Nickerson Alissa, Davidson Lisa S, Uchanski Rosalie M
Department of Speech and Hearing Science, University of Illinois, Champaign, IL.
Program in Audiology and Communication Science, St. Louis, MO.
J Am Acad Audiol. 2019 Sep;30(8):703-711. doi: 10.3766/jaaa.17126. Epub 2019 Apr 17.
Audibility of speech for children with hearing loss (HL) depends on the degree of HL and the fitting of the hearing aids (HAs) themselves. Many studies on cochlear implant (CI) users have demonstrated that preimplant hearing is associated with postimplant outcomes, but there have been very few reports on the fitting of HAs before surgery.
The aims of this study were to characterize HA fittings and aided audibility of speech for pediatric HA users with severe to profound HL and to examine the relation between preimplant aided audibility and postimplant speech perception.
A descriptive/observational and correlational study. Audiologic records of pediatric CI participants involved in a larger study examining the effects of early acoustic hearing were analyzed retrospectively; when available, these records included HA verification and speech recognition performance.
The CI participants were enrolled in audiology centers and oral schools for the deaf across the United States.
To determine whether deviations from prescribed DSL target were significantly greater than zero, 95% confidence intervals of the mean deviation were calculated for each frequency (250, 500, 1000, 2000, and 4000 Hz). Correlational analyses were used to examine the relationship between preimplant aided Speech Intelligibility Indices (SIIs) and postimplant speech perception in noise. Correlational analyses were also used to explore the relationship between preimplant aided SIIs and demographic data. T-tests were used to compare preimplant-aided SIIs of HAs of listeners who later became users of either sequential CIs, simultaneous CIs, or bimodal devices.
Preimplant fittings of HAs were generally very close to prescriptive targets, except at 4000 Hz for those HAs with active frequency-lowering processing, and preimplant SIIs, albeit low, were correlated with postimplant speech recognition performance in noise. These results suggest that aided audibility should be maximized throughout the HA trial for later speech recognition purposes.
It is recommended that HA fittings be optimized to support speech audibility even when considering implantation. In addition to the age at which HA use begins, the aided audibility itself is important in determining CI candidacy and decisions regarding bimodal HA use.
听力损失（HL）儿童的言语可听度取决于HL的程度以及助听器（HA）本身的适配情况。许多关于人工耳蜗（CI）使用者的研究表明，植入前的听力与植入后的效果相关，但关于手术前HA适配的报道却非常少。
本研究的目的是描述重度至极重度HL的儿童HA使用者的HA适配情况和助听听力言语可听度，并研究植入前助听听力言语可听度与植入后言语感知之间的关系。
一项描述性/观察性和相关性研究。对参与一项更大规模研究（该研究考察早期听觉听力的影响）的儿童CI参与者的听力学记录进行回顾性分析；如有可用记录，这些记录包括HA验证和言语识别表现。
CI参与者在美国各地的听力学中心和聋儿口语学校登记入组。
为确定与规定的DSL目标的偏差是否显著大于零，计算每个频率（250、500、1000、2000和4000赫兹）平均偏差的95%置信区间。相关性分析用于检验植入前助听言语可懂度指数（SII）与植入后噪声环境下言语感知之间的关系。相关性分析还用于探索植入前助听SII与人口统计学数据之间的关系。t检验用于比较后来成为顺序CI使用者、同时CI使用者或双模式设备使用者的听众的HA植入前助听SII。
HA的植入前适配通常非常接近规定目标，但对于具有有源降频处理功能的HA，在4000赫兹时除外，并且植入前SII尽管较低，但与植入后噪声环境下的言语识别表现相关。这些结果表明，为了后期言语识别目的，在整个HA试用期间应使助听听力言语可听度最大化。
建议即使在考虑植入时，也应优化HA适配以支持言语可听度。除了开始使用HA的年龄外，助听听力言语可听度本身对于确定CI候选资格和关于双模式HA使用的决策也很重要。
