和双侧人工耳蜗植入儿童的双耳性能相似。然而，当背景噪声来自第一个设备侧（双侧人工耳蜗使用者的第一个人工耳蜗侧或双耳聆听对侧有助者的人工耳蜗侧）时，双侧人工耳蜗组的言语感知能力优于双耳聆听对侧有助组。因此，如果双耳性能明显低于背景噪声下双侧人工耳蜗性能的平均值，这些结果表明，应考虑将儿童从双耳聆听对侧有助转换为双侧人工耳蜗植入。
