Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
Department of Speech and Hearing Science, Arizona State University, Tempe, AZ 85287, USA.
Ear Hear. 2019 May/Jun;40(3):501-516. doi: 10.1097/AUD.0000000000000657.
The objectives of this study were to assess the effectiveness of various measures of speech understanding in distinguishing performance differences between adult bimodal and bilateral cochlear implant (CI) recipients and to provide a preliminary evidence-based tool guiding clinical decisions regarding bilateral CI candidacy.
This study used a multiple-baseline, cross-sectional design investigating speech recognition performance for 85 experienced adult CI recipients (49 bimodal, 36 bilateral). Speech recognition was assessed in a standard clinical test environment with a single loudspeaker using the minimum speech test battery for adult CI recipients as well as with an R-SPACE 8-loudspeaker, sound-simulation system. All participants were tested in three listening conditions for each measure including each ear alone as well as in the bilateral/bimodal condition. In addition, we asked each bimodal listener to provide a yes/no answer to the question, "Do you think you need a second CI?"
This study yielded three primary findings: (1) there were no significant differences between bimodal and bilateral CI performance or binaural summation on clinical measures of speech recognition, (2) an adaptive speech recognition task in the R-SPACE system revealed significant differences in performance and binaural summation between bimodal and bilateral CI users, with bilateral CI users achieving significantly better performance and greater summation, and (3) the patient's answer to the question, "Do you think you need a second CI?" held high sensitivity (100% hit rate) for identifying likely bilateral CI candidates and moderately high specificity (77% correct rejection rate) for correctly identifying listeners best suited with a bimodal hearing configuration.
Clinics cannot rely on current clinical measures of speech understanding, with a single loudspeaker, to determine bilateral CI candidacy for adult bimodal listeners nor to accurately document bilateral benefit relative to a previous bimodal hearing configuration. Speech recognition in a complex listening environment, such as R-SPACE, is a sensitive and appropriate measure for determining bilateral CI candidacy and also likely for documenting bilateral benefit relative to a previous bimodal configuration. In the absence of an available R-SPACE system, asking the patient whether or not s/he thinks s/he needs a second CI is a highly sensitive measure, which may prove clinically useful.
本研究旨在评估各种语音理解测量指标在区分成年双侧和双侧人工耳蜗（CI）植入者之间的表现差异方面的有效性，并提供一个初步的循证工具，以指导关于双侧 CI 候选资格的临床决策。
本研究采用了一个多基线、横断面设计，调查了 85 名经验丰富的成年 CI 接受者的语音识别表现（49 名双侧，36 名双侧）。使用成人 CI 接受者的最小语音测试电池，以及 R-SPACE 8 个扬声器、声音模拟系统，在标准的临床测试环境中，使用单个扬声器评估语音识别。所有参与者在每个测量值的三种听力条件下进行测试，包括每个耳朵单独以及双侧/双侧条件。此外，我们还要求每位双侧聆听者回答一个“是否认为需要第二个 CI”的问题。
本研究得出了三个主要发现：（1）在临床语音识别测量中，双侧和双侧 CI 性能或双耳总和之间没有显著差异；（2）在 R-SPACE 系统中的自适应语音识别任务揭示了双侧和双侧 CI 用户之间在性能和双耳总和方面的显著差异，双侧 CI 用户的表现和总和明显更好；（3）患者对“是否认为需要第二个 CI”这个问题的回答，对于识别可能的双侧 CI 候选者具有高灵敏度（100%的命中率），对于正确识别最适合双侧听力配置的聆听者具有中等特异性（77%的正确拒绝率）。
临床医生不能仅依靠当前使用单个扬声器的临床语音理解测量来确定成年双侧聆听者的双侧 CI 候选资格，也不能准确记录相对于以前的双侧听力配置的双侧获益。在复杂的听力环境（如 R-SPACE）中进行语音识别，是确定双侧 CI 候选资格的敏感和适当的测量方法，也可能用于记录相对于以前的双侧配置的双侧获益。在没有可用的 R-SPACE 系统的情况下，询问患者是否认为需要第二个 CI，是一个高度敏感的测量方法，可能在临床上有用。
