Dorman Michael F, Gifford Rene H
Department of Speech and Hearing Science, Arizona State University, Tempe.
Vanderbilt University, Nashville, TN.
J Speech Lang Hear Res. 2017 Oct 17;60(10):3019-3026. doi: 10.1044/2017_JSLHR-H-17-0035.
The aim of this article is to summarize recent published and unpublished research from our 2 laboratories on improving speech understanding in complex listening environments by listeners fit with cochlear implants (CIs).
CI listeners were tested in 2 listening environments. One was a simulation of a restaurant with multiple, diffuse noise sources, and the other was a cocktail party with 2 spatially separated point sources of competing speech. At issue was the value of the following sources of information, or interventions, on speech understanding: (a) visual information, (b) adaptive beamformer microphones and remote microphones, (c) bimodal fittings, that is, a CI and contralateral low-frequency acoustic hearing, (d) hearing preservation fittings, that is, a CI with preserved low-frequency acoustic in the same ear plus low-frequency acoustic hearing in the contralateral ear, and (e) bilateral CIs.
A remote microphone provided the largest improvement in speech understanding. Visual information and adaptive beamformers ranked next, while bimodal fittings, bilateral fittings, and hearing preservation provided significant but less benefit than the other interventions or sources of information. Only bilateral CIs allowed listeners high levels of speech understanding when signals were roved over the frontal plane.
The evidence supports the use of bilateral CIs and hearing preservation surgery for best speech understanding in complex environments. These fittings, when combined with visual information and microphone technology, should lead to high levels of speech understanding by CI patients in complex listening environments.
本文旨在总结我们两个实验室近期已发表和未发表的关于改善使用人工耳蜗（CI）的聆听者在复杂聆听环境中言语理解能力的研究。
对人工耳蜗聆听者在两种聆听环境中进行测试。一种是模拟有多个扩散噪声源的餐厅环境，另一种是有两个空间分离的竞争性言语点声源的鸡尾酒会环境。研究的问题是以下信息源或干预措施对言语理解的价值：（a）视觉信息，（b）自适应波束形成器麦克风和远程麦克风，（c）双耳联合选配，即人工耳蜗和对侧低频听觉，（d）听力保留选配，即同一耳保留低频声学听力并结合人工耳蜗，对侧耳有低频声学听力，以及（e）双侧人工耳蜗。
远程麦克风在言语理解方面带来的改善最大。视觉信息和自适应波束形成器次之，而双耳联合选配、双侧选配和听力保留选配虽有显著效果，但益处小于其他干预措施或信息源。只有双侧人工耳蜗能让聆听者在信号在额平面上移动时达到较高的言语理解水平。
证据支持使用双侧人工耳蜗和听力保留手术以在复杂环境中实现最佳言语理解。这些选配方式与视觉信息和麦克风技术相结合，应能使人工耳蜗患者在复杂聆听环境中达到较高的言语理解水平。
