Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, The Netherlands.
Ear Hear. 2018 Nov/Dec;39(6):1039-1045. doi: 10.1097/AUD.0000000000000577.
Bimodal hearing has shown to improve speech recognition in quiet and in noise and to improve sound localization compared with unilateral cochlear implant (CI) use alone. Fitting the CI and hearing aid (HA) separately has been described well, but HA fitting procedures for bimodal CI users are not well researched or widely accepted. The aim of the present study was to systematically review the literature on the effect of different HA fitting strategies on auditory performance in bimodal CI users.
Original articles, written in English, were identified through systematic searches in Medline (OvidSP), Embase, Web of Science, Scopus, CINAHL, Cochrane, PubMed publisher, and Google Scholar. The quality of the studies was assessed on five aspects: methodologic quality (with the methodological index for nonrandomized studies score), number of subjects, quality of the description of contralateral hearing loss, quality of HA verification, and direct comparison of HA fitting procedures based on auditory performance.
A total of 1665 records were retrieved, of which 17 were included for systematical reviews. Critical appraisal led to three high-quality studies, 10 medium-quality studies, and four low-quality studies. The results of the studies were structured according to four topics: frequency response, frequency translation/transposition, dynamic range compression, and loudness. In general, a bimodal benefit was found in most studies, using various strategies for the HA fitting. Using a standard prescription rule such as National Acoustics Laboratory formula-non-linear 1, National Acoustics Laboratory formula-non-linear 2, or desired sensation level is a good starting point in children and adults.
Although a bimodal benefit was found in most studies, there is no clear evidence how certain choices in HA fitting contribute to optimal bimodal performance. A generally accepted HA prescription rule is an essential part of most fitting procedures used in the studies. Current evidence suggests that frequency lowering or transposition is not beneficial. Individual fine tuning based on loudness or general preference is often applied, but its additional value for auditory performance should be investigated more thoroughly. Good quality comparative studies are needed to further develop evidence-based fitting procedures in case of bimodal listening.
与单独使用单侧人工耳蜗（CI）相比，双模式听力已被证明可提高安静环境和噪声环境中的言语识别能力，并改善声源定位。已经很好地描述了单独为 CI 和助听器（HA）进行适配的方法，但双模式 CI 用户的 HA 适配程序并未得到很好的研究或广泛接受。本研究的目的是系统地回顾关于不同 HA 适配策略对双模式 CI 用户听觉表现影响的文献。
通过在 Medline（OvidSP）、Embase、Web of Science、Scopus、CINAHL、Cochrane、PubMed 出版商和 Google Scholar 中进行系统搜索，确定了英文原始文章。使用非随机研究方法指数评分评估研究的质量，并从五个方面评估研究的质量：方法学质量、研究对象数量、对健侧听力损失的描述质量、HA 验证质量以及基于听觉表现的 HA 适配程序的直接比较。
共检索到 1665 条记录，其中有 17 条被纳入系统评价。批判性评估导致了三项高质量研究、十项中等质量研究和四项低质量研究。研究结果根据四个主题进行了结构化：频率响应、频率转换/转换、动态范围压缩和响度。一般来说，使用各种 HA 适配策略，大多数研究都发现了双模式受益。在儿童和成人中，使用标准处方规则，如国家声学实验室公式非线性 1、国家声学实验室公式非线性 2 或期望感觉水平，是一个很好的起点。
尽管大多数研究都发现了双模式受益，但没有明确的证据表明 HA 适配中的某些选择如何有助于最佳双模式性能。被广泛接受的 HA 处方规则是大多数研究中使用的适配程序的重要组成部分。目前的证据表明，频率降低或转换没有益处。基于响度或一般偏好的个体精细调谐经常被应用，但它对听觉表现的额外价值应更深入地研究。需要高质量的比较研究来进一步发展双模式听力的循证适配程序。
