Boys Town National Research Hospital (Center for Hearing Research), Omaha, Nebraska, USA.
Ear Hear. 2019 Sep/Oct;40(5):1162-1173. doi: 10.1097/AUD.0000000000000693.
Previous research has demonstrated the feasibility of programming cochlear implants (CIs) via telepractice. To effectively use telepractice in a comprehensive manner, all components of a clinical CI visit should be validated using remote technology. Speech-perception testing is important for monitoring outcomes with a CI, but it has yet to be validated for remote service delivery. The objective of this study, therefore, was to evaluate the feasibility of using direct audio input (DAI) as an alternative to traditional sound-booth speech-perception testing for serving people with CIs via telepractice. Specifically, our goal was to determine whether there was a significant difference in speech-perception scores between the remote DAI (telepractice) and the traditional (in-person) sound-booth conditions.
This study used a prospective, split-half-design to test speech perception in the remote DAI and in-person sound-booth conditions. Thirty-two adults and older children with CIs participated; all had a minimum of 6 months of experience with their device. Speech-perception tests included the consonant-nucleus-consonant (CNC) words, Hearing-in-Noise test (HINT) sentences, and Arizona Biomedical Institute at Arizona State University (AzBio) sentences. All three tests were administered at levels of 50 and 60 dBA in quiet. Sentence stimuli were also presented in 4-talker babble at signal to noise ratios (SNRs) of +10 and +5 dB for both the 50- and 60-dBA presentation levels. A repeated-measures analysis of variance was used to assess the effects of location (remote, in person), stimulus level (50, 60 dBA), and SNR (if applicable; quiet, +10, +5 dB) on each outcome measure (CNC, HINT, AzBio).
The results showed no significant effect of location for any of the tests administered (p > 0.1). There was no significant effect of presentation level for CNC words or phonemes (p > 0.2). There was, however, a significant effect of level (p < 0.001) for both HINT and AzBio sentences, but the direction of the effect was opposite of what was expected-scores were poorer for 60 dBA than for 50 dBA. For both sentence tests, there was a significant effect of SNR, with poorer performance for worsening SNRs, as expected.
The present study demonstrated that speech-perception testing via telepractice is feasible using DAI. There was no significant difference in scores between the remote and in-person conditions, which suggests that DAI testing can be used as a valid alternative to standard sound-booth testing. The primary limitation is that the calibration tools are presently not commercially available.
先前的研究已经证明了通过远程实践对人工耳蜗 (CI) 进行编程的可行性。为了全面有效地使用远程实践，临床 CI 访问的所有组件都应该通过远程技术进行验证。言语感知测试对于监测 CI 的结果很重要，但尚未对其进行远程服务交付验证。因此，本研究的目的是评估使用直接音频输入 (DAI) 作为替代传统隔声室言语感知测试的可行性，以便通过远程实践为 CI 使用者提供服务。具体而言，我们的目标是确定远程 DAI（远程实践）和传统（现场）隔声室条件之间的言语感知分数是否存在显著差异。
本研究使用前瞻性、半分割设计来测试远程 DAI 和现场隔声室条件下的言语感知。32 名成人和儿童 CI 使用者参与了研究；所有参与者均使用其设备至少 6 个月。言语感知测试包括辅音-核-辅音 (CNC) 词、噪声下言语测试 (HINT) 句子和亚利桑那州立大学亚利桑那生物医学研究所 (AzBio) 句子。所有三个测试均在安静环境下 50 和 60 dBA 水平下进行。在 50 和 60 dBA 呈现水平下，还在 4 个说话者的背景噪声中以+10 和+5 dB 的信噪比 (SNR) 呈现句子刺激。使用重复测量方差分析评估位置（远程、现场）、刺激水平（50、60 dBA）和 SNR（如果适用；安静、+10、+5 dB）对每个结果测量（CNC、HINT、AzBio）的影响。
结果表明，任何测试的位置效应均无统计学意义（p > 0.1）。CNC 词或音位的呈现水平无统计学意义（p > 0.2）。然而，HINT 和 AzBio 句子的水平有显著影响（p < 0.001），但影响的方向与预期相反——60 dBA 的得分比 50 dBA 差。对于这两个句子测试，信噪比都有显著影响，随着信噪比的恶化，性能也随之恶化，这是符合预期的。
本研究表明，通过 DAI 进行远程实践的言语感知测试是可行的。远程和现场条件下的分数没有显著差异，这表明 DAI 测试可以作为标准隔声室测试的有效替代方法。主要限制是校准工具目前还没有商业化。
